I received a question from a reader asking what women can do to prevent bladder infections. Here is some information about these infections that are so common and some strategies to prevent them.
Bladder infections can affect both men and women, but are 10 to 50 times more common in women (depending on which reference you read!), probably due to the much shorter urethra we have. The actions you can take to prevent a bladder infection will likely also reduce your risk of a vaginal infection and, in men, prostate infection.
Generally, infections start in the urethra, travel up to the bladder and, if not treated, can continue to spread up the ureters to the kidneys, leading to a much more serious infection. The recommendations below are for preventing infection; if you have signs of infection – pain or irritation with urination, needing to go frequently or urgently, blood in the urine, pelvic pressure or lower abdomen discomfort – you should see your doctor right away for diagnosis and treatment.
Bacteria that are normal to have in the bowel can cause an infection if they move into the reproductive or urinary systems. So, one of the first preventive measures is to pay attention to how you wash your genital area, making sure you are moving bacteria away from your vagina and urethra and toward the rectum when you wash or wipe these areas. Basically, always wipe from front to back with a clean tissue or cloth.
Infectious organisms also like warmth and moisture, so wearing looser-fitting cotton underwear can help keep the area drier – boxer shorts for men may help but I haven’t seen this style for women yet! However, at least we can choose comfy 100% cotton undies and avoid synthetic “non-breathing” materials. Thong-style underwear may increase the chance of movement of bacteria from the rectal area to the vagina or urethra, and are also more likely to irritate these areas – might be best to avoid this style of undies if you have recurring problems with urinary tract infections (UTI).
Avoiding long baths can be helpful, as bath water can become contaminated with bacteria fairly quickly, and using tampons is advised to keep the bladder opening drier, limiting bacterial growth.
Avoiding long intervals between urinating can also be extremely effective, and make sure to completely empty the bladder each time. Try to urinate every 4 hours if you are prone to infections, even if you do not feel the need to go. Drinking more water is thought to be helpful to dilute the urine, encourage more frequent urination and flush any bacteria from the bladder before it can attach to the bladder wall and start an infection.
Sexual activity can increase the risk of infection because it tends to introduce bacteria to the urethra opening. Keep in mind that spermicidal jellies and creams also kill normal flora that help keep harmful bacteria in check. If an association between sexual activity and infection is identified, doctors will sometimes prescribe a dose of a mild antibiotic to be taken afterward. Urinating after sex can help to flush away bacteria before it has a chance to enter the urethra, too.
The tissues of both the urethra and vagina are dependent on estrogen for growth and, as women age, these tissues can become thinner, less healthy and more prone to infection. Sometimes doctors will prescribe estrogen in suppository or cream form to improve the health of this area directly. Only a low dose is needed (for example, 10 micrograms of estradiol is used as a suppository, as compared to 1000 micrograms as a common strength of the tablets given by mouth for menopause symptoms). Compounding pharmacists can also make a gel or cream using estriol, a very weak estrogen that is very effective in improving the health of the genital tissues. Estriol has little or no effect in stimulating the growth of breast or endometrium tissues and is therefore sometimes preferred for women who would benefit from a local estrogen effect but have increased concerns about reproductive cancers.
The normal human bacterial flora, a mixture of non-harmful bacteria that grow on and in our bodies, is increasingly recognized as an important defense to infection. And since antibiotics kill normal flora along with the infecting bacteria, they may actually set us up for recurrent infections. As well, bacterial resistance to antibiotics is a growing problem – they quickly learn how to survive our cures. We need to be careful to only use antibiotics when they are truly needed, and to finish the full treatment so none of the infectious organisms are left behind… the bacteria that are the slowest to be destroyed are those that have already begun to develop some resistance to the antibiotic being used.
Probiotics are products containing live, non-harmful organisms that are beneficial when given in adequate amounts. When taken by mouth or applied to an area of the body that needs protection, they tend to overgrow disease-causing organisms and create an environment that is resistant to infection.
Studies suggest that when taken by mouth or applied vaginally, probiotics can reduce recurrent urinary tract infections (UTIs). Although somewhat less effective at prevention than low dose daily antibiotic therapy, probiotic treatment does not cause the bacterial resistance that is seen with antibiotics. So, although more research needs to be done to find the ideal way to use probiotics, it’s worth discussing with your doctor if you have recurrent UTIs.
Lastly, cranberries and blueberries contain a substance that can help prevent bacteria from sticking to the bladder wall, an essential step in the beginning of an infection. Cranberry juice, however, contains a lot of sugar to counter its bitter taste, and this sugar can promote the infections you are trying to prevent. Cranberry concentrate capsules are an option without sugar, but you need to read and compare the labels carefully – all cranberry supplements are not created equal! Some may contain as little as 5mg of concentrate but be labeled as over 1000mg – the amount of fruit it was extracted from… very misleading! Also, cranberry, like grapefruit, can interact with other medications you may be taking. Be sure to check with your pharmacist before taking large amounts of cranberry if you take other medications!
In summary, actions that reduce the amount of bacteria that reach the urethral opening, prevent bacteria from sticking to the bladder wall and maintain a healthy bacterial flora (especially after a treatment with antibiotics) will all help to prevent recurrent urinary tract infection.
