Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Urinary Tract Infections: From Symptoms to Solutions
Discover the secrets to maintaining optimal urinary health as Dr. Holly Thacker unravels the complexities of urinary tract infections (UTIs) that particularly affect women. Have you ever wondered why women are more susceptible to these irritating infections, especially with age and hormonal changes?
Join her as she dissects the anatomical differences and lifestyle factors that make women prone to UTIs and uncover the role of menopause in increasing this vulnerability. Dr. Thacker shares crucial insights on recognizing symptoms, understanding the distinction between lower and upper urinary tract infections, and the severe complications that can arise if left untreated.
Equip yourself with practical strategies to prevent and manage UTIs effectively. Dr. Thacker covers all the bases, from local estrogen treatments and the newly approved Pivya (pivmecillinam) to understanding the benefits and limitations of cranberry extract.
For those dealing with recurrent infections, find out why a urologic evaluation might be necessary and explore preventive measures that can safeguard your wellbeing. Tune in for an insightful conversation designed to empower women with knowledge and solutions for better urinary health.
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Welcome to the Speaking of Women's Health podcast. I'm your host, dr Holly Thacker, the Executive Director of Speaking of Women's Health, and I'm back in the Sunflower House for a new podcast, and on this new podcast I will begin to talk about a common problem that afflicts especially women, and that's urinary tract infections. And one of the reasons why it affects women so much more than men is because the urethra in women is much smaller, whereas the urethra in males is much longer. So we all normally have bacteria on our skin, but the bladder and the urine is a sterile environment, and if that bacteria crawls up into the bladder it can become an infection. And it's very common in women, and it becomes increasingly more common with age, especially if there's low estrogen status, which, of course, is what I've spent my career focusing on is the ovaries, ovarian aging and estrogen and the effects of estrogen throughout the entire body. And it also has some links to sexual activity, because even regular sexual activity involves contact with the vulva, which can predispose people to bladder infections, which can predispose people to bladder infections, and approximately one half of all women experience at least one UTI in their lifetime.
Speaker 1:Now, my last bladder infection, I'm embarrassed to say, was right before I saw our wonderful center nurse practitioner, dana Leslie, who will be on again this season, and I was seeing her for a routine exam and I was just overly scrubbing and washing myself, which you should not do prior to your gynecologic exam. First of all, the vagina is self-cleansing and you only want to use very mild soap, if soap at all, on the vulva and keep it away from the urethra. And the symptoms of urinary tract infection can begin with severe burning on urination, increased frequency and sometimes even blood in the urine. In fact, this was the last time that I had a bladder infection, was the first time I saw blood, even little blood clots. It was really quite shocking. And of course you have to make sure it's not coming from the vagina or the vulva. And sometimes this infection can spread and go into the kidneys, which can cause back pain or a systemic infection called pyelonephritis.
Speaker 1:So most all of the infections usually begin in the urethra, which is that little tube that takes the urine from the bladder to the outside, and the theory is that because the opening of the urethra is in such close proximity to the vagina and the perianal area area that it's not difficult for bacteria to travel up and establish an infection and these facts do account for the higher rate of bladder infections compared to men. But certainly men can get prostatitis. Men can have bladder infections after instrumentation, prostate surgery, bladder catheters being placed. Now menopausal and postmenopausal women appear to have a somewhat increased risk of UTIs because when there's lack of estrogen and DHEA and sex hormones in the body, if it's not treated, can lead to a thinning of that whole vulvovaginal tissue, the entire urethra and the trigone or the base of the bladder, and when the skin is more delicate and sensitive, it's a lot more likely to get infections. Now postmenopausal women may experience bladder or uterine prolapse, particularly if there's a family history of it, if there's been childbearing, obesity, constipation, lots of pressure on the abdomen or the bladder, and if the bladder does not totally empty urine, it's a lot more conducive to bacterial overgrowth.
Speaker 1:One of the simple tests that we do in the office is a little ultrasound test where we have the woman go and empty her bladder. A lot of times we want what's called a clean catch urine culture, meaning the woman wipes the vulva you always wipe from front to back, urinates a little bit, that opens the sterile cup and then urinates the mid part of the stream and then, without touching inside, closes it, sits it down, then sits down and completely empties the bladder and just relaxes, sits down and completely empties the bladder and just relaxes. And then we do a little ultrasound scan over the bladder area and we can measure how many cc's are left in the urine in the bladder and it's really very good when there's zero, but we want at least two-thirds of the bladder empty. Sometimes women are anxious or they're not relaxed and we have them do a second void, or they're not relaxed and we have them do a second void. But when there is urinary retention because of urethral stricture or prior surgery or radiation or in men who've had prostate procedures, that overexpansion of the bladder and all that urine there is kind of like a breeding ground for bacteria.
Speaker 1:The other thing that can affect postmenopausal women is when you lose estrogen, you lose the glycogen in the cells and you lose the support for healthy bacteria, the lactobacillus, which keeps the vagina acidic and helps keep the bad bacteria and the yeast away. And I always tell women that when we start to treat their significant vaginal thinning, usually I recommend a moratorium on any pelvic contact examinations, speculums, tampons, dildos, sexual activity until the tissue is healed, which takes at least four to six weeks. Now, using systemic hormones with the local estrogen improves that and a lot of my patients I find out stop their local treatment because, oh, I'm not sexually active anymore. And I tell them we don't care what you do with your vagina, we just want it healthy and everyone needs a healthy bladder and it's not uncommon for women over 65 to get a bladder infection that turns to urosepsis and then causes death. I recently had a longtime patient, who usually listens to most of what I say, who stopped her vaginal estrogen because she had a couple of girlfriends who were diagnosed with cancer. And of course I admonished her that vaginal estrogen does not increase the risk of breast cancer and that by stopping the vaginal estrogen it's not just about dryness or using a lubricant. You want that integrity of the tissue to be healthy. And she said well, I never had a bladder infection. I'm like that's terrific, but you don't want your first bladder infection to be your last bladder infection, ie because it knocked you off this earth. So it is really serious Now.
Speaker 1:Sometimes the terms UTI, bladder infection and kidney infection are used interchangeably, but there's really a big difference. Urinary tract infections can affect any part of the urinary tract, including the urethra, and the ureters connect the kidneys to the bladder or the bladder or the kidneys themselves, and your kidney is just a powerhouse of cleaning your blood and, over a lifetime, has a lot of work to do. So you really want to protect your kidneys and the kidney tissue cannot regenerate if it's scarred, whereas the liver, which is another powerhouse and I've done podcasts on the liver and fatty liver and coffee, tea or me, because coffee and tea are beneficial to your liver and there's lots of things metabolically you can do to reduce your risk of fatty liver, which is really at an epidemic and can lead to scarring and cirrhosis. But the kidney doesn't have that ability and a plain bladder infection like I had just affects the bladder and it was very painful initially. I kept running to the bathroom, didn't know if I was going to be able to finish seeing my patients that day which I was able to, thankfully, because I work in a hospital and I saw my clinician. I was able to get the culture with my lovely nurse, beth, who just ran it right away, and get the prescription for an antibiotic and start it within an hour of my symptoms. That's pretty unusual and that was just lucky because I developed it like right as I was heading into work and to my appointment.
Speaker 1:Now, bacteria when it involves other parts of this urinary tract and infects the kidneys. It's much more serious to have an upper urinary tract infection as opposed to just a lower one urinary tract infection as opposed to just a lower one. They can have similar symptoms, but a kidney infection is much more serious. It's a lot more likely to make you feel sick, give you a fever or chills, cause pain in the area of your kidneys which is usually the mid back, mid-back Now. Signs and symptoms include, as I mentioned, pain or burning called dysuria.
Speaker 1:Frequent urination because your bladder is irritated and it's trying to pee out that bacteria and you can still have that urge to urinate even if there's no urine in the bladder. There can be pelvic pain or pain in the abdomen. You can see gross blood to the naked eye, like I did, or it can just be microscopic when the nurse does the dip and looks at it. There can be fever or chills, confusion, especially an older person. Sometimes the only sign of a bladder infection is a change in mental status no fever or complaints of pain. So if you have any elderly relatives who just seem a little off, whether they're a male or female, they should always be checked for a bladder infection. And the same thing in newborns and young babies. They may not exhibit or they obviously can't communicate to you that they're having pain. It just may be a change in their status.
Speaker 1:Now, once your periods stop, even if you feel great, even if you don't have hot flashes, you've got to assess both your bone status and we've had lots and lots of podcasts on osteoporosis. May is osteoporosis month, so for the last two seasons we've had a lot of information on the bone. And the other thing that has to be assessed is the genitourinary system, because most women will have changes if they're not treated, and the good news is local treatment is very effective. And the other good news for women over 65 is vaginal estrogen. In that large study that traversed over a period of 13 years and studied 11 million American women. Go back and listen to October of 2024's podcast on that research. That's one of my favorite podcasts because it covers so much information and so much data and it showed that the women who had the lowest risk of death were women on vaginal estrogen.
Speaker 1:So when you lose the estrogen, the tissue gets really, really thin and sensitive and atrophic, and even if you don't have symptoms of pain or if you're not sexually active or you're somehow not bothered by it, it's still really put you at an increased risk of bladder infections. So there's a lot of things that you can do to reduce your risk of bladder infections, and you have been listening to the Speaking of Women's Health podcast I am your host, dr Holly Thacker, in the Sunflower House, talking all things urinary tract infections. So we're now going to focus on how can you reduce the risk of bladder infections. Well, one important thing is to drink plenty of good old H2O water.
Speaker 1:You want to regularly flush bacteria that might be starting to crawl up the urethra and try not to hold your urine. You know I talk to and see a lot of school teachers and they talk about their long hours teaching and how sometimes they can't leave their classroom to go to the bathroom and there has to be some sort of plan to be able to empty your bladder in four hours or six hours or if you have that need. You should always wipe from front to back and not be too rough with either. Your toilet paper should be soft. It should not be rough. I've had some women tell me that they're in a restroom and there's no Kleenex or toilet paper, so they get the really harsh hand towels and just by wiping themselves with something rough, that alone is enough to stimulate and change the bacterial flora bacterial flora.
Speaker 1:It's important to urinate before and after any vulvar manipulation. So that of course includes sexual activity and it also includes pelvic exam. So before you go in to see your gynecologist or women's health nurse practitioner or physician assistant and you know you're going to get an exam, you should always empty your bladder. Okay, empty your bladder before the exam, before you get undressed, and then you want to drink enough fluid and empty your bladder afterwards. That really makes a big difference. You have to avoid vaginal hygiene sprays and douching. It's not recommended. It can affect the bacterial flora and if you are a menstruating woman having a period, you have to regularly change your pads and tampons. That's very important. It's also important to wear loose-fitting clothes and 100% cotton crotch underwear. Tight, ill-fitting clothing creates a moist, damp environment which promotes bacterial growth and in women's health. We're not fans of thong underwear because that thin string is like anal floss and can push bacteria up to your urethra where you don't want it.
Speaker 1:Now, supplements that might help bladder infections, and I always keep my trusty cranberry extract because cranberries do seem to inhibit E coli's absorption onto the urethral mucosa. And I didn't think to take any cranberry extract that morning of my exam because I wasn't having any symptoms and I don't necessarily want to drink full cranberry juice with all that sugar. I'm not someone who really likes to drink my calories and so getting the extract is a very high concentration. Now, anytime that you're taking a cranberry extract or any supplement that's over the counter, you really want to look on the bottle for the lot number and expiration, because that does imply some quality controls, because if it's not a food or it's not a drug, it isn't regulated. So it is. Buyer beware. And just because something's not a prescription doesn't mean it can't interfere with other prescription medicines or lab tests. If you didn't listen to the podcast on biotin biotin's B7, that interferes with a lot of blood tests and ideally you should be off it for three days before getting blood work and you should tell anyone, especially if you're in the emergency room, if you've been on high-dose biotin and they're drawing cardiac or hormonal blood work on you.
Speaker 1:Another supplement that I frequently recommend to women sometimes in combination with the cranberry extract, sometimes separately is D-mannose. It's a simple sugar that's found in fruits and it is used to help prevent and treat UTIs. The supplement dosage is based on whether or not you have a bladder infection or you're trying to prevent it. So to prevent a urinary tract infection, you should take 500 milligrams of D-mannose three times a day, but if you're experiencing a bladder infection, you need to take one gram three times a day.
Speaker 1:What foods might you want to avoid? Well, certain foods can contribute to urinary frequency, urgency and discomfort, like when I first had my urinary discomfort, I thought maybe it was because I had some coffee and some green tea in the morning, because caffeine can irritate the bladder. There are a list of foods that you can find on our Speaking Women's Health site that are known to be bladder irritants. It doesn't mean that you have to always avoid those foods, but sometimes women find in combination, if they're eating multiple types of these foods or taking B-complex vitamins, which are water soluble excreted in the urine, that can change the urine a darker yellow color and cause irritation. Some women will actually do an elimination and then add back every seven to 10 days the possible offending substance and then, if they can identify what the irritant is, they can identify it and either avoid it or drink a lot more water and have other foods at the same time. And there are acidic foods that sometimes irritate the bladder and should be avoided if you're prone to urinary tract infections, like alcohol beverages. There's lots of reasons to avoid alcohol and certainly avoiding regular alcohol in general is a healthy thing to do.
Speaker 1:Apples and apple juice, cantaloupe and some women carbonated beverages can be irritating to the bladder or stomach. Chili and spicy foods don't just affect heartburn but can the bladder. Chocolate, which is a good source of iron and magnesium and does have caffeine, and in some people irritates them. Caffeine and in some people irritates them along with citrus fruits. Coffee, also the decaffeinated brands. Ironically, cranberry and cranberry juice can be irritating to some women's bladder, even though it does inhibit E coli. Now there's other bacteria that can cause bladder infections.
Speaker 1:I was happy in my case when I got the result I had just simple E coli UTI and the blood all cleared up and that you have to go back and be rechecked to make sure that you're not bleeding from something else wrong in the bladder. Grapes are another bladder irritant Guava, peaches, pineapples, plums, strawberries, which have a very high histamine content, tea, sugar and tomatoes those are the big ones. Vinegar and B-complex vitamins. Now, not all women say that sugar bothers their bladder, but there is a definite group of women and you can be healthy and survive without any sugar in your diet and the average American consumes, you know, several pounds of sugar a year and it's really too much. And it does promote metabolic syndrome, weight gain, elevated triglycerides, fatty liver. So sugar also feeds tumors and women or any patient with cancer many times is advised to follow more of a high-protein, high-fat, so-called ketogenic diet and getting the sugar which feeds tumors and the simple sugar feeds that bacteria as well in your bladder. Now, some of the diabetic treatments that some people with type 2 diabetes undergo promotes sugar loss in the urine which of course increases bladder infections and yeast vaginal infections. And if you haven't heard my podcast on vulvovaginal problems, vaginal infections, care of the vulva, we have that on prior podcasts, as well as great information on how to properly care for your vulva on speakingofwomenshealthcom.
Speaker 1:So if you think you have a bladder infection, it's best to see your physician or healthcare clinician as soon as possible. You might be directed to go to the local urgent care or express care center get a urinalysis and a urine culture. Now a urinalysis is just sent to the laboratory or the nurse may assess it in the office to check for things like red blood cells, white blood cells, nitrites and leukocyte esterase, and if those are positive, that signifies some irritation, inflammation and possible infection. Now the urine culture the lab puts the urine on samples culture material to grow it to see if there's any strains of bacteria, and it's very important because they can determine based on it if there's any antibiotic resistance. So a lot of times when I see a patient and I think they have a bladder infection, I will give them a prescription and tell them after we get the culture started right away. But then I give them the caveat that within 48 hours we'll know whether that's effective or not and you may or may not have to change antibiotics.
Speaker 1:Now, sometimes very minor bladder infections can go on away on their own, but usually most need to be treated, and with all prescribed antibiotics it is important that you finish the full course and follow the directions. It's also important to know if you have true antibiotic allergies, especially if you have hives or anaphylaxis, as that can be life-threatening. Now a lot of women I see they have all these things that they don't tolerate, or maybe they had stomach upset or some minor symptom and they just don't like the medicine, but it's not a true allergy. So you really want to know what your true allergies are versus what are medicines that you just had a side effect or didn't tolerate or don't really want to be on. And it's important to keep these lists straight, as well as knowing all the medications that you're on and bringing in your prescription medicines, the bottles as well as over-the-counter supplements. It's very important and I always am so happy when I have a patient bring me in what she's taking. I'm like, yes, you get an A for today, because it is important to know what you're on today. Because it is important to know what you're on Now.
Speaker 1:Some of the more commonly used antibiotics for just a straightforward simple bladder infection include trimethoprim, sulfamethoxazole, so that's two substances together. One of the brand names is Bactrim or Bactrim DS. If you have a true sulfa allergy, you wouldn't want to take this Now. Phosphomycin, or monoyerol, is a newer bladder antibiotic, nitroferantoin, macrodantin macrobid, also known as ferandantin, which is what Dana prescribed for me is a bacteriostatic. It's not bactericidal, so sometimes it's not strong enough for more severe infections. Now, cephalexin and ceftriaxone are cephalosporins, so they're kind of similar to penicillins. Are cephalosporins, so they're kind of similar to penicillins.
Speaker 1:There is a group of antibiotics known as fluoroquinolones, like ciprofloxacin, and we now do not use these medicines for simple UTIs. I have taken cipro in the past. Levofloxacin is another one, but in general they're reserved for more serious infections, even though they're excreted in the urine and a low dose is usually pretty effective. But they do have risk and one of the risks can be tendon rupture. So that's a pretty serious complication and it takes a long time for tendons to heal. But if you have a complicated urinary tract infection or one that's traveled to your kidneys, causing pyelonephritis, your health care clinician may actually prescribe a fluoroquinoline for you.
Speaker 1:In April of 2024, last year, the United States Food and Drug Administration approved PIVIA, which is pivomicelamine, and it's a tablet for the treatment of adult females with uncomplicated bladder infections caused by susceptible isolates of E coli, proteus mirabilis, of E coli, proteus mirabilis and Staphylococcus saphylococcus. Sometimes Staphylococcus saphylococcus is a common skin bacteria. So one of the most common reasons why women are prescribed antibiotics is because of UTIs, and an uncomplicated urinary tract infection is one where there's no known structural abnormalities of the urinary tract and at least one in every two women is going to have at least one bladder infection. Some of us are more predisposed than others and we'll talk about recurrent urinary tract infections and when that needs additional evaluation. Now, one of the most common side effects of PIVYA can include nausea and diarrhea, which are not uncommon side effects with antibiotics, and you should always consult with your physician about any other side effects to any medication and to see if it's the right one for you and if your urinary culture is consistent with it. Now, what about the group of women, the special group of women who have frequent urinary tract infections or recurrent urinary tract infections? Well, sometimes, first of all, if you've got three infections documented in six months, you've bought yourself a urologic evaluation because we really want to make sure there's not a kidney stone or some anatomic abnormality with your kidney or your bladder. So you're really deserving of seeing a specialist that might be a urogynecologist or a urologist, or a urologist that specializes in female urology. Sometimes, low dose antibiotics might be prescribed for six months, or a single dose antibiotic after sexual activity if your urinary tract infections are related to sexual activity. Now I have seen women in mutually monogamous relationships with their partner and everything is fine, but they've suffered enough with post-coital bladder infections that it causes like an aversion to having sexual activity because they're so fearful of the symptoms and what's going to happen. And so whenever you pair bad physical activity or response to an activity, even if it's something that's harmless and I always tell the story about I love chocolate, I love brownies.
Speaker 1:I've actually written columns on the health benefits of chocolate. In fact, the other day my husband was kind of feeling a little bit down the dumps and he said I'm going to have a piece of chocolate and I've rarely ever heard him hear that. That seems a lot more common amongst women and he said it perked him up and there are substances that kind of perk you up. So a lot of people love chocolate, including my granddaughter Trixie. You say chocolate and that will immediately get her attention. Well, I ate a brownie, okay, and then I got sick and threw up. Who knows Could have been the flu or food poisoning. I didn't eat a brownie or want to look at a brownie for 10 years, even though in my mind, I knew that it was fine.
Speaker 1:And so when you have a painful experience like after sexual activity, because of a bladder infection or because of untreated vaginal atrophy, so-called genitourinary syndrome of menopause which is more common in women without estrogen or in women who are being treated with estrogen deprivation therapies, it can really be hard for the protective aspect of your body and brain to get over that. So that's one reason why, if you've had a bladder infection associated with sexual activity you know, more than once or twice, you really should have a conversation with your healthcare team. Now, some women are given permission to diagnose and treat themselves when the straightforward symptoms come, but you need to stay in touch with your healthcare clinician and women who've experienced simple UTIs that are not recurrent, who may be going away for a honeymoon or a vacation or an extended holiday, or a vacation or an extended holiday. In some situations, it may be appropriate, especially if you've had uncomplicated bladder infections without a complicated medical history, to have a small supply of antibiotics ready to self-treat. That being said, if you're pregnant, if you have sugar diabetes, if you have signs of sepsis, with fever chills, signs of a more serious infection, then even if you're on vacation, having the time of your life you're going to have to go seek medical assistance, because if you self-treat and you don't really know what you're treating, you can really get into difficulty, and if you're post-menopausal, you should have a discussion about whether vaginal estrogen is right for you or other treatments, including non-hormonal treatments like oral ospemafen or precursor substance like vaginal DHEA.
Speaker 1:If you're over 65, though, and you're not on systemic hormones, I think a little bit of natural estrogen to the vulva once or twice a week is really good insurance for most women. But, again, this is not medical advice. This is just information and resources to help empower you to be strong, be healthy and be in charge. So thank you for listening to this podcast on Speaking of Women's Health. Don't miss any future podcasts Hit, subscribe or follow. Wherever you listen to podcasts Apple Podcasts, spotify, tunein wherever Please give us a five-star rating. Please forward and share our podcast with your friends and family. Thanks again, and I look forward to seeing you next time in the Sunflower House.
