Talking Menopause and Urinary Tract Infection (UTI)
If you have ever experienced a UTI, also known as Cystitis, you might be familiar with the agonising wait for the Doctors surgery to open to make the call for treatment. Severe symptoms can be razorblades painful; you could be passing blood* and feel unwell (understatement!).
Not everyone has dramatic symptoms, and an infection could begin gradually with a feeling of pressure ‘down there’, while your intuition is telling you that things aren’t quite working right. Maybe you’re peeing a bit more at night, it’s not coming out or perhaps you feel like you’re not quite fully emptying the bladder. Your urine could be smelly, or a different colour and stinging when you pass urine.
For women who have had many infections over time, they develop a second sense and ‘just know’ when an infection is brewing. It might be possible to trace an infection back to something we did, like having a new sex partner or wiping the wrong way, but this is often not the case.
*Note Blood in the urine could be a sign of Pyelonephritis (kidney infection). Symptoms include kidney pain/tenderness in back under ribs, flu like illness, shaking, chills or temperature of 37.9°C or above, nausea/vomiting. In the case of blood in the urine seek medical assistance.
Is it an infection or not?
Dr Susan Baumgaertel tells me that “sitting in a hot tub doesn’t make you infected, douching doesn’t make you infected, not wiping perfectly doesn’t necessarily cause infection, if you are overweight that doesn’t cause infection and if you’re using tight tights that doesn’t cause infection.”
Urinary tract infections occur when ‘bad’ bacteria ascend and multiply on, and sometimes within, the lining of the urinary tract and bladder. Doctors can diagnose a UTI based only on the signs and symptoms, but a definitive diagnosis is made when a urine sample culture grows more than 100,000* colony forming units (CFU) per ml of urine. The most common invader is Escherichia coli (E. Coli) a bacteria normally found in the gut and vagina. Cribby S et al. Interdiscip Perspect Infect Dis. 2008
*In people with urinary symptoms, UTI is usually indicated by more than
1000 CFU/mL of Escherichia coli or Staphylococcus saprophyticus.
10,000 CFU/mL of a single organism.
100,000 mixed growth with one predominant organism.
National Institute for Health and care excellence
Recurrent UTI
Three or more uncomplicated UTIs in 12 months is the measure used to define recurrent uncomplicated UTI. Recurrent UTIs may be due to bacterial reinfection or bacterial relapse. A relapse occurs when the same organism is not eradicated from the urine after 2 weeks despite appropriate antimicrobial treatment Women get UTIs more often because a woman’s urethra (the tube from the bladder to where the urine comes out of the body) is shorter than a man’s. This makes it easier for bacteria to get into a woman’s bladder. We can’t do anything about our biology but how infections are managed may just make a difference in the recurrence.
Menopause and UTI – The Podcast.
Check out the Menopause and UTI conversation with me, Dr Susan Baumgaertel, Aromatherapist Claire Ottewell and Clinical Hypnotherapist Jacquie Whur
Why are postmenopausal women more susceptible to urinary infections?
I’m quite sure that there are several influencing factors that when put together will create ‘the perfect storm’. Lifestyle factors must be a consideration and inherited tendencies are a consideration. However, the declining levels of female sex hormones as we approach, and travel beyond menopause is one thing they all have in common.
Effects of Oestrogen decline on the Female Urogenital System
The effects of Oestrogen decline are wide reaching and there is a whole host of urogenital symptoms women might experience including:
1. Genital symptoms – dryness, burning, and irritation
2. Sexual symptoms – lack of lubrication, discomfort/pain
3. Urinary symptoms – urgency, painful urination, and recurrent urinary tract infections
These group of symptoms is known as the Genitourinary Syndrome of Menopause (GSM).
Kim HK, Kang SY, Chung YJ, Kim JH, Kim MR, J Menopausal Med. 2015
Treatment Options
Self Help
The following self-help measures are outlined in NICE guideline [NG112] Urinary tract infection (recurrent): antimicrobial prescribing Published: 31 October 2018 to reduce the risk of UTI:
- Drink enough fluids to avoid dehydration,
- Don’t delaying habitual and post-coital urination,
- Wipe from front to back after a bowel motion,
- Avoid douching and opt for ‘spacious’ underwear.
Medical Management
Vaginal Oestrogen
Oestrogen can be prescribed as a cream, in a pessary or a ring that is placed inside your vagina. Based on evidence vaginal oestrogens have been shown to be effective in reducing the risk of recurrent UTI in postmenopausal women. This medication can also relieve local symptoms such as vaginal dryness, but it will not help with other more widespread symptoms like hot flushes. The good news is that vaginal oestrogen does not carry the usual risks of HRT and does not increase your risk of breast cancer, so you can use it without taking progestogen, even if you still have a womb.
nhs.uk
Antibiotics
Unfortunately antibiotics are overused, and antibiotic resistance is on the increase, but antibiotics do have a part to play in treating a diagnosed UTI. We can all play our part in minimising the inappropriate use of antibiotics by taking appropriate self-help measures. However, it is important to seek out timely medical support to ensure safe and effective treatment for a UTI.
Symptoms of a UTI can often present as dementia or psychosis in the elderly, which is another reason why it is so important to check a urine test (dip) and culture, and treat accordingly with antibiotics when positive.
New Approaches
Urinary Antiseptics such as methenamine and methylene blue are being used in the symptomatic treatment of urinary tract infections (UTIs). Both treatments have been shown to be effective in reducing UTI symptoms after 3 days of treatment as assessed by the UTI Symptom Assessment Questionnaire. Gama CRB et al, Res Rep Urol. Dec 2020
A recent study at Newcastle University showed that there was only a small difference between their two study groups suggesting that methenamine was no worse than antibiotics at preventing urinary tract infection. Methenamine is also associated with reduced antibiotic consumption and similar levels of adverse reactions and treatment satisfaction compared to daily antibiotics. Source This is great news for women and may just herald a new era in the management of recurrent UTI.
If Menopause is a contributory factor what about HRT?
Hormone replacement therapy (HRT) is a treatment to relieve symptoms of the menopause. It replaces hormones that are at a lower level as you approach the menopause. The main benefit of HRT is that it can help relieve most of the menopausal symptoms, including, hot flushes, night sweats, mood swings, vaginal dryness and reduced sex drive.
nhs.uk
Based on a lack evidence of effectiveness, and taking account of Medicines and Healthcare products Regulatory Agency (MHRA) safety advice, the NICE guideline [NG112] committee agreed to not recommend oral oestrogens (HRT) specifically to prevent recurrent UTI in postmenopausal women.
However, in the event that your UTI is occurring as part of the puzzle of menopause symptoms and HRT is a safe option for you, it is perhaps worth having a conversation with your Doctor.
What about the Vaginal Biome and UTI?
There are an estimated 39 trillion microbial cells including bacteria, viruses and fungi that live on and in us. Pathogenic (bad) and non-pathogenic (good) coexist symbiotically but problems can arise when imbalances occur.
“The microbiota of healthy vaginal tract of premenopausal woman is generally dominated by the bacteria species Lactobacillus.” However, as oestrogen levels are decreasing in postmenopausal women there is a decrease in the numbers of lactobacilli present. There is a suggestion that these lactobacilli can act as protection from pathogens and infection. Cribby S et al. Interdiscip Perspect Infect Dis. 2008
One suggested mechanism for how HRT could benefit repeated UTI is by altering the bacterial profile of the vaginal tract of postmenopausal women. Restoring a lactobacilli-dominated state, and thus reducing the incidence of urinary tract infections (UTI). Cribby S et al. Interdiscip Perspect Infect Dis. 2008
Natural Approaches to Management
Supplements
The supplement D -Mannose is a form of sugar related to glucose that is derived from a tree bark. The theory is that the sugars bind onto the lining of the urinary tract and can help to repel bacteria like E-coli. There is a small randomised controlled trial (RCT) suggesting that D‑mannose was effective in reducing the risk of recurrent UTI in non-pregnant women.
Source: The Urinary tract infection (recurrent): antimicrobial prescribing NICE guideline [NG112] Published: 31 October 2018
You might have heard of cranberry juice being used to treat symptoms of a UTI. A range of cranberry products are available; a liquid (juice or syrup), tablets or capsules. For the most part there is very low-quality evidence showing the benefit of cranberry products for reducing the risk of UTI. Unfortunately cranberries are naturally bitter and so Cranberry juice will have a high sugar content to it palatable.
Probiotics
If what we eat can affect the gut biome; shifting the balance between the good and bad bacteria. This could in turn alter the risk of invasion purely due to the proximity of the anus, vagina and urethra. Although the evidence is inconclusive when it comes to the consumption of probiotic lactobacillus for recurrent UTI, I think I might be tempted to give it a try and find out for myself.
Managing Stress and UTI
Clinical Hypnotherapist Jacquie Whur told me “There is evidence that high levels of stress can contribute to the incidence of UTI. Stress depletes our immune system and this can leave us open to infection.” There are factors that we may be unaware of that can contribute to a whole host of health issues including a poor diet and lack of sleep. Whatever the mechanism there is no doubt that high levels of stress are a hazard to health. Stress relief techniques to try include:
- Breathing exercises
- Relaxation techniques
- Mindful movement practices like Yoga and Pilates.
- Journaling
- Managing negative thought loops
- Maintaining healthy boundaries
- Therapies such as hypnosis and CBT
Got 5 minutes to spare? Try my ribcage breathing done right
You are what you eat! And drink…
There is so much evidence that what we eat and drink can affect our bodies and even our minds, why would the bladder be any different? Why would the bladder exist as a little pocket untouched by our lifestyle? This can’t possibly be the case! Want a quick fix? Check all food labels before you buy and avoid any ingredients that you can’t pronounce, or find in the garden, field, or pond. keep up your levels of hydration; increasing our intake of good old H2O and reducing levels of alcohol, coffee, tea and caffeinated drinks like cola.
Plant Medicine: Essential oils
I have been using essential oils to support the health and wellbeing of my family for many years. Essential oils are made from plants and can be used in a variety of ways to support a healthy urinary tract. Aromatherapist Claire Ottewell says “natural essential oils go where they need to go” and you could:
- Massage a blend of oils over the lower abdomen
- Add a few drops of oil in a carrier oil to a bath
- Use a diffuser in the room where you spend the most time. Some oils have molecules small enough to cross the blood brain barrier and create beneficial effects in the central nervous system when inhaled.
- Some of the nutrition grade oils are appropriate ingest in small amounts to help infection or create anti-inflammatory effects.
Five oils you could try:
1. Bergamot can help our genitourinary system and is antiseptic, antidepressant, anti-spasmodic, and blends well with lavender and chamomile.
2. Chamomile is good for menopausal problems and is pain relieving, anti-inflammatory, bactericidal, fungicidal, and antispasmodic and blends well with Lavender and Bergamot amongst others.
3. Frankincense can help cystitis and anxiety and stress related conditions it is anti-inflammatory, antiseptic and sedative.
4. lavender oil is analgesic (pain relieving), antidepressant, antiseptic, antispasmodic, deodorant, and sedative and can be usedful in cases of cystitis (UTI).
5. Vetiver is an oil that can help conditions associated with the nervous system including depression insomnia and nervous tension. Vetiver is deeply relaxing and so valuable in massage and added to a bath for anybody experiencing stress, it is also antiseptic, antispasmodic and sedative.
What about Movement as Medicine?
Working to strengthen your pelvic floor can will help you empty your bladder more effectively without pushing. The better you empty your bladder, the lower the risk of future infections.
Checkout this video for some top tips to find, feel and ‘wake up’ your pelvic floor.
When to see your Doctor
I love the idea that we can take care of ourselves with movement, nutrition, mindfulness, and natures pharmacy but there is always the exception. Self-management of a UTI could delay you from receiving appropriate medical treatment. It is particularly important that young people receive prompt assessment and treatment to prevent the development of a chronic condition that is then resistant to treatment. UTI’s can be dangerous if the infection spreads to your kidneys. Go straight to your doctor if you experience fevers, shaking, nausea, or vomiting, as these may be signs of a more serious infection. Never ignore a UTI as kidney damage could occur and sepsis; a life-threatening medical emergency, is also possible.
Contributors:
Phillipa Butler Chartered Physiotherapist, Pilates and Yoga Teacher and Host
Claire Ottewell Aromatherapist
Jacquie Whur Clinical Hypnotherapist Mind and Motivation Coach
Dr Susan Baumgaertel
Disclaimer: any advice we provide in this podcast is for information only, and if you are unsure of its suitability for your specific circumstances, you should consult your medical practitioner before making any lifestyle changes.
