Aging brings challenges. My least favorite one, so far, has been the attack of persistent UTIs. Menopause seemed to have opened that door. Anyone who has experienced a urinary tract infection will know immediately if she gets another one. How can we avoid UTIs without using antibiotics?
How We get UTIs
Bacteria make their way into the urinary tract—mainly the urethra and bladder—and they grow. This overgrowth causes an infection.
What is it about aging that adds to the frequency and tenacity of UTIs? Studies conclude different answers, but common ones rise to the top. And they’re linked to menopause.
When we hit menopause, our bodies produce less estrogen and progesterone. This causes, among other things, genital tissues to lose plumpness and vaginas to become less moist. Why does that matter?
The labia provide cover for the urethra, which is positioned just below the clitoris and just above the opening to the vagina. With the drawing back of those tissues, the opening to the urethra is more exposed. Bacteria find an easier entrance and can make their way up the tube and into our bladders. Once there, they can settle in. More on that in a moment.
pH Balance
When our vaginas become drier, the pH balance changes. We measure pH on a scale from 1 to 14. The middle ground, or neutral, measures at a 7. Anything from 0 to 6 is considered a low pH, or acidic. The lower the number, the higher the acid level. Numbers from 8 to 14 are alkaline (or basic). We need vaginas to be slightly acidic, which makes an unfriendly environment for the bacteria. A healthy vaginal pH falls between 3.8 and 4.5. Urine should be around 5–6, only slightly off from water, which is a neutral 7. We’ll throw a little math in here just for fun. The pH scale is logarithmic, which means a pH of 4 is ten times more acidic than a pH of 5. So, even though these numbers look close, the levels vary widely.
In a normal vaginal biome, good lactobacilli bacteria thrive. This good bacterium eats glycogen (a form of sugar) found in vaginal mucus, producing lactic acid and hydrogen peroxide. (Ever notice small bleached-looking patches on your underwear? It’s because your body creates hydrogen peroxide.) An acidic environment is formed, which lowers the pH. Bacteria or yeast find it difficult to live there. With declining levels of estrogen, however, the vaginal walls dry out and become thin. Less exfoliation occurs, and glucose levels drop. The pH becomes more alkaline, which leaves the door wide open to bacteria. Just so you know, this will also change the way your vagina smells, which is not exactly a topic of dinner conversation. If you notice this when you go to the bathroom, it can be an indicator that your vaginal biome is changing. And that can be a precursor to trouble.
The most reported cause of a UTI is sexual activity. How does this God-given activity hold the power to change something so good into something so bad? Your sexual partner can transfer bacteria to your urethra. This bacterium can come from inside your vagina, which is now the Holiday Inn for any bacterium, or from your anus, which could have E. coli bacteria on its surface. When things start, ahem, poking around, bacteria transfer is easy to effect.
The second-most reported cause is dehydration, followed by stress. The less you drink, the less you need to pee. Every time you urinate, urine acts like a pressure washer, rinsing any lurking bacteria back to the cold, cruel world whence it came. Many jobs are busy and stressful, leaving little time for breaks, either to drink water or to run to the restroom. Combine those two things together, and you’re rolling out the welcome mat for our unwelcome guests.
How to Prevent UTIs Physically
Certainly, prevention is far better than curing. In today’s medical environment, it can take days to get a doctor’s appointment. Anyone who has ever suffered through a UTI shudders at the thought of waiting even five minutes longer than necessary to start a treatment of antibiotics. Plus, the more often we take an antibiotic, the more we risk developing a tolerance to it. Antibiotics kill off all the bacteria in your body, good and bad. So those little glucose-munching guys in your vagina that we want, the ones that produce the hydrogen peroxide? They’re out the window, too, right along with the infection-causing ones in your bladder.
Be aware of the physical things you can do.
- When you urinate, make sure your bladder is completely empty. Lean forward when your flow stops to ensure you’ve drained every last drop.
- Wipe your bottom from front to back. E. coli bacteria hang out at the back end, so don’t bring them forward. Carry wet wipes in your purse in case you have a messy bowel movement. If you can afford one, invest in a bidet to help ensure your bum is squeaky clean after you have a bowel movement.
- Drink water. Lots of it. Set an alarm and swallow a cup of water every hour if you have to. The more water, the more diluted your urine, and the more often you’re running that pressure washer to clean your urethra. Keep a glass on your bedside table and take a few sips if you wake up in the night (another unwelcome visitor brought along by menopause).
- Urinate after sex. Sure, it’s not as nice as cuddling up and falling asleep in the warm afterglow. But if all that poking around pushed bacteria into your urethra, now is the time to flush them right back out again.
- Consider your underwear. We need to let our lady bits breathe. Bacteria, like a lot of unsavory things, flourish in dark, damp places. Wear cotton underpants. Sleep without them, if possible.
- Avoid thongs like the plague. That tiny strap is pulled tight against your bottom, and with only the smallest of shifts, it can act like a conveyor belt, bringing E. coli straight to your vagina or urethra. Throw them away.
- Another item to consider ditching is shapewear. Not only do they clamp everything snugly against your skin, making air circulation difficult, but they’re also next to impossible to get in and out of without a lot of wriggling, heaving, and panting.
- Nothing will put you off making a trip to the bathroom more than the fear of making a fool of yourself. And we don’t want to hold our bladders because urine is collecting, concentrating, and growing bacteria. Go freely and go often! Shapewear holds you back from that.
- Take vitamin C, D-mannose, or methenamine Hippurate (Hiprex). Vitamin C boosts your immune system. D-mannose is a simple sugar found in fruits like apples, grapes, and cranberries. Unlike an antibiotic, it does not kill the bacteria. Instead, it binds to them, which prevents them from attaching to the lining of your bladder. Methenamine Hippurate converts into formaldehyde in your urine, acting as an antibacterial.
How to Prevent UTIs Internally
Many women use estrogen cream when they hit menopause. It is inserted vaginally, using a plastic applicator similar to the ones that deliver tampons. This helps the pH balance inside the vagina stay at its proper level, preventing the growth of unwanted bacteria, plus it also reduces the chance of painful intercourse, a happy side effect.
Take probiotic capsules. These live bacteria and yeasts affect our gut biome, often called “the second brain” due to the extreme effects it has on our physical health. Probiotics change the gut by increasing the good guys and decreasing the harmful ones. There are many different types of probiotics on the market, and they are available over the counter. Pay attention to the “end of shelf life” date, as probiotics need to be alive when you take them. Uqora is a company who specializes in products that help prevent UTIs, and they make a probiotic.
Eat fermented foods like Greek yogurt, kefir, miso soup, kombucha, sauerkraut, or kimchi. Some people swear by drinking a shot of apple cider vinegar (with the mother) once a day. These foods provide probiotics in a less concentrated quantity than the capsules.
It can be very frustrating when a UTI recurs only weeks after you’ve rid yourself of one, particularly when you’re doing everything you’ve been advised to do. It’s probable the UTI is not new but instead is caused by the same bacteria as before. Bacteria can grow a protective film called a biofilm on the wall of the bladder. If you’ve ever slipped on a slimy rock while walking across a creek, you’ve seen a biofilm. Bacteria stick to each other and attach to the biofilm, which provides a shield for them to hide behind. Both your own white blood cells and antibiotics find it difficult to penetrate through the biofilm. Bacteria lay dormant until conditions are ripe, then they break free and start the process all over again. The key is to keep your pH balance at the proper level, so the ripe conditions never repeat. Probiotics can help with that.
However, it’s possible you experience something called interstitial cystitis (IC). The symptoms feel the same—frequent urge to go; burning sensation with urination; achy, painful pelvic area; and pain during sex. Urine can become so acidic that it irritates the bladder. This can mimic the sensation of a UTI. Eating more fruits and vegetables will cause your urine to move toward the alkaline end of the scale. Foods like meats, caffeine, and alcohol will create a more acidic urine.
When a doctor suspects you have a UTI, she checks your urine by dipping a test strip into the sample you provide. The strip checks for the presence of white blood cells. Normally, if white blood cells are in your urine, that indicates an infection. A doctor may assume a UTI, especially if the symptoms you’ve described fit a UTI. But IC creates white blood cells because it is an auto-immune condition, and your body is attacking itself. If antibiotics don’t seem to relieve your symptoms, ask your doctor to check for IC.
There is no easy test to check for IC. Instead, doctors will run various tests which may rule out a UTI. When all else has been discounted, IC may be left as the culprit.
If you suspect you have IC, try this. At first signs of what appears to be a UTI (like, the morning after a fun romp in the sheets), instead of reaching for an antibiotic, try drinking lots of water. Use a product like Azo Urinary Pain Relief to reduce the urge to constantly go and temporarily mask the pain associated with urination. Take your vitamin C and D-mannose. If symptoms subside without the use of antibiotics, you may be one of the unlucky few who experience IC. Although there is no cure, your doctor has options that will help you get it under control.
We live in a world where new diseases come at us each year. We must find a way to reduce our reliance on antibiotics. Take a proactive approach to your health and do what you can to prevent your next UTI. I’ll raise my shot glass of apple cider vinegar and cheer you on.
Author Bio:
A fifth-generation Texan, Paula Peckham, published her first novel in 2022. She now has three novels and two anthologies to her name. Her debut novel, Protected Book 1, in The San Antonio series, was published in April 2022. It finalized in ACFW’s Genesis contest and won the gold medal in the 2022 Global Book Awards. Book 2, A Father’s Gift, finished third in the 2023 Selah contest. Book 3, Accepted, came out in October 2023, and won first prize in the Bookfest Awards and finalized in the 2024 Selah contest. She is currently working on a contemporary romance titled Still Haven’t Found What I’m Looking For. Paula divides her time between her home in Texas and Rio Bravo, Mexico. You can find Paula on Facebook, Instagram, TikTok, and her blog Real People with Real-life Struggles.