June 4, 2025 • 35 mins
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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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
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, andI'm back in the Sunflower House
for a new podcast, and on thisnew podcast I will begin to talk
(00:25):
about a common problem thatafflicts especially women, and
that's urinary tract infections.
And one of the reasons why itaffects women so much more than
men is because the urethra inwomen is much smaller, whereas
the urethra in males is muchlonger.
(00:48):
So we all normally havebacteria on our skin, but the
bladder and the urine is asterile environment, and if that
bacteria crawls up into thebladder it can become an
infection.
And it's very common in women,and it becomes increasingly more
(01:12):
common with age, especially ifthere's low estrogen status,
which, of course, is what I'vespent my career focusing on is
the ovaries, ovarian aging andestrogen and the effects of
estrogen throughout the entirebody.
And it also has some links tosexual activity, because even
(01:35):
regular sexual activity involvescontact with the vulva, which
can predispose people to bladderinfections, which can
predispose people to bladderinfections, and approximately
one half of all women experienceat least one UTI in their
lifetime.
Now, my last bladder infection,I'm embarrassed to say, was
(01:58):
right before I saw our wonderfulcenter nurse practitioner, dana
Leslie, who will be on againthis season, and I was seeing
her for a routine exam and I wasjust overly scrubbing and
washing myself, which you shouldnot do prior to your
gynecologic exam.
First of all, the vagina isself-cleansing and you only want
(02:18):
to use very mild soap, if soapat all, on the vulva and keep it
away from the urethra.
And the symptoms of urinarytract infection can begin with
severe burning on urination,increased frequency and
sometimes even blood in theurine.
(02:39):
In fact, this was the last timethat 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 makesure it's not coming from the
vagina or the vulva.
And sometimes this infectioncan spread and go into the
kidneys, which can cause backpain or a systemic infection
(03:02):
called pyelonephritis.
So most all of the infectionsusually begin in the urethra,
which is that little tube thattakes the urine from the bladder
to the outside, and the theoryis that because the opening of
the urethra is in such closeproximity to the vagina and the
(03:24):
perianal area area that it's notdifficult for bacteria to
travel up and establish aninfection and these facts do
account for the higher rate ofbladder infections compared to
men.
But certainly men can getprostatitis.
(03:46):
Men can have bladder infectionsafter instrumentation, prostate
surgery, bladder cathetersbeing placed.
Now menopausal andpostmenopausal women appear to
have a somewhat increased riskof UTIs because when there's
lack of estrogen and DHEA andsex hormones in the body, if
(04:08):
it's not treated, can lead to athinning of that whole
vulvovaginal tissue, the entireurethra and the trigone or the
base of the bladder, and whenthe skin is more delicate and
sensitive, it's a lot morelikely to get infections.
Now postmenopausal women mayexperience bladder or uterine
(04:32):
prolapse, particularly ifthere's a family history of it,
if there's been childbearing,obesity, constipation, lots of
pressure on the abdomen or thebladder, and if the bladder does
not totally empty urine, it's alot more conducive to bacterial
overgrowth.
(04:53):
One of the simple tests that wedo in the office is a little
ultrasound test where we havethe woman go and empty her
bladder.
A lot of times we want what'scalled a clean catch urine
culture, meaning the woman wipesthe vulva you always wipe from
front to back, urinates a littlebit, that opens the sterile cup
and then urinates the mid partof the stream and then, without
(05:16):
touching inside, closes it, sitsit down, then sits down and
completely empties the bladderand just relaxes, sits down and
completely empties the bladderand just relaxes.
And then we do a littleultrasound scan over the bladder
area and we can measure howmany cc's are left in the urine
in the bladder and it's reallyvery good when there's zero, but
we want at least two-thirds ofthe bladder empty.
(05:38):
Sometimes women are anxious orthey're not relaxed and we have
them do a second void, orthey're not relaxed and we have
them do a second void.
But when there is urinaryretention because of urethral
stricture or prior surgery orradiation or in men who've had
prostate procedures, thatoverexpansion of the bladder and
(05:59):
all that urine there is kind oflike a breeding ground for
bacteria.
The other thing that can affectpostmenopausal women is when you
lose estrogen, you lose theglycogen in the cells and you
lose the support for healthybacteria, the lactobacillus,
(06:20):
which keeps the vagina acidicand helps keep the bad bacteria
and the yeast away.
And I always tell women thatwhen we start to treat their
significant vaginal thinning,usually I recommend a moratorium
on any pelvic contactexaminations, speculums, tampons
(06:41):
, dildos, sexual activity untilthe tissue is healed, which
takes at least four to six weeks.
Now, using systemic hormoneswith the local estrogen improves
that and a lot of my patients Ifind out stop their local
treatment because, oh, I'm notsexually active anymore.
And I tell them we don't carewhat you do with your vagina, we
(07:05):
just want it healthy andeveryone needs a healthy bladder
and it's not uncommon for womenover 65 to get a bladder
infection that turns tourosepsis and then causes death.
I recently had a longtimepatient, who usually listens to
most of what I say, who stoppedher vaginal estrogen because she
had a couple of girlfriends whowere diagnosed with cancer.
(07:27):
And of course I admonished herthat vaginal estrogen does not
increase the risk of breastcancer and that by stopping the
vaginal estrogen it's not justabout dryness or using a
lubricant.
You want that integrity of thetissue to be healthy.
And she said well, I never hada bladder infection.
I'm like that's terrific, butyou don't want your first
(07:47):
bladder infection to be yourlast bladder infection, ie
because it knocked you off thisearth.
So it is really serious Now.
Sometimes the terms UTI, bladderinfection and kidney infection
are used interchangeably, butthere's really a big difference.
Urinary tract infections canaffect any part of the urinary
(08:12):
tract, including the urethra,and the ureters connect the
kidneys to the bladder or thebladder or the kidneys
themselves, and your kidney isjust a powerhouse of cleaning
your blood and, over a lifetime,has a lot of work to do.
(08:33):
So you really want to protectyour kidneys and the kidney
tissue cannot regenerate if it'sscarred, whereas the liver,
which is another powerhouse andI've done podcasts on the liver
and fatty liver and coffee, teaor me, because coffee and tea
are beneficial to your liver andthere's lots of things
metabolically you can do toreduce your risk of fatty liver,
(08:56):
which is really at an epidemicand can lead to scarring and
cirrhosis.
But the kidney doesn't havethat ability and a plain bladder
infection like I had justaffects the bladder and it was
very painful initially.
I kept running to the bathroom,didn't know if I was going to
(09:17):
be able to finish seeing mypatients that day which I was
able to, thankfully, because Iwork in a hospital and I saw my
clinician.
I was able to get the culturewith my lovely nurse, beth, who
just ran it right away, and getthe prescription for an
antibiotic and start it withinan hour of my symptoms.
That's pretty unusual and thatwas just lucky because I
(09:41):
developed it like right as I washeading into work and to my
appointment.
Now, bacteria when it involvesother parts of this urinary
tract and infects the kidneys.
It's much more serious to havean upper urinary tract infection
as opposed to just a lower oneurinary tract infection as
(10:07):
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 makeyou feel sick, give you a fever
or chills, cause pain in thearea of your kidneys which is
usually the mid back, mid-backNow.
Signs and symptoms include, asI mentioned, pain or burning
(10:28):
called dysuria.
Frequent urination because yourbladder is irritated and it's
trying to pee out that bacteriaand you can still have that urge
to urinate even if there's nourine in the bladder.
(10:49):
There can be pelvic pain orpain in the abdomen.
You can see gross blood to thenaked eye, like I did, or it can
just be microscopic when thenurse does the dip and looks at
it.
There can be fever or chills,confusion, especially an older
person.
Sometimes the only sign of abladder infection is a change in
mental status no fever orcomplaints of pain.
So if you have any elderlyrelatives who just seem a little
(11:11):
off, whether they're a male orfemale, they should always be
checked for a bladder infection.
And the same thing in newbornsand young babies.
They may not exhibit or theyobviously can't communicate to
you that they're having pain.
It just may be a change intheir status.
Now, once your periods stop,even if you feel great, even if
(11:33):
you don't have hot flashes,you've got to assess both your
bone status and we've had lotsand lots of podcasts on
osteoporosis.
May is osteoporosis month, sofor the last two seasons we've
had a lot of information on thebone.
(11:53):
And the other thing that has tobe assessed is the
genitourinary system, becausemost women will have changes if
they're not treated, and thegood news is local treatment is
very effective.
And the other good news forwomen over 65 is vaginal
estrogen.
In that large study thattraversed over a period of 13
(12:17):
years and studied 11 millionAmerican women.
Go back and listen to Octoberof 2024's podcast on that
research.
That's one of my favoritepodcasts because it covers so
much information and so muchdata and it showed that the
women who had the lowest risk ofdeath were women on vaginal
estrogen.
(12:40):
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'renot sexually active or you're
somehow not bothered by it, it'sstill really put you at an
increased risk of bladderinfections.
So there's a lot of things thatyou can do to reduce your risk
(13:02):
of bladder infections, and youhave been listening to the
Speaking of Women's Healthpodcast I am your host, dr Holly
Thacker, in the Sunflower House, talking all things urinary
tract infections.
So we're now going to focus onhow can you reduce the risk of
(13:24):
bladder infections.
Well, one important thing is todrink plenty of good old H2O
water.
You want to regularly flushbacteria that might be starting
to crawl up the urethra and trynot to hold your urine.
You know I talk to and see alot of school teachers and they
talk about their long hoursteaching and how sometimes they
(13:46):
can't leave their classroom togo to the bathroom and there has
to be some sort of plan to beable to empty your bladder in
four hours or six hours or ifyou have that need.
You should always wipe fromfront to back and not be too
rough with either.
Your toilet paper should besoft.
It should not be rough.
(14:07):
I've had some women tell methat they're in a restroom and
there's no Kleenex or toiletpaper, so they get the really
harsh hand towels and just bywiping themselves with something
rough, that alone is enough tostimulate and change the
bacterial flora bacterial flora.
(14:27):
It's important to urinate beforeand after any vulvar
manipulation.
So that of course includessexual activity and it also
includes pelvic exam.
So before you go in to see yourgynecologist or women's health
nurse practitioner or physicianassistant and you know you're
(14:47):
going to get an exam, you shouldalways empty your bladder.
Okay, empty your bladder beforethe exam, before you get
undressed, and then you want todrink enough fluid and empty
your bladder afterwards.
That really makes a bigdifference.
You have to avoid vaginalhygiene sprays and douching.
(15:09):
It's not recommended.
It can affect the bacterialflora and if you are a
menstruating woman having aperiod, you have to regularly
change your pads and tampons.
That's very important.
It's also important to wearloose-fitting clothes and 100%
cotton crotch underwear.
(15:29):
Tight, ill-fitting clothingcreates a moist, damp
environment which promotesbacterial growth and in women's
health.
We're not fans of thongunderwear because that thin
string is like anal floss andcan push bacteria up to your
urethra where you don't want it.
(15:52):
Now, supplements that might helpbladder infections, and I
always keep my trusty cranberryextract because cranberries do
seem to inhibit E coli'sabsorption onto the urethral
mucosa.
And I didn't think to take anycranberry extract that morning
(16:14):
of my exam because I wasn'thaving any symptoms and I don't
necessarily want to drink fullcranberry juice with all that
sugar.
I'm not someone who reallylikes to drink my calories and
so getting the extract is a veryhigh concentration.
Now, anytime that you're takinga cranberry extract or any
(16:35):
supplement that's over thecounter, you really want to look
on the bottle for the lotnumber and expiration, because
that does imply some qualitycontrols, because if it's not a
food or it's not a drug, itisn't regulated.
So it is.
Buyer beware.
And just because something'snot a prescription doesn't mean
it can't interfere with otherprescription medicines or lab
(16:57):
tests.
If you didn't listen to thepodcast on biotin biotin's B7,
that interferes with a lot ofblood tests and ideally you
should be off it for three daysbefore getting blood work and
you should tell anyone,especially if you're in the
emergency room, if you've beenon high-dose biotin and they're
(17:19):
drawing cardiac or hormonalblood work on you.
Another supplement that Ifrequently recommend to women
sometimes in combination withthe cranberry extract, sometimes
separately is D-mannose.
It's a simple sugar that'sfound in fruits and it is used
to help prevent and treat UTIs.
(17:40):
The supplement dosage is basedon whether or not you have a
bladder infection or you'retrying to prevent it.
So to prevent a urinary tractinfection, you should take 500
milligrams of D-mannose threetimes a day, but if you're
experiencing a bladder infection, you need to take one gram
(18:04):
three times a day.
What foods might you want toavoid?
Well, certain foods cancontribute to urinary frequency,
urgency and discomfort, likewhen I first had my urinary
discomfort, I thought maybe itwas because I had some coffee
and some green tea in themorning, because caffeine can
(18:26):
irritate the bladder.
There are a list of foods thatyou can find on our Speaking
Women's Health site that areknown to be bladder irritants.
It doesn't mean that you haveto always avoid those foods, but
sometimes women find incombination, if they're eating
multiple types of these foods ortaking B-complex vitamins,
(18:47):
which are water soluble excretedin the urine, that can change
the urine a darker yellow colorand cause irritation.
Some women will actually do anelimination and then add back
every seven to 10 days thepossible offending substance and
(19:08):
then, if they can identify whatthe irritant is, they can
identify it and either avoid itor drink a lot more water and
have other foods at the sametime.
And there are acidic foods thatsometimes irritate the bladder
and should be avoided if you'reprone to urinary tract
(19:29):
infections, like alcoholbeverages.
There's lots of reasons toavoid alcohol and certainly
avoiding regular alcohol ingeneral is a healthy thing to do
.
Apples and apple juice,cantaloupe and some women
carbonated beverages can beirritating to the bladder or
(19:50):
stomach.
Chili and spicy foods don'tjust affect heartburn but can
the bladder.
Chocolate, which is a goodsource of iron and magnesium and
does have caffeine, and in somepeople irritates them.
Caffeine and in some peopleirritates them along with citrus
(20:12):
fruits.
Coffee, also the decaffeinatedbrands.
Ironically, cranberry andcranberry juice can be
irritating to some women'sbladder, even though it does
inhibit E coli.
Now there's other bacteria thatcan cause bladder infections.
I was happy in my case when Igot the result I had just simple
E coli UTI and the blood allcleared up and that you have to
(20:33):
go back and be rechecked to makesure that you're not bleeding
from something else wrong in thebladder.
Grapes are another bladderirritant Guava, peaches,
pineapples, plums, strawberries,which have a very high
histamine content, tea, sugarand tomatoes those are the big
(20:59):
ones.
Vinegar and B-complex vitamins.
Now, not all women say thatsugar bothers their bladder, but
there is a definite group ofwomen and you can be healthy and
survive without any sugar inyour diet and the average
American consumes, you know,several pounds of sugar a year
(21:19):
and it's really too much.
And it does promote metabolicsyndrome, weight gain, elevated
triglycerides, fatty liver.
So sugar also feeds tumors andwomen or any patient with cancer
many times is advised to followmore of a high-protein,
(21:42):
high-fat, so-called ketogenicdiet and getting the sugar which
feeds tumors and the simplesugar feeds that bacteria as
well in your bladder.
Now, some of the diabetictreatments that some people with
type 2 diabetes undergopromotes sugar loss in the urine
(22:03):
which of course increasesbladder infections and yeast
vaginal infections.
And if you haven't heard mypodcast on vulvovaginal problems
, vaginal infections, care ofthe vulva, we have that on prior
podcasts, as well as greatinformation on how to properly
(22:24):
care for your vulva onspeakingofwomenshealthcom.
So if you think you have abladder infection, it's best to
see your physician or healthcareclinician as soon as possible.
You might be directed to go tothe local urgent care or express
care center get a urinalysisand a urine culture.
(22:46):
Now a urinalysis is just sentto the laboratory or the nurse
may assess it in the office tocheck for things like red blood
cells, white blood cells,nitrites and leukocyte esterase,
and if those are positive, thatsignifies some irritation,
(23:07):
inflammation and possibleinfection.
Now the urine culture the labputs the urine on samples
culture material to grow it tosee if there's any strains of
bacteria, and it's veryimportant because they can
determine based on it if there'sany antibiotic resistance.
(23:28):
So a lot of times when I see apatient and I think they have a
bladder infection, I will givethem a prescription and tell
them after we get the culturestarted right away.
But then I give them the caveatthat within 48 hours we'll know
whether that's effective or notand you may or may not have to
change antibiotics.
Now, sometimes very minorbladder infections can go on
(23:51):
away on their own, but usuallymost need to be treated, and
with all prescribed antibioticsit is important that you finish
the full course and follow thedirections.
It's also important to know ifyou have true antibiotic
allergies, especially if youhave hives or anaphylaxis, as
(24:14):
that can be life-threatening.
Now a lot of women I see theyhave all these things that they
don't tolerate, or maybe theyhad stomach upset or some minor
symptom and they just don't likethe medicine, but it's not a
true allergy.
So you really want to know whatyour true allergies are versus
(24:35):
what are medicines that you justhad a side effect or didn't
tolerate or don't really want tobe on.
And it's important to keepthese lists straight, as well as
knowing all the medicationsthat you're on and bringing in
your prescription medicines, thebottles as well as
over-the-counter supplements.
It's very important and Ialways am so happy when I have a
(24:59):
patient bring me in what she'staking.
I'm like, yes, you get an A fortoday, because it is important
to know what you're on today.
Because it is important to knowwhat you're on Now.
Some of the more commonly usedantibiotics for just a
straightforward simple bladderinfection include trimethoprim,
sulfamethoxazole, so that's twosubstances together.
(25:20):
One of the brand names isBactrim or Bactrim DS.
If you have a true sulfaallergy, you wouldn't want to
take this Now.
Phosphomycin, or monoyerol, isa newer bladder antibiotic,
nitroferantoin, macrodantinmacrobid, also known as
(25:44):
ferandantin, which is what Danaprescribed for me is a
bacteriostatic.
It's not bactericidal, sosometimes it's not strong enough
for more severe infections.
Now, cephalexin and ceftriaxoneare cephalosporins, so they're
(26:05):
kind of similar to penicillins.
Are cephalosporins, so they'rekind of similar to penicillins.
There is a group of antibioticsknown as fluoroquinolones, like
ciprofloxacin, and we now do notuse these medicines for simple
UTIs.
I have taken cipro in the past.
Levofloxacin is another one,but in general they're reserved
(26:30):
for more serious infections,even though they're excreted in
the urine and a low dose isusually pretty effective.
But they do have risk and oneof the risks can be tendon
rupture.
So that's a pretty seriouscomplication and it takes a long
time for tendons to heal.
(26:51):
But if you have a complicatedurinary tract infection or one
that's traveled to your kidneys,causing pyelonephritis, your
health care clinician mayactually prescribe a
fluoroquinoline for you.
In April of 2024, last year, theUnited States Food and Drug
(27:12):
Administration approved PIVIA,which is pivomicelamine, and
it's a tablet for the treatmentof adult females with
uncomplicated bladder infectionscaused by susceptible isolates
of E coli, proteus mirabilis, ofE coli, proteus mirabilis and
(27:37):
Staphylococcus saphylococcus.
Sometimes Staphylococcussaphylococcus is a common skin
bacteria.
So one of the most commonreasons why women are prescribed
antibiotics is because of UTIs,and an uncomplicated urinary
tract infection is one wherethere's no known structural
(27:57):
abnormalities of the urinarytract and at least one in every
two women is going to have atleast one bladder infection.
Some of us are more predisposedthan others and we'll talk
about recurrent urinary tractinfections and when that needs
additional evaluation.
(28:18):
Now, one of the most commonside effects of PIVYA can
include nausea and diarrhea,which are not uncommon side
effects with antibiotics, andyou should always consult with
your physician about any otherside effects to any medication
and to see if it's the right onefor you and if your urinary
(28:41):
culture is consistent with it.
Now, what about the group ofwomen, the special group of
women who have frequent urinarytract infections or recurrent
urinary tract infections?
Well, sometimes, first of all,if you've got three infections
(29:03):
documented in six months, you'vebought yourself a urologic
evaluation because we reallywant to make sure there's not a
kidney stone or some anatomicabnormality with your kidney or
your bladder.
So you're really deserving ofseeing a specialist that might
be a urogynecologist or aurologist, or a urologist that
(29:27):
specializes in female urology.
Sometimes, low dose antibioticsmight be prescribed for six
months, or a single doseantibiotic after sexual activity
if your urinary tractinfections are related to sexual
activity.
Now I have seen women inmutually monogamous
(29:50):
relationships with their partnerand everything is fine, but
they've suffered enough withpost-coital bladder infections
that it causes like an aversionto having sexual activity
because they're so fearful ofthe symptoms and what's going to
happen.
And so whenever you pair badphysical activity or response to
(30:15):
an activity, even if it'ssomething that's harmless and I
always tell the story about Ilove chocolate, I love brownies.
I've actually written columns onthe health benefits of
chocolate.
In fact, the other day myhusband was kind of feeling a
little bit down the dumps and hesaid I'm going to have a piece
of chocolate and I've rarelyever heard him hear that.
(30:35):
That seems a lot more commonamongst women and he said it
perked him up and there aresubstances that kind of perk you
up.
So a lot of people lovechocolate, including my
granddaughter Trixie.
You say chocolate and that willimmediately get her attention.
Well, I ate a brownie, okay,and then I got sick and threw up
.
Who knows Could have been theflu or food poisoning.
(30:58):
I didn't eat a brownie or wantto look at a brownie for 10
years, even though in my mind, Iknew that it was fine.
And so when you have a painfulexperience like after sexual
activity, because of a bladderinfection or because of
untreated vaginal atrophy,so-called genitourinary syndrome
(31:18):
of menopause which is morecommon in women without estrogen
or in women who are beingtreated with estrogen
deprivation therapies, it canreally be hard for the
protective aspect of your bodyand brain to get over that.
So that's one reason why, ifyou've had a bladder infection
associated with sexual activityyou know, more than once or
(31:41):
twice, you really should have aconversation with your
healthcare team.
Now, some women are givenpermission to diagnose and treat
themselves when thestraightforward symptoms come,
but you need to stay in touchwith your healthcare clinician
and women who've experiencedsimple UTIs that are not
(32:04):
recurrent, who may be going awayfor a honeymoon or a vacation
or an extended holiday, or avacation or an extended holiday.
In some situations, it may beappropriate, especially if
you've had uncomplicated bladderinfections without a
complicated medical history, tohave a small supply of
(32:25):
antibiotics ready to self-treat.
That being said, if you'repregnant, if you have sugar
diabetes, if you have signs ofsepsis, with fever chills, signs
of a more serious infection,then even if you're on vacation,
having the time of your lifeyou're going to have to go seek
(32:46):
medical assistance, because ifyou self-treat and you don't
really know what you're treating, you can really get into
difficulty, and if you'repost-menopausal, you should have
a discussion about whethervaginal estrogen is right for
you or other treatments,including non-hormonal
(33:07):
treatments like oral ospemafenor precursor substance like
vaginal DHEA.
If you're over 65, though, andyou're not on systemic hormones,
I think a little bit of naturalestrogen to the vulva once or
twice a week is really goodinsurance for most women.
But, again, this is not medicaladvice.
(33:31):
This is just information andresources to help empower you to
be strong, be healthy and be incharge.
So thank you for listening tothis podcast on Speaking of
Women's Health.
Don't miss any future podcastsHit, subscribe or follow.
(33:55):
Wherever you listen to podcastsApple Podcasts, spotify, tunein
wherever Please give us afive-star rating.
Please forward and share ourpodcast with your friends and
family.
Thanks again, and I lookforward to seeing you next time
(34:15):
in the Sunflower House.
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, andI'm back in the Sunflower House
for a new podcast, and on thisnew podcast I will begin to talk
(00:25):
about a common problem thatafflicts especially women, and
that's urinary tract infections.
And one of the reasons why itaffects women so much more than
men is because the urethra inwomen is much smaller, whereas
the urethra in males is muchlonger.
(00:48):
So we all normally havebacteria on our skin, but the
bladder and the urine is asterile environment, and if that
bacteria crawls up into thebladder it can become an
infection.
And it's very common in women,and it becomes increasingly more
(01:12):
common with age, especially ifthere's low estrogen status,
which, of course, is what I'vespent my career focusing on is
the ovaries, ovarian aging andestrogen and the effects of
estrogen throughout the entirebody.
And it also has some links tosexual activity, because even
(01:35):
regular sexual activity involvescontact with the vulva, which
can predispose people to bladderinfections, which can
predispose people to bladderinfections, and approximately
one half of all women experienceat least one UTI in their
lifetime.
Now, my last bladder infection,I'm embarrassed to say, was
(01:58):
right before I saw our wonderfulcenter nurse practitioner, dana
Leslie, who will be on againthis season, and I was seeing
her for a routine exam and I wasjust overly scrubbing and
washing myself, which you shouldnot do prior to your
gynecologic exam.
First of all, the vagina isself-cleansing and you only want
(02:18):
to use very mild soap, if soapat all, on the vulva and keep it
away from the urethra.
And the symptoms of urinarytract infection can begin with
severe burning on urination,increased frequency and
sometimes even blood in theurine.
(02:39):
In fact, this was the last timethat 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 makesure it's not coming from the
vagina or the vulva.
And sometimes this infectioncan spread and go into the
kidneys, which can cause backpain or a systemic infection
(03:02):
called pyelonephritis.
So most all of the infectionsusually begin in the urethra,
which is that little tube thattakes the urine from the bladder
to the outside, and the theoryis that because the opening of
the urethra is in such closeproximity to the vagina and the
(03:24):
perianal area area that it's notdifficult for bacteria to
travel up and establish aninfection and these facts do
account for the higher rate ofbladder infections compared to
men.
But certainly men can getprostatitis.
(03:46):
Men can have bladder infectionsafter instrumentation, prostate
surgery, bladder cathetersbeing placed.
Now menopausal andpostmenopausal women appear to
have a somewhat increased riskof UTIs because when there's
lack of estrogen and DHEA andsex hormones in the body, if
(04:08):
it's not treated, can lead to athinning of that whole
vulvovaginal tissue, the entireurethra and the trigone or the
base of the bladder, and whenthe skin is more delicate and
sensitive, it's a lot morelikely to get infections.
Now postmenopausal women mayexperience bladder or uterine
(04:32):
prolapse, particularly ifthere's a family history of it,
if there's been childbearing,obesity, constipation, lots of
pressure on the abdomen or thebladder, and if the bladder does
not totally empty urine, it's alot more conducive to bacterial
overgrowth.
(04:53):
One of the simple tests that wedo in the office is a little
ultrasound test where we havethe woman go and empty her
bladder.
A lot of times we want what'scalled a clean catch urine
culture, meaning the woman wipesthe vulva you always wipe from
front to back, urinates a littlebit, that opens the sterile cup
and then urinates the mid partof the stream and then, without
(05:16):
touching inside, closes it, sitsit down, then sits down and
completely empties the bladderand just relaxes, sits down and
completely empties the bladderand just relaxes.
And then we do a littleultrasound scan over the bladder
area and we can measure howmany cc's are left in the urine
in the bladder and it's reallyvery good when there's zero, but
we want at least two-thirds ofthe bladder empty.
(05:38):
Sometimes women are anxious orthey're not relaxed and we have
them do a second void, orthey're not relaxed and we have
them do a second void.
But when there is urinaryretention because of urethral
stricture or prior surgery orradiation or in men who've had
prostate procedures, thatoverexpansion of the bladder and
(05:59):
all that urine there is kind oflike a breeding ground for
bacteria.
The other thing that can affectpostmenopausal women is when you
lose estrogen, you lose theglycogen in the cells and you
lose the support for healthybacteria, the lactobacillus,
(06:20):
which keeps the vagina acidicand helps keep the bad bacteria
and the yeast away.
And I always tell women thatwhen we start to treat their
significant vaginal thinning,usually I recommend a moratorium
on any pelvic contactexaminations, speculums, tampons
(06:41):
, dildos, sexual activity untilthe tissue is healed, which
takes at least four to six weeks.
Now, using systemic hormoneswith the local estrogen improves
that and a lot of my patients Ifind out stop their local
treatment because, oh, I'm notsexually active anymore.
And I tell them we don't carewhat you do with your vagina, we
(07:05):
just want it healthy andeveryone needs a healthy bladder
and it's not uncommon for womenover 65 to get a bladder
infection that turns tourosepsis and then causes death.
I recently had a longtimepatient, who usually listens to
most of what I say, who stoppedher vaginal estrogen because she
had a couple of girlfriends whowere diagnosed with cancer.
(07:27):
And of course I admonished herthat vaginal estrogen does not
increase the risk of breastcancer and that by stopping the
vaginal estrogen it's not justabout dryness or using a
lubricant.
You want that integrity of thetissue to be healthy.
And she said well, I never hada bladder infection.
I'm like that's terrific, butyou don't want your first
(07:47):
bladder infection to be yourlast bladder infection, ie
because it knocked you off thisearth.
So it is really serious Now.
Sometimes the terms UTI, bladderinfection and kidney infection
are used interchangeably, butthere's really a big difference.
Urinary tract infections canaffect any part of the urinary
(08:12):
tract, including the urethra,and the ureters connect the
kidneys to the bladder or thebladder or the kidneys
themselves, and your kidney isjust a powerhouse of cleaning
your blood and, over a lifetime,has a lot of work to do.
(08:33):
So you really want to protectyour kidneys and the kidney
tissue cannot regenerate if it'sscarred, whereas the liver,
which is another powerhouse andI've done podcasts on the liver
and fatty liver and coffee, teaor me, because coffee and tea
are beneficial to your liver andthere's lots of things
metabolically you can do toreduce your risk of fatty liver,
(08:56):
which is really at an epidemicand can lead to scarring and
cirrhosis.
But the kidney doesn't havethat ability and a plain bladder
infection like I had justaffects the bladder and it was
very painful initially.
I kept running to the bathroom,didn't know if I was going to
(09:17):
be able to finish seeing mypatients that day which I was
able to, thankfully, because Iwork in a hospital and I saw my
clinician.
I was able to get the culturewith my lovely nurse, beth, who
just ran it right away, and getthe prescription for an
antibiotic and start it withinan hour of my symptoms.
That's pretty unusual and thatwas just lucky because I
(09:41):
developed it like right as I washeading into work and to my
appointment.
Now, bacteria when it involvesother parts of this urinary
tract and infects the kidneys.
It's much more serious to havean upper urinary tract infection
as opposed to just a lower oneurinary tract infection as
(10:07):
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 makeyou feel sick, give you a fever
or chills, cause pain in thearea of your kidneys which is
usually the mid back, mid-backNow.
Signs and symptoms include, asI mentioned, pain or burning
(10:28):
called dysuria.
Frequent urination because yourbladder is irritated and it's
trying to pee out that bacteriaand you can still have that urge
to urinate even if there's nourine in the bladder.
(10:49):
There can be pelvic pain orpain in the abdomen.
You can see gross blood to thenaked eye, like I did, or it can
just be microscopic when thenurse does the dip and looks at
it.
There can be fever or chills,confusion, especially an older
person.
Sometimes the only sign of abladder infection is a change in
mental status no fever orcomplaints of pain.
So if you have any elderlyrelatives who just seem a little
(11:11):
off, whether they're a male orfemale, they should always be
checked for a bladder infection.
And the same thing in newbornsand young babies.
They may not exhibit or theyobviously can't communicate to
you that they're having pain.
It just may be a change intheir status.
Now, once your periods stop,even if you feel great, even if
(11:33):
you don't have hot flashes,you've got to assess both your
bone status and we've had lotsand lots of podcasts on
osteoporosis.
May is osteoporosis month, sofor the last two seasons we've
had a lot of information on thebone.
(11:53):
And the other thing that has tobe assessed is the
genitourinary system, becausemost women will have changes if
they're not treated, and thegood news is local treatment is
very effective.
And the other good news forwomen over 65 is vaginal
estrogen.
In that large study thattraversed over a period of 13
(12:17):
years and studied 11 millionAmerican women.
Go back and listen to Octoberof 2024's podcast on that
research.
That's one of my favoritepodcasts because it covers so
much information and so muchdata and it showed that the
women who had the lowest risk ofdeath were women on vaginal
estrogen.
(12:40):
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'renot sexually active or you're
somehow not bothered by it, it'sstill really put you at an
increased risk of bladderinfections.
So there's a lot of things thatyou can do to reduce your risk
(13:02):
of bladder infections, and youhave been listening to the
Speaking of Women's Healthpodcast I am your host, dr Holly
Thacker, in the Sunflower House, talking all things urinary
tract infections.
So we're now going to focus onhow can you reduce the risk of
(13:24):
bladder infections.
Well, one important thing is todrink plenty of good old H2O
water.
You want to regularly flushbacteria that might be starting
to crawl up the urethra and trynot to hold your urine.
You know I talk to and see alot of school teachers and they
talk about their long hoursteaching and how sometimes they
(13:46):
can't leave their classroom togo to the bathroom and there has
to be some sort of plan to beable to empty your bladder in
four hours or six hours or ifyou have that need.
You should always wipe fromfront to back and not be too
rough with either.
Your toilet paper should besoft.
It should not be rough.
(14:07):
I've had some women tell methat they're in a restroom and
there's no Kleenex or toiletpaper, so they get the really
harsh hand towels and just bywiping themselves with something
rough, that alone is enough tostimulate and change the
bacterial flora bacterial flora.
(14:27):
It's important to urinate beforeand after any vulvar
manipulation.
So that of course includessexual activity and it also
includes pelvic exam.
So before you go in to see yourgynecologist or women's health
nurse practitioner or physicianassistant and you know you're
(14:47):
going to get an exam, you shouldalways empty your bladder.
Okay, empty your bladder beforethe exam, before you get
undressed, and then you want todrink enough fluid and empty
your bladder afterwards.
That really makes a bigdifference.
You have to avoid vaginalhygiene sprays and douching.
(15:09):
It's not recommended.
It can affect the bacterialflora and if you are a
menstruating woman having aperiod, you have to regularly
change your pads and tampons.
That's very important.
It's also important to wearloose-fitting clothes and 100%
cotton crotch underwear.
(15:29):
Tight, ill-fitting clothingcreates a moist, damp
environment which promotesbacterial growth and in women's
health.
We're not fans of thongunderwear because that thin
string is like anal floss andcan push bacteria up to your
urethra where you don't want it.
(15:52):
Now, supplements that might helpbladder infections, and I
always keep my trusty cranberryextract because cranberries do
seem to inhibit E coli'sabsorption onto the urethral
mucosa.
And I didn't think to take anycranberry extract that morning
(16:14):
of my exam because I wasn'thaving any symptoms and I don't
necessarily want to drink fullcranberry juice with all that
sugar.
I'm not someone who reallylikes to drink my calories and
so getting the extract is a veryhigh concentration.
Now, anytime that you're takinga cranberry extract or any
(16:35):
supplement that's over thecounter, you really want to look
on the bottle for the lotnumber and expiration, because
that does imply some qualitycontrols, because if it's not a
food or it's not a drug, itisn't regulated.
So it is.
Buyer beware.
And just because something'snot a prescription doesn't mean
it can't interfere with otherprescription medicines or lab
(16:57):
tests.
If you didn't listen to thepodcast on biotin biotin's B7,
that interferes with a lot ofblood tests and ideally you
should be off it for three daysbefore getting blood work and
you should tell anyone,especially if you're in the
emergency room, if you've beenon high-dose biotin and they're
(17:19):
drawing cardiac or hormonalblood work on you.
Another supplement that Ifrequently recommend to women
sometimes in combination withthe cranberry extract, sometimes
separately is D-mannose.
It's a simple sugar that'sfound in fruits and it is used
to help prevent and treat UTIs.
(17:40):
The supplement dosage is basedon whether or not you have a
bladder infection or you'retrying to prevent it.
So to prevent a urinary tractinfection, you should take 500
milligrams of D-mannose threetimes a day, but if you're
experiencing a bladder infection, you need to take one gram
(18:04):
three times a day.
What foods might you want toavoid?
Well, certain foods cancontribute to urinary frequency,
urgency and discomfort, likewhen I first had my urinary
discomfort, I thought maybe itwas because I had some coffee
and some green tea in themorning, because caffeine can
(18:26):
irritate the bladder.
There are a list of foods thatyou can find on our Speaking
Women's Health site that areknown to be bladder irritants.
It doesn't mean that you haveto always avoid those foods, but
sometimes women find incombination, if they're eating
multiple types of these foods ortaking B-complex vitamins,
(18:47):
which are water soluble excretedin the urine, that can change
the urine a darker yellow colorand cause irritation.
Some women will actually do anelimination and then add back
every seven to 10 days thepossible offending substance and
(19:08):
then, if they can identify whatthe irritant is, they can
identify it and either avoid itor drink a lot more water and
have other foods at the sametime.
And there are acidic foods thatsometimes irritate the bladder
and should be avoided if you'reprone to urinary tract
(19:29):
infections, like alcoholbeverages.
There's lots of reasons toavoid alcohol and certainly
avoiding regular alcohol ingeneral is a healthy thing to do
.
Apples and apple juice,cantaloupe and some women
carbonated beverages can beirritating to the bladder or
(19:50):
stomach.
Chili and spicy foods don'tjust affect heartburn but can
the bladder.
Chocolate, which is a goodsource of iron and magnesium and
does have caffeine, and in somepeople irritates them.
Caffeine and in some peopleirritates them along with citrus
(20:12):
fruits.
Coffee, also the decaffeinatedbrands.
Ironically, cranberry andcranberry juice can be
irritating to some women'sbladder, even though it does
inhibit E coli.
Now there's other bacteria thatcan cause bladder infections.
I was happy in my case when Igot the result I had just simple
E coli UTI and the blood allcleared up and that you have to
(20:33):
go back and be rechecked to makesure that you're not bleeding
from something else wrong in thebladder.
Grapes are another bladderirritant Guava, peaches,
pineapples, plums, strawberries,which have a very high
histamine content, tea, sugarand tomatoes those are the big
(20:59):
ones.
Vinegar and B-complex vitamins.
Now, not all women say thatsugar bothers their bladder, but
there is a definite group ofwomen and you can be healthy and
survive without any sugar inyour diet and the average
American consumes, you know,several pounds of sugar a year
(21:19):
and it's really too much.
And it does promote metabolicsyndrome, weight gain, elevated
triglycerides, fatty liver.
So sugar also feeds tumors andwomen or any patient with cancer
many times is advised to followmore of a high-protein,
(21:42):
high-fat, so-called ketogenicdiet and getting the sugar which
feeds tumors and the simplesugar feeds that bacteria as
well in your bladder.
Now, some of the diabetictreatments that some people with
type 2 diabetes undergopromotes sugar loss in the urine
(22:03):
which of course increasesbladder infections and yeast
vaginal infections.
And if you haven't heard mypodcast on vulvovaginal problems
, vaginal infections, care ofthe vulva, we have that on prior
podcasts, as well as greatinformation on how to properly
(22:24):
care for your vulva onspeakingofwomenshealthcom.
So if you think you have abladder infection, it's best to
see your physician or healthcareclinician as soon as possible.
You might be directed to go tothe local urgent care or express
care center get a urinalysisand a urine culture.
(22:46):
Now a urinalysis is just sentto the laboratory or the nurse
may assess it in the office tocheck for things like red blood
cells, white blood cells,nitrites and leukocyte esterase,
and if those are positive, thatsignifies some irritation,
(23:07):
inflammation and possibleinfection.
Now the urine culture the labputs the urine on samples
culture material to grow it tosee if there's any strains of
bacteria, and it's veryimportant because they can
determine based on it if there'sany antibiotic resistance.
(23:28):
So a lot of times when I see apatient and I think they have a
bladder infection, I will givethem a prescription and tell
them after we get the culturestarted right away.
But then I give them the caveatthat within 48 hours we'll know
whether that's effective or notand you may or may not have to
change antibiotics.
Now, sometimes very minorbladder infections can go on
(23:51):
away on their own, but usuallymost need to be treated, and
with all prescribed antibioticsit is important that you finish
the full course and follow thedirections.
It's also important to know ifyou have true antibiotic
allergies, especially if youhave hives or anaphylaxis, as
(24:14):
that can be life-threatening.
Now a lot of women I see theyhave all these things that they
don't tolerate, or maybe theyhad stomach upset or some minor
symptom and they just don't likethe medicine, but it's not a
true allergy.
So you really want to know whatyour true allergies are versus
(24:35):
what are medicines that you justhad a side effect or didn't
tolerate or don't really want tobe on.
And it's important to keepthese lists straight, as well as
knowing all the medicationsthat you're on and bringing in
your prescription medicines, thebottles as well as
over-the-counter supplements.
It's very important and Ialways am so happy when I have a
(24:59):
patient bring me in what she'staking.
I'm like, yes, you get an A fortoday, because it is important
to know what you're on today.
Because it is important to knowwhat you're on Now.
Some of the more commonly usedantibiotics for just a
straightforward simple bladderinfection include trimethoprim,
sulfamethoxazole, so that's twosubstances together.
(25:20):
One of the brand names isBactrim or Bactrim DS.
If you have a true sulfaallergy, you wouldn't want to
take this Now.
Phosphomycin, or monoyerol, isa newer bladder antibiotic,
nitroferantoin, macrodantinmacrobid, also known as
(25:44):
ferandantin, which is what Danaprescribed for me is a
bacteriostatic.
It's not bactericidal, sosometimes it's not strong enough
for more severe infections.
Now, cephalexin and ceftriaxoneare cephalosporins, so they're
(26:05):
kind of similar to penicillins.
Are cephalosporins, so they'rekind of similar to penicillins.
There is a group of antibioticsknown as fluoroquinolones, like
ciprofloxacin, and we now do notuse these medicines for simple
UTIs.
I have taken cipro in the past.
Levofloxacin is another one,but in general they're reserved
(26:30):
for more serious infections,even though they're excreted in
the urine and a low dose isusually pretty effective.
But they do have risk and oneof the risks can be tendon
rupture.
So that's a pretty seriouscomplication and it takes a long
time for tendons to heal.
(26:51):
But if you have a complicatedurinary tract infection or one
that's traveled to your kidneys,causing pyelonephritis, your
health care clinician mayactually prescribe a
fluoroquinoline for you.
In April of 2024, last year, theUnited States Food and Drug
(27:12):
Administration approved PIVIA,which is pivomicelamine, and
it's a tablet for the treatmentof adult females with
uncomplicated bladder infectionscaused by susceptible isolates
of E coli, proteus mirabilis, ofE coli, proteus mirabilis and
(27:37):
Staphylococcus saphylococcus.
Sometimes Staphylococcussaphylococcus is a common skin
bacteria.
So one of the most commonreasons why women are prescribed
antibiotics is because of UTIs,and an uncomplicated urinary
tract infection is one wherethere's no known structural
(27:57):
abnormalities of the urinarytract and at least one in every
two women is going to have atleast one bladder infection.
Some of us are more predisposedthan others and we'll talk
about recurrent urinary tractinfections and when that needs
additional evaluation.
(28:18):
Now, one of the most commonside effects of PIVYA can
include nausea and diarrhea,which are not uncommon side
effects with antibiotics, andyou should always consult with
your physician about any otherside effects to any medication
and to see if it's the right onefor you and if your urinary
(28:41):
culture is consistent with it.
Now, what about the group ofwomen, the special group of
women who have frequent urinarytract infections or recurrent
urinary tract infections?
Well, sometimes, first of all,if you've got three infections
(29:03):
documented in six months, you'vebought yourself a urologic
evaluation because we reallywant to make sure there's not a
kidney stone or some anatomicabnormality with your kidney or
your bladder.
So you're really deserving ofseeing a specialist that might
be a urogynecologist or aurologist, or a urologist that
(29:27):
specializes in female urology.
Sometimes, low dose antibioticsmight be prescribed for six
months, or a single doseantibiotic after sexual activity
if your urinary tractinfections are related to sexual
activity.
Now I have seen women inmutually monogamous
(29:50):
relationships with their partnerand everything is fine, but
they've suffered enough withpost-coital bladder infections
that it causes like an aversionto having sexual activity
because they're so fearful ofthe symptoms and what's going to
happen.
And so whenever you pair badphysical activity or response to
(30:15):
an activity, even if it'ssomething that's harmless and I
always tell the story about Ilove chocolate, I love brownies.
I've actually written columns onthe health benefits of
chocolate.
In fact, the other day myhusband was kind of feeling a
little bit down the dumps and hesaid I'm going to have a piece
of chocolate and I've rarelyever heard him hear that.
(30:35):
That seems a lot more commonamongst women and he said it
perked him up and there aresubstances that kind of perk you
up.
So a lot of people lovechocolate, including my
granddaughter Trixie.
You say chocolate and that willimmediately get her attention.
Well, I ate a brownie, okay,and then I got sick and threw up
.
Who knows Could have been theflu or food poisoning.
(30:58):
I didn't eat a brownie or wantto look at a brownie for 10
years, even though in my mind, Iknew that it was fine.
And so when you have a painfulexperience like after sexual
activity, because of a bladderinfection or because of
untreated vaginal atrophy,so-called genitourinary syndrome
(31:18):
of menopause which is morecommon in women without estrogen
or in women who are beingtreated with estrogen
deprivation therapies, it canreally be hard for the
protective aspect of your bodyand brain to get over that.
So that's one reason why, ifyou've had a bladder infection
associated with sexual activityyou know, more than once or
(31:41):
twice, you really should have aconversation with your
healthcare team.
Now, some women are givenpermission to diagnose and treat
themselves when thestraightforward symptoms come,
but you need to stay in touchwith your healthcare clinician
and women who've experiencedsimple UTIs that are not
(32:04):
recurrent, who may be going awayfor a honeymoon or a vacation
or an extended holiday, or avacation or an extended holiday.
In some situations, it may beappropriate, especially if
you've had uncomplicated bladderinfections without a
complicated medical history, tohave a small supply of
(32:25):
antibiotics ready to self-treat.
That being said, if you'repregnant, if you have sugar
diabetes, if you have signs ofsepsis, with fever chills, signs
of a more serious infection,then even if you're on vacation,
having the time of your lifeyou're going to have to go seek
(32:46):
medical assistance, because ifyou self-treat and you don't
really know what you're treating, you can really get into
difficulty, and if you'repost-menopausal, you should have
a discussion about whethervaginal estrogen is right for
you or other treatments,including non-hormonal
(33:07):
treatments like oral ospemafenor precursor substance like
vaginal DHEA.
If you're over 65, though, andyou're not on systemic hormones,
I think a little bit of naturalestrogen to the vulva once or
twice a week is really goodinsurance for most women.
But, again, this is not medicaladvice.
(33:31):
This is just information andresources to help empower you to
be strong, be healthy and be incharge.
So thank you for listening tothis podcast on Speaking of
Women's Health.
Don't miss any future podcastsHit, subscribe or follow.
(33:55):
Wherever you listen to podcastsApple Podcasts, spotify, tunein
wherever Please give us afive-star rating.
Please forward and share ourpodcast with your friends and
family.
Thanks again, and I lookforward to seeing you next time
(34:15):
in the Sunflower House.
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