If you’re one of the many women who’ve struggled with bladder infections and thought it was because of something you did, take heart, I’ve got information for you…
Every year approximately 50% of all women will have a bladder infection. Of those who get an infection, approximately 20-30% will get a re-infection within three months.
These infections account for a large burden placed on women that negatively affects their quality of life. Besides the usual symptoms of painful urination, urgency and frequency; women also report fatigue, anxiety, depression and sleep loss.
The sudden and often painful onset of bladder symptoms can sideline women from work and homelife activities. Repeated infections can have financial consequences as well with many women reporting they have to take time off for doctor appointments, not to mention the cost of medication.
As a result many women report becoming anxious about future plans, expressing reluctance to travel or make vacation plans.
The burden on young women is especially great.
For young women the association of sex with recurrent UTIs can undermine intimate relationships.
Some women report they are hesitant to form relationships due to the threat of an infection that can take weeks to clear afterwards.
As a pelvic health physical therapist I often treat women who are recovering from a bladder infection or have had one in the past. Many of these ladies share with me the belief that they must have done something wrong to cause the infection.
So what are these things we’ve been told to do?
Pee before and after sex
Wipe only from front to back
Use the bathroom whenever you get an urge, don’t delay
Avoid Douching
Avoid use of hot tubs
Stop taking bubble baths
Avoid tight clothing
Wear only natural fiber clothing
The list goes on…. and I’ve only touched on the most common ones!
But are any of these strategies proven to be effective?
A review of the research on these behavioral strategies has found that NONE of these commonly promoted suggestions has been found to be effective in preventing bladder infections.
With one researcher writing that healthcare professionals need to better educate patients, citing the fact that a number of studies have ‘failed to identify any association’ between recurrent UTIs and the above mentioned behavioral strategies.
Noting that, ‘such myths should be cleared up with patients’.
In other words, we need to stop blaming the infection on wiping patterns, clothing choices or bubble baths. These myths perpetuate the unproven belief that if women alter their behavior in one of the ways listed above, they could have avoided the infection in the first place.
Further, I would argue that by not dispelling these myths sufficiently, we do women a great disservice when it comes to accessing healthcare and interactions with healthcare providers. Feeling ‘at fault’ has the potential to compel women to delay seeking care or become reluctant to share information with healthcare providers.
The reality is that a bladder infection is a complex biological imbalance that can be extremely harmful and in some cases fatal if not treated appropriately. Therefore it is imperative that behavioral strategies are based on scientifically proven, evidence-based information.
So what is a bladder infection?
Bladder infections are caused by the invasion and adherence of bacteria to the lining of the bladder (or bladder wall) and urethra. If the invading bacteria get a chance to multiply, they will outnumber the normal bladder bacteria and create an imbalance.
This bacterial imbalance is called a ‘dysbiosis’, and can lead to a bladder infection.
A bladder infection or recurrent UTI is typically treated with a course of antibiotics. While antibiotics are effective, there are downsides to their use. Allergies may develop, bacterial resistance, and GI effects like nausea and diarrhea.
Given the growing concern about developing bacterial resistance, prevention has become even more important.
Risk factors for UTIs or recurrent bladder infections are;
Prior bladder infection as a child
Family history of UTIs
Pregnant
Post menopausal
Compromised immune system
Using a catheter
Basically any woman who has a compromised immune system, genetic predisposition, is low in estrogen or uses a catheter will be more prone to developing a UTI.
What strategies ARE helpful to prevent UTIs and recurrent bladder infections from occurring?
Drink more water!
A recent Journal of American Medical Association (JAMA) study looked at the effect of increasing daily water intake in premenopausal women with a history of recurrent UTI. This study found that an increase in daily water intake by 1.5L above what you normally drink can decrease your chances of recurrent UTI by 50%.
Increasing hydration also has the added benefit of preventing your urine from becoming concentrated. A light ‘straw’ colored urine means you’re less likely to get bladder urgency and frequency associated with bladder irritation. For more on this subject check out my blog post here.
We all know increasing our water consumption is good for us, and this is one more reason to put refilling your water bottle at the top of your list!
Avoid spermicidal birth control methods
Women of reproductive age are twice as likely to develop UTI when they use spermicidal birth control methods including diaphragms and condoms. Use of spermicides raises a woman’s vaginal pH, which prevents the good bacteria (lactobacilli) from thriving and leaves women vulnerable to infection.
If you’ve experienced bladder infections after sex, and you use a spermacide-based contraceptive, discuss this with your Gynecologist. Your doctor will be able to suggest alternatives that work better for your body.
Supplement with d-Mannose
D-Mannose is a type of sugar, found in many fruits and vegetables, that has been shown to be effective in prevention of E.coli initiated bladder infections. D-mannose works by latching onto the finger-like projections outside of the bacteria thus preventing the bacteria from attaching to the bladder wall.
This anti-adhesion mechanism means the bacteria will be eliminated at the next bathroom break. Since E.coli and it’s family members make up the largest group responsible for infections, d-Mannose is a good choice when it comes to prevention. For more information on d-Mannose check out my blog on the subject.
Women in Menopause may be helped by topical estrogen
After menopause, the amount of estrogens circulating in the body decrease and the estrogen sensitive tissues like the vagina, vulva and urethra become thinner, dryer and more fragile. At the same time the vaginal pH rises, allowing potential disruptive bacteria to flourish. This combination of changes allow bacteria to move into the urethra then the bladder and put you at risk of infection.
Low dose topical estrogen helps the vagina by keeping the vaginal pH low and letting the beneficial lactobacilli bacteria flourish as well as supporting the urethral tissue to prevent bacteria from moving in.
Studies show that topical estrogen does NOT increase circulatory levels of estrogen beyond post-menopausal levels. However, women with history cancer or estrogen sensitive conditions may not be a candidate. A discussion with your doctor is a must when considering topical estrogen.
Empty your bladder well!
Bladder emptying is a often overlooked but very important behavioral strategy for preventing bladder infections. If your bladder doesn’t empty well, urine is left in the bladder allowed to collect.
This partial emptying is called urinary retention. A small amount of urine left in the bladder is normal, but a large amount can be problematic. In some cases the large amount of extra urine allows bacteria to flourish and eventually become a bladder infection.
Relaxing the pelvic floor muscles is key to being able to get the urine out. As a bladder health specialist I often teach a specific posture for peeing that helps with emptying.
I also teach how to use your breath for pelvic floor muscle relaxation rather than pushing to get your pee out, and why hovering is not good for bladder emptying.
Once you’re able to empty well, your bladder feels MUCH better, and you are less likely to get a bladder infection.
Should we be thinking differently about bladder infections?
Yes! Given that bladder infections and recurrent UTIs are incredibly common and disabling to many women, clarity on myths surrounding this complex disorder is essential.
Women will always be more susceptible to UTI due anatomy alone, the short length of the urethra makes us more likely to develop one compared to men.
But rather than focusing on the problem as a lifestyle issue, the focus needs to be on better bladder management.
An emphasis on management and prevention, takes the shame out of the discussion and redirects it to a more constructive conversation with healthcare providers on strategies that work.
Granted, even with all of this information, you may still want to follow some of the old advice.
That’s OK, that’s your choice, and you are uniquely able to decide what’s right for your body. What’s important is that you know what’s a proven bladder management strategy, versus what’s speculation at best.
What myths have you encountered? Love to hear from you, leave me a comment below!
Happy bladder wishes my ladies! 
~ Tami
Tami Lines is a licensed Physical Therapist with certifications in Pelvic Rehabilitation and Women’s Health Coaching. She is the founder of Pelvic-Health-Matters. Tami has over 15 years of experience with expertise in bladder Health, and pelvic floor muscle dysfunction for adolescent and adult women. She is also a mom of two wonderful young adults working their way through college.
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Aydin A, Ahmed K, Zaman I. Recurrent urinary tract infections in women. Int Urogynecol J 2015 26:795-804
Scholes D, Hooton T, Roberts P, Stapleton A, Gupta K, Stamm W. Risk Factors for Recurrent Urinary Tract Infection in Young Women J of Infectious Diseases Vol 182:4 2000 1177-1182
Hooton T, Vecchio M, Alison I. Effect of Increased Daily Water Intake in Premenopausal Women with Recurrent Bladder Infections. Jama Intern Med. 2018; 178 (11):1509-1515.
