Root Causes of UTIs in Women + How to Prevent Them

Let’s be honest, UTIs are miserable. But turns out they’re more of a shared experience than you may think as 60% of women and 10% of men wind up getting a UTI in his or her lifetime. It’s also worth mentioning that ¼  of the women who get UTIs suffer from recurrent infections, which is defined as 3 UTIs per year. With antibiotics as the primary solution, you can see how it’s quite easy to slip into a vicious cycle of chronic UTIs. 

While it may be tempting to ignore the symptoms and hope it goes away on its own, a UTI can be pretty dangerous if left untreated. Yet there is so much conflicting information out there on why you might keep getting UTIs, what to do when you have one, and how to prevent them. Like, is cranberry juice really a thing? Do wet swimsuits cause UTIs? We break down these familiar theories, explore the (often overlooked) root causes of infections, and offer suggestions for how to steer clear of them in the first place.

What even is a UTI?

In simple terms, a urinary tract infection (UTI) is an infection in any part of your urinary system which includes your kidneys, ureters, bladder and urethra. Typically, the infection occurs in the lower portion of your urinary tract, in your bladder and/or urethra. However, if left untreated or improperly treated, these initial infections can spread to your kidneys which can lead to serious health issues and must be dealt with immediately! While a number of bacterial species can cause UTIs, E. coli is by far the most common culprit. 

Why are women more prone to UTIs than men?

You can blame your anatomy for this one. Unfortunately, women naturally have a much shorter urethra than men do – we’re talking 1-2 inches long versus 6 inches long. Of course your urethra is an exit for your urine first and foremost but it also can serve as an entrance for bacteria into your urinary tract. Bacteria live at the opening of your urethra (called the urethra meatus) so if you have a shorter urethra, bacteria have a quicker journey up into your bladder where they can wreak havoc on your urinary tract.

Another factor here is urethral tissue. Women’s urethra and urethral meatus are made up of mucosal tissue which is quite thin and delicate. It’s helpful to think about other areas in your body where you have moist mucosal tissue, like your mouth, stomach lining, esophagus, and nose. It’s relatively easy to tear or irritate these soft cells, giving bacteria an opportunity to proliferate. Lastly, pregnant and post-menopausal women are more likely to get UTIs due to hormonal fluctuations and subsequent tissue changes. 

Symptoms of UTIs

• Strong urge to pee that just won’t go away even after you empty your bladder 
• Burning feeling when you pee
• Peeing frequently
• Cloudy urine
• Darker orange or red pee, which indicates blood 
• Pressure or crampy pain in your lower abdomen 
• Foul-smelling urine 
• Low-grade fever (rarer)

Why UTIs happen:

Microbiome Imbalance 

A 2022 study performed by researchers at Washington University School of Medicine, MIT and Harvard suggests that women who get chronic UTIs may get stuck in a cycle of antibiotic-induced gut dysbiosis (1). This is because taking a course of antibiotics for a UTI may be successful in killing off pathogenic bacteria in your urinary tract but not from your intestinal tract. Therefore the bacterial population (often E. coli) explodes in your gut and then ultimately spreads to your urinary tract…again.

This pattern repeats itself in so many women with antibiotics offering only temporary relief and creating another issue: an imbalanced gut microbiome. The 2022 study showed that women with less diverse gut microbiomes struggled with recurrent UTIs. Specifically, women with chronic UTIs lack bacterial strains that produce butyrate, a short-chain fatty acid (SCFA) that acts as an anti-inflammatory among many other things. This suggests that women with a diverse, balanced gut microbiome are able to clear pathogenic bacteria such as E. coli from their urinary tracts before they cause an infection while women with gut dysbiosis can not. 

Dehydration

At this point, it feels like water is the panacea for all ailments, especially if you’re familiar with the viral videos on social media of men telling their girlfriends to “try drinking water”. As overplayed and basic as it may seem, drinking water really does work wonders for many health issues, particularly UTIs. One randomized controlled study looked at the correlation between water intake and UTI occurrence in premenopausal women. The control group drank their usual amount of water (less than 1.5 liters daily) while the experimental group drank their usual amount plus 1.5 liters. Researchers found that women who drank an additional 1.5 liters per day had 50% fewer UTIs and required fewer rounds of antibiotics than the women who drank less than 1.5 liters per day (2).

This study is noteworthy as many of the research studies examining UTIs and dehydration have predominantly been on geriatric populations. This is because residents of care facilities are at a higher risk of dehydration for a number of reasons (staffing issues, difficulty swallowing, not being able to drink water on their own, etc). Across four different care facilities, implementing periodic “drink rounds” run by trained staff reduced the number of UTIs requiring antibiotics by 58% and UTIs requiring hospitalization by 36% (3). 

Constipation

Although they may not seem correlated, constipation and UTIs often go hand-in-hand. Large amounts of waste in your colon puts pressure on your bladder, causing it to contract when it shouldn’t be or making it feel like it’s full when it’s actually not. Additionally, the presence of stool in your colon prevents your bladder from emptying completely. All three of these factors can easily lead to UTIs.

Another piece of the puzzle here is pelvic floor muscle function. When your bladder is spasming or contracting more than normal, your pelvic floor muscles may tighten up which perpetuates constipation as you’re unable to relax fully. In other words, stressed pelvic floor muscles cause hypertension and, ultimately, UTIs.

Improper Hygiene 

One surefire way to get a UTI? Wearing a wet swimsuit or leaving your yoga pants on after a super sweaty workout. The bottom line here is that bacteria love moisture so you want to avoid creating an environment down there for bacteria to thrive and cause infection. Another hygiene-related cause of UTIs is wiping incorrectly after you go to the bathroom. Since UTI-causing E. coli is found in feces, it’s important that you wipe front-to-back, not vice versa.

Holding your pee

Sometimes needing to pee is just downright inconvenient. Nonstop travel, lack of public restrooms, hectic work schedules, camping – we’ve all been there! But research shows that holding your urine for extended periods of time increases your risk of getting UTIs. Similar to the dehydration discussion, holding in your urine allows pathogenic bacteria that is clinging to your urinary tract to multiply and cause infection. Emptying your bladder fully and often will naturally flush out your entire urinary tract, along with any infection-causing bacteria. It’s also good practice to pee after sex as it clears out any bacteria that made their way into your urethra during intercourse. 

How to prevent UTIs holistically:

• Don’t hold your pee – you should be going to the bathroom every 3-6 hours (depending on your age, medical conditions, and hydration levels)

• Drink enough water – aim to consume 9 cups or about 2 liters of water per day to ensure healthy flushing of your urinary tract

• Incorporate more cranberries – the specific A-type proanthocyanidins (PACs) only found in cranberries inhibit adhesion of E. coli and other UTI-causing bacteria to the walls of your urinary tract

• Take a probiotic – Lactobacillus strains physically crowd out pathogenic bacteria in both your vagina and gut, thus balancing both microbiomes

• Avoid spermicides – spermicide-coated condoms and other birth control methods can disrupt your vaginal flora by damaging beneficial bacteria like Lactobacilli

• Wear loose-fitting and/or cotton clothing – opting for loose, moisture-wicking, non-synthetic clothing (like cotton or linen) helps to reduce bacterial growth down there

Flora-V Coming Soon

The vagina requires a unique set of probiotics for a strong microbiome: specifically, an abundance of Lactobacilli species that maintain stable, acidic pH levels in order to ward off dysbiosis.

A vaginal flora with a reduced proportion of Lactobacilli increases susceptibility to infections such as yeast, BV and UTIs – as well as some that have been linked to serious health consequences that can even affect our fertility.

The combination of clinically studied strains and pink-proanthocyanidin-packed cranberry extract provides a superior solution to those looking for long lasting relief from recurring vaginal and urinary discomfort!

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