Why Do I Keep Getting Urinary Tract Infections?

It’s comforting to know that many women are in the same boat – fed up with taking rounds of antibiotics, staying close to the loo and drinking endless cranberry juice – but you might also be keen to know why so many of us keep getting a UTI!

Once you have ruled out any clinical damage to your kidneys (e.g. kidney stones) or bladder function (e.g. voiding), there are a number of factors that may encourage UTIs. Most of these are not scientifically proven, but there are experiences women associate with common UTI triggers, which we explore below.

What is a recurrent UTI?

The clinical definition of a recurrent UTI is two episodes within six months or three episodes within a year⁴. This recurrence means that bacteria keep getting into areas where they don’t belong. Recurrent sufferers often have an unbalanced microbiome – this is where the presence of invading ‘bad’ microbes such as E.coli causes an imbalance, with too few protective bugs (Lactobacillus), which weakens the natural protective environment against infection.

What causes recurrent UTIs?

Recurrent UTIs in women are in many ways a result of the female anatomy – it’s down to unfortunate design!

• The rectum and the vaginal opening are very close to one another so it’s easier for bacteria to transfer between the anus and the vagina or urinary tract.
• No external genitalia – we don’t have testicles like men, which means internal transfer is more likely.
• Many women have a shorter urinary tract than men, which means bacteria are more likely to reach the bladder or kidneys and cause an infection. Our design is worse!

If bacteria enter and start colonising the wrong space, this can lead to an unbalanced microbiome. You want Lactobacillus in your vaginal microbiota, as these microbes act to protect you from infection. Less Lactobacilli = a weaker natural barrier = a higher risk of UTIs.

You then take antibiotics to treat the infection, or antifungals if it is thrush, but this can have the knock-on effect of further disrupting your vaginal and urinary microbiome. Essentially, you want to keep the good guys in and the bad guys out, but antibiotics can prevent this. Therefore, many women who suffer from recurrent urinary tract infections are stuck in a painful cycle – reactively managing their symptoms with antibiotics rather than preventing the recurrence of UTIs.

What could be potential triggers for recurrent UTIs?

For those of us who are long-time sufferers, we all know it’s hard to avoid UTIs. However, there are many things that women have reported as possible triggers. We share them below so you can see whether there are any you identify with!

(Penetrative) sex

Penetrative sex is known as one of the greatest risk factors for recurrent UTIs¹. This may depend on the frequency of sex, the kind of sex (oral, penetrative, vaginal or anal) and the number of sexual partners. Due to increased movement, sex promotes the transfer of bacteria in your intimate areas, including your anus, vagina and urinary tract.

Oral sex, anal sex and the use of sex toys are also variations of sex which can increase the chances of urinary tract infection as you are introducing more opportunities for bacteria to transfer. If you are using sex toys regularly, make sure they are cleaned (with a gentle, vagina-friendly cleanser) before and after, and consider changing to a new toy if you keep having issues.

Microbes can also be transferred from your partner in some cases. If you keep getting UTIs while sleeping with a regular partner, it is worth checking their penile and/or oral microbiome.

Sex is an enjoyable and meaningful activity for most of us! Therefore, you’re obviously not going to avoid it completely, but some women find it helps to urinate before and afterwards, avoid mixing types of sex at once, stick to certain positions, and avoid using condoms or diaphragms with spermicides that can disrupt your vaginal flora.

Hormonal changes

Women at all life stages suffer from UTIs and we are more prone to them when undergoing hormonal changes. This is because there might be fewer protective flora during these periods of hormonal flux. You may be more prone to UTIs that keep coming back during your period, pregnancy, or the onset of menopause.

Post-menopausal women also have higher rates of UTIs¹ because of pelvic prolapse, lack of oestrogen, and loss of lactobacilli in the vaginal flora which often leads to increased colonisation of invading bacteria, such as E. coli.

Broad-spectrum antibiotics

Antibiotics are prescribed for many infections and medical conditions. These can have an impact on your whole body and disrupt your microbiome (not only your gut but also your vaginal microbiome!).

They kill the bad guys and the good guys, including healthy and protective bacteria such as lactobacillus, which impacts the balance of your normal vaginal flora. If you can consider using alternatives, try those too. Products boosting the natural microbiota can be taken in parallel with antibiotics or afterwards to restore the natural microbiota, which may help your future susceptibility to infection.

Stress and illness

As with most infections and illnesses, being stressed or run down puts the immune system under pressure so it can’t fight the invading pathogens as effectively. This is the same with urinary tract infections as we tend to be more prone if we are stressed or unwell.

Not drinking enough fluids

Water is important for our health in many ways, and this is also the case when it comes to avoiding UTIs. It is believed that drinking water regularly and having a normal urination pattern can flush out the ‘bad’ microbes from your urinary tract. Cranberry juice has long been recommended for UTIs and while it is not harmful, there is also not much evidence to support it being effective⁵ (and you may need to watch the high sugar content).

Wearing tight-fitting underwear or clothing

Tight underwear and synthetic fabrics are thought to be a trigger for some people because it creates a warm, humid environment where the overgrowth of bacteria can occur and disrupt your normal microbiota. They can also cause irritation.

Using scented washes, sprays and sanitary towels

While they might smell great, using overly fragranced products in your vaginal area can throw off the balance of your normal vaginal flora and ultimately lead to a UTI, so don’t be tempted! The vagina is self-cleaning so you don’t need scented products or invasive methods – instead, wash the area gently with warm water.

Diet

Your diet impacts your gut flora⁶ which acts as a source for potential UTIs if the bacteria transfer. Therefore, you want to have a healthy gut flora so you have less nasty stuff coming out!

If your diet causes you to be constipated, it is also more difficult to empty your bladder fully, which increases the risk of UTI. Everyone has different needs, but potential dietary triggers include low-fibre and high-sugar diets.

Drinking too much alcohol or coffee

There is no evidence that alcohol causes UTIs, but some people believe that since alcohol can cause dehydration, we aren’t flushing out our urinary tract as often, which is important as we mentioned earlier. This is the same with coffee – although it is a much-needed morning wake-up call for many, it may impact your hydration levels due to its diuretic effect which can increase the urgency to urinate.

Bladder function problems or kidney stones

Some people who suffer from chronic or recurrent UTIs have issues with their bladder function or have blockages in their urinary tract, such as a kidney stone. It’s important to investigate any potential bladder or kidney issues first.

Swimming pools and baths

Some women also believe that going swimming or having regular baths increases their susceptibility to recurrent urinary tract infections. This is because there may be bacteria in the water that can enter the urethra and increase the risk of infection.

What can you do about recurrent UTIs?

If you suffer from urinary tract infections and they keep coming back, you can run through our checklist below.

1. Make sure you have no underlying problems with your bladder function (such as voiding), kidneys or pelvic floor. Consult a medical professional if you are concerned. They can do a non-invasive ultrasound and functionality tests.
2. Do you only have sex with one partner but suffer from recurrent infections? Try changing the sex toys you use or consider getting your partner’s intimate microbiome checked.
3. Take a microbiome test to check the microbes in your vagina and urinary tract. Is there anything that does not belong there?
4. Consider alternatives to the ongoing use of broad-spectrum antibiotics as this can significantly impact your microbiome.
5. Try to boost your natural defences with probiotics.

We hope this guide to why UTIs keep coming back and some potential triggers you can look out for has been useful. For more intimate health updates, you can keep an eye on our blog and sign up to our newsletter.

You can also share your common UTI triggers with us below in the comments section – we’d love to hear about your personal experience as we are all unique!

Sources

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3749018/
2. https://pubmed.ncbi.nlm.nih.gov/12113866/
3. https://www.aafp.org/pubs/afp/issues/2016/0401/p560.html
4. https://www.ncbi.nlm.nih.gov/books/NBK557479/
5. https://www.nccih.nih.gov/health/cranberry
6. https://medicine.wustl.edu/news/recurrent-utis-linked-to-gut-microbiome-chronic-inflammation/