In order to prevent urinary tract infections, you must know the main UTI causes.
Many think that poor hygiene is the main reason for UTI, but this is far from the truth. In most cases, your hygiene habits have little to do with your chances to develop a UTI. Surprisingly, if you are a woman, the secret to a UTI-less life could be in your vagina. And if you keep experiencing persistent chronic UTIs, bacterial biofilms might be the one to blame.
To make it a little easier, I grouped UTI causes in 5 main “buckets” to help you to remember what to watch out for. Altogether, there are 26 main reasons discussed in this article but, of course, the list is still far from being complete. Since chronic and recurrent UTI is a systemic problem, many things could contribute to your UTI susceptibility but this post is a good start to examine your risk factors.
Misbalanced Vaginal Flora
Compromised vaginal flora is one of the most overlooked UTI causes. There is a very close link between loss of normal vaginal flora (particularly, Lactobacillus species) and an increased risk of contracting a UTI.
“Wait for a second,” I hear you saying, “if UTIs happen in my bladder, what does my vagina have to do with it?”.
Unfortunately, the important role of a healthy vagina in UTI prevention is not a common knowledge. The fact is E.coli bacteria (that cause 90% of all UTIs and live in your lower intestines) ascend from your anal region toward your urethra. On the way toward your urethra pathogenic bacteria pass through your vagina. If your vaginal flora is healthy, the bad guys will struggle to survive. However, if vaginal flora is compromised, E.coli bacteria will multiply and continue climbing up toward your urethra, and, eventually, the bladder.
A healthy vaginal flora consists of predominantly Lactobacillus species. Those tiny good bacteria are on your side. Every day researchers find more and more ways how these beneficial bacteria help our bodies to function and how the lack of those bacteria could lead to various misalignments.
For example, scientists speculate that:
- Lactobacillus species might help to maintain low pH of the genital area
- Produce hydrogen peroxide
- Hinder the growth of E. coli
- And also help to down-regulate inflammatory reactions caused by E. coli.
In plain words, not only good bacteria make it hard for E. coli bacteria to grow and populate your genitals, but also reduce inflammation and support healthy pH of your vagina.
However, it is easy to affect the wellbeing of your well-meaning bacteria. Those tiny warriors are kind of fragile and plenty of things can disrupt their ability to grow and protect you.
Here are are some factors that can affect your vaginal flora and therefore, could be considered risk factors for UTI.
1. Condoms with spermicide
Most popular spermicide used on condoms is Nonoxynol-9. This chemical is known to disrupt the life of your vaginal bacteria and to suppress their growth.
No wonder, many think that condoms cause UTI, while in fact, it’s the spermicide that works against you. If you can, use condoms without spermicide to avoid this UTI risk-factor.
2. Other Nonoxynol-9 contraceptives
Plenty of other contraceptive products use Nonoxynol-9 such as contraceptive film, sponges, suppositories, cremes, tablets. You want to avoid these as much as you can. If in doubt, make sure to read the label.
I used to get the yeast infection every time after using a lubricant. And no wonder, lubricants could be a contributing factor and of the UTI causes as well.
I would advise avoiding lubricants that have Glycerin or Sorbitol on their ingredient list since these tend to feed your pathogenic bacteria and yeast, in turn, suppressing the growth of the protective Lactobacilli.
Antibiotics are supposed to cure, not cause a UTI, right? That’s true, they will help you to get rid of an acute infection, but in doing so could handicap your own natural defenses.
You see, when an antibiotic is busy killing E.coli and other bad bacteria that caused your UTI, your good bacteria also suffer. As you can expect, you find yourself in a vicious cycle: you need antibiotics to fight an acute infection, but after the fight is over you vagina is no longer protected against pathogenic bacteria. That’s why ladies who suffer from recurrent UTIs could be most vulnerable to contract a UTI again within a week after an antibiotic treatment.
This factor seems to affect all aspects of our health. Whatever health problem you have, more often than not you can link some of them to stress. Not only you feel nervous, anxious but your bacteria suffer too.
Apparently, some studies show that stress decreases the number of Lactobacillus species that live and prosper in your body (as reported by Femke Lutgendorff et al. in the June 2008 issue of Current Molecular Medicine). Take a deep breath and make yourself a chamomile tea, go for a walk and count your blessings. More importantly, include special probiotics in your diet so you can lend a helping hand to your Lactobacilli population.
Apparently, your friendly bacteria are picky eaters. Also, they like healthy food and lots of fiber. Oh, and they also need a variety of fiber, so drinking lots of psyllium husk won’t be enough. Stuck up on various veggies, fruits, exclude processed food, sugars and add a nice prebiotic blend to your diet.
7. Lack of estrogen
Women don’t have it easy: periods, cramps, UTIs, babies, and menopause! Menopause frequently comes with an increased risk of UTI due to lack of estrogen that, in turn, disbalances their vaginal flora. On top of it, lack of estrogen can lead to thinning vaginal walls helps pathogenic bacteria to hide in the vaginal wall’s lining.
Of course, change in your hormones could happen at any age, but chances are higher that you’ll need estrogen supplementation once you grow wiser.
Studies show that when women are given estrogen hormones their vaginal Lactobacillus flora increased and therefore, hormonal changes could be counted as one of the important UTI causes.
Increased number of opportunistic bacteria
More than 80% of all UTIs in the world are caused by opportunistic bacteria, such as Escherichia coli bacteria (E. coli) that reside in your own gut. Therefore, we can speculate that higher E. coli concentration can lead to increased chances of contracting a UTI.
Constipation is not only unpleasant but also is a symptom of a bigger problem. The thing is, your guts, similar to your vagina, are also populated by various bacteria.
Your body needs bacteria to aid in various important functions such as the breakdown of food products into absorbable nutrients, stimulates the host immune system, prevents the growth of pathogenic bacteria and produces a great variety of biologically important compounds… E. coli bacteria, when contained in the lower gut are helpful in producing vitamin K, for example.
However, constipation could be a sign of an alteration in your microbiome. Some bacteria species reduce their activity, others continue to strive. Unfortunately, the bacteria that continue to grow are mostly the ones that could become pathogenic if they get into your urethra.
Therefore, constipation is a risk factor for UTI because it could increase the number of bad bacteria in your stool, and therefore around your anus. On top of it, constipation might also cause an internal pressure on your bladder, obstructing it and making it more difficult to empty it completely.
Bottom line, eat your veggies and exercise to prevent UTIs caused by constipation.
Unless this is your very first UTI, you must have heard million times that it is important to stay hydrated to prevent urinary tract infections. Why? Well, gone are days when scientists thought that your bladder is sterile. It is not. As everywhere else, there are dozens of various strains of bacteria in your bladder, doing whatever they need to do to keep you healthy. However, pathogenic bacteria enter your bladder from time to time as well. All those bacteria live their busy lives and multiply.
If there is no fresh urine that washes through your bladder frequently, the old urine harbors growing pathogenic bacteria and this could cause a UTI.
10. Vesicoenteric fistulae
And, in some rare cases, bacteria could be leaking from your gut straight into your bladder. This condition is known as Vesicoenteric fistulae (or enterovesical or intestinovesical fistulae). This is literally an opening between the bowel and the bladder that could happen as a result of a surgery, accident, cancer, abnormal anatomic development of an embryo. Most frequently, however, due to physiological differences, this could be observed in men rather than in women.
Inability to fully void your bladder is one of the main reasons for UTIs. As described above, when old urine remains in your bladder, it allows bacteria to grow. Anything that causes urine to stay in the bladder for a prolonged period of time can increase your chances to develop a UTI.
Evidently, anyone with an abnormality of the urinary tract that obstructs the flow of urine—a kidney stone or enlarged prostate, for example—is at risk for a UTI.
Therefore, these are five UTI causes related to bladder obstruction:
11. Spinal cord injuries or other nerve damage around the bladder
In this cases, a patient simply does not feel the urge to urinate, leaving urine in the bladder for too long.
12. Kidney and bladder stones
These are not only obstructing normal urine flow, but also damage protective bladder lining allowing for pathogenic bacteria to hide and prosper, causing recurrent UTIs. On top of that, bacteria are able to create their own colonies on the surface of the stones, called biofilms that are often impossible to irradicate with antibiotics.
13. Anatomic abnormalities
Some folks are born with a deformity that could actually make urine to flow backward (aka Vesicoureteral reflux (VUR). If your small kid is diagnosed with recurrent UTIs, the doctors would most likely check with ultrasound equipment if his kidneys function well.
14. Bladder and urethra scarring, blood clots
The more infections you experience, the higher are your chances to develop bladder lining abnormalities. Anything but perfectly healthy bladder lining could be a cause for recurring UTIs.
15. Enlarged prostate
This is the only factor that is unique to guys. The prostate is located in a close proximity to the urethra and if enlarged could make it hard or even impossible to pee. If you can’t pee out your old urine, you are just asking for trouble. Moreover, if the prostate is infected by E.coli bacteria they can eventually reach your bladder and cause a bloodborne UTI.
16. Weak bladder muscles
In this case, a patient can’t squeeze his or her bladder muscles strong enough to empty the bladder completely, constantly leaving old urine in the bladder. This as you know by now, could cause a UTI.
Decreased number of good bacteria in your bladder is one of the reasons bad bacteria can grow faster. As we discussed earlier, your bladder is not sterile. Certain microbes, including beneficial ones, exist in the healthy human bladder.
Multiple factors including diet and even your blood type can affect your bladder flora making it more or less prone to urinary tract infections.
These factors include:
17. Certain diseases (for example, diabetes)
If you have diabetes, you are twice as likely to contract a urinary tract infection (UTI). Extra glucose in your urine drives changes in your bladder flora making you more prone to UTIs.
Certain types of surgeries, for example, TransVaginal Mesh can be a risk factor for UTI. Any bladder surgery messes up your natural bladder microbiome and could potentially result in a UTI.
19. Use of instrumentation and catheters
Catheters are a known culprit of UTIs. Think of it as a bridge and also a hiding place for pathogenic bacteria in your bladder.
Similar to how antibiotics affect your vaginal microbiome, they influence the bacterial composition of your bladder as well.
21. Bacterial Biofilms
One could argue, bacterial biofilms in the bladder are the number one reason for chronic recurrent urinary tract infections. These are bacterial colonies that attach themselves to the bladder surface and produce protective slime to avoid antibiotics and immune system defenses. Pathogenic bacteria under the slime is often dormant during the treatment but wake up and grow after the treatment is over. If you notice that your symptoms subside during antibiotic treatment, but a week or two later you have an infection again, this could be due to bacterial biofilms.
Activities that transfer bacteria
Your hygiene routines can pose greater UTI risk, in some cases. I’m sure, if you are an adult, you are wiping from front to back. Should we even talk about it? Nonetheless, if you ever go to a physician’s office you are destined to hear it again.
Besides wiping, there are other activities that can help your E. coli bacteria to “get a lift” from your anus towards your urethra and will increase the chances of contracting a UTI.
22. Bad hygiene
Take your shower, do not sleep in the same underwear that you wear all day. Oh, and, of course, wipe from front to back.
If your vaginal flora is compromised, E. coli can grow in your vagina. Next time when you have sex, they’ll get much closer to your urethra, greatly increasing your chances of a UTI. Sex on its own doesn’t cause a UTI, but it’s a major risk factor if your vaginal flora is compromised.
A narrow piece of material will pick up more bacteria and then slide back and forth while you move. While studies did not find conclusive evidence, many doctors recommend to opt out for simple cotton panties instead of thongs.
25. Feminine menstrual products
Just remember to change them regularly or they could become a breeding ground for pathogenic bacteria. Blood is alkaline but and your Lactobacilli prefer an acidic environment. So do not put too much stress on your vaginal flora and change pads and tampons as frequently as possible.
26. Anal sex
On its own, anal sex or finger anal play would not cause a UTI. However, as you know, E.coli live in your lower intestines and these activities bring the bacteria from inside to the surface of your anal region. To be safe, use a condom and discard it right away. Do not use the same condom for vaginal penetration.
Am I missing anything? Leave me a comment below and share your thoughts.
Next: read how to Prevent UTI: Myths and Facts
- The female urinary microbiota, urinary health, and common urinary disorders
- Probiotic therapy: an immunomodulating approach toward urinary tract infection.
- Urinary Tract Infection in Postmenopausal Women