For many years, scientists and healthcare professionals believed the urine to be almost sterile. Now we know much more about the bacteria that live in our body and know that we have a microbiome not only in our gut, but in the mouth, vagina, the placenta and in the urinary tract.
The urinary microbiome and our health
We are learning more and more about the beneficial bacteria that live here, the unwanted overgrowths and how these are associated with urinary issues such as:
- Urinary tract infections (UTI) and reoccurring UTI
- Cystitis (bladder infection)
- Kidney infections
- Urgency and incontinence
- Overactive bladder
- Possibly interstitial cystitis
UTIs and cystitis are extremely common in women. 50-60% of women will experience this in their lifetime1 with reoccurrence being common and resulting in repeated antibiotic treatment. Urgency, incontinence and overactive bladder tend to be more common with hormonal changes including post-menopause and in the peri-menopause. There are oestrogen receptors in the bladder and urinary tract that are affected by decreasing oestrogen at this time. It is also believed that hormonal changes influence the microbiome, much in the same way as with the vaginal microbiome.
There are far less bacteria in the urinary tract than we have living in our gut. While diversity is key to gut health, the vaginal microbiome and the urinary tract microbiome should be dominated by Lactobacillus strains. These are essential to health, maintain a low pH, influence the immune system and protect against infections. Through more advanced testing, we also know more now about certain strains of Lactobacillus that confer health. For example, Lactobacillus crispatus in the vaginal microbiome is associated with better IVF outcomes2. This strain was also associated with better bladder health when present in the urinary microbiome3
Bacteria as a cause of bladder conditions and UTI
E.coli is the dominant infectious strain in uncomplicated UTI. However as stated in a 2017 medical paper “unlike the conventional view of UTI that assumes invasion of a sterile field by a single uropathogen, it is more likely that there is a spectrum of urinary dysbiosis”1.
We are not simply trying to prevent E coli from getting a hold, although some strategies around cranberry and d-mannose can still be helpful, we are trying to promote urinary health and long term protection against UTI and other bladder issues.
Testing the microbiome
Testing the urinary microbiome is still under development. With advanced techniques we expect to be able to test for the bacteria in the urine in much the same way as we can detect those in a stool sample or a vaginal swab. While we wait, it is valuable to understand that these microbiomes are of course related. If you have suffer from recurrent thrush, bacterial vaginosis, or irritations or dryness of the vagina, the microbiome may be disturbed. A vaginal swab may actually be very informative as the predominant strain here is also Lactobacillus. The beneficial vaginal strain Lactobacillus crispatus can reduce UTI when taken as a vaginal probiotic4. There are also certain strains in the gut that may predispose to urinary tract such as Enterococcus faecalis which is measured on the comprehensive GI Ecologix.
Restoring the microbiome
Depending on the underlying reason for repeat infections and urinary issues, along with your personal health history, your Nutritionist can advise you on relevant tests, probiotic supplements, support for the immune system and health of the urinary tract lining and hormonal supports as needed.
If you would like more information about the services we offer, including testing, please get in touch.
- Medina, M., & Castillo-Pino, E. (2019). An introduction to the epidemiology and burden of urinary tract infections. Therapeutic advances in urology, 11, 1756287219832172. https://doi.org/10.1177/1756287219832172
- Mueller, E. R., Wolfe, A. J., & Brubaker, L. (2017). Female urinary microbiota. Current opinion in urology, 27(3), 282–286. https://doi.org/10.1097/MOU.0000000000000396
- Koedooder, R., Singer, M., Schoenmakers, S., Savelkoul, P., Morré, S. A., de Jonge, J. D., Poort, L., Cuypers, W., Beckers, N., Broekmans, F., Cohlen, B. J., den Hartog, J. E., Fleischer, K., Lambalk, C. B., Smeenk, J., Budding, A. E., & Laven, J. (2019). The vaginal microbiome as a predictor for outcome of in vitro fertilization with or without intracytoplasmic sperm injection: a prospective study. Human reproduction (Oxford, England), 34(6), 1042–1054. https://doi.org/10.1093/humrep/dez065
- Pearce, M. M., Hilt, E. E., Rosenfeld, A. B., Zilliox, M. J., Thomas-White, K., Fok, C., Kliethermes, S., Schreckenberger, P. C., Brubaker, L., Gai, X., & Wolfe, A. J. (2014). The female urinary microbiome: a comparison of women with and without urgency urinary incontinence. mBio, 5(4), e01283-14. https://doi.org/10.1128/mBio.01283-14
- Stapleton, A. E., Au-Yeung, M., Hooton, T. M., Fredricks, D. N., Roberts, P. L., Czaja, C. A., Yarova-Yarovaya, Y., Fiedler, T., Cox, M., & Stamm, W. E. (2011). Randomized, placebo-controlled phase 2 trial of a Lactobacillus crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 52(10), 1212–1217. https://doi.org/10.1093/cid/cir183