How Can Women Prevent Urinary Tract Infections?

R. Mark Ellerkmann, M.D., is Director of The Urogynecology Center at Mercy in The Institute for Gynecologic Care. The Urogynecology Center specializes in the treatment of urinary incontinence in women of all ages. In a recent media interview, Dr. Ellerkmann answered questions regarding steps women can take to avoid developing urinary tract infections or UTIs.

What qualifies as “Recurrent Urinary Tract Infection”?

Recurrent urinary tract infection (UTI) refers to ≥2 infections in six months or ≥3 infections in one year. Most recurrences are thought to represent reinfection.  Most UTIs uropathogens originate in the rectal flora, colonize the periurethral area and urethra, and ascend to the bladder. Increasing evidence suggests that alteration of the normal vaginal flora, especially loss of H2O2-producing lactobacilli, may predispose women to introital colonization with E. coli and to UTI.  

There are a number of risk factors that may cause women to more prone to UTIs (aside from the obvious anatomic difference between men and women (shorter urethra with the opening (urethral meatus) located within the vaginal introitus (opening)).  Some of these risk factors include: Poorly controlled diabetes mellitus, pregnancy, functional or anatomic abnormality of the urinary tract, other immunocompromising condition (e.g., chronic high-dose corticosteroid use, use of other immunosuppressive agents, neutropenia, advanced HIV infection, B or T leukocyte deficiency).

How much water should one be consuming to help prevent a UTI?

It is always a good idea to remain well hydrated, but there is no set rule or recommendation on how much water an individual should drink during a given 24 hr period.  Typically, the sensation of “thirst” occurs before one is clinically dehydrated, so I tell my patients to drink when they are thirsty.  There are rare medical conditions that will trigger individuals to drink too frequently (like diabetes insipidus) and too much water can actually lead to dangerous decreases in serum sodium levels and lead to a condition called hyponatremia which can be fatal.  

If someone has symptoms of a UTI (i.e. painful urination, frequency, burning with urination), it is thought that drinking a lot of water can help “flush” out bacteria, but whether this is true or not, I am not sure. Doing so briefly probably won’t be harmful, but it will also make you have more urinary frequency.

Are there supplements women can take to prevent this?

Dietary supplements such as cranberry extract and D-mannose may be helpful, although this is often debated in the literature.  Native Americans first used cranberries medicinally to address lower urinary complaints.  We have come to discover that it is proanthrocyanins—a compound in cranberries that is thought to be helpful by encapsulating (covering) certain bacteria (specifically e.coli) and making them less able to adhere (stick) to the wall of the bladder and urethra.  

D-mannose is a naturally occurring component of glucose and appears to act similarly in reducing the risk of UTIs.  Probiotics are live micro-organisms that confer a benefit to the host may be helpful too—specifically lactobacilli-containing probiotics (they produce hydrogen peroxide and lactic acid)—in reducing the risk of UTIs.  Specific lactobacilli which have been studied include: L.fermentum, L. rhamnosus and L.casei.   

Finally, vaginal estrogen cream or tablets can promote a more acidic vaginal pH, thus making the vaginal a less hospitable place for opportunistic bacteria (like e. Coli) that want to migrate from the perineum/peri-anal skin into the vagina.

In terms of hygiene, what do women need to be doing to prevent UTI?

Wiping front to back; there is no data to suggest that hygienic wipes are any better that toilet paper. 

Can the kind of underwear you wear impact if you can get a UTI or not? Please explain. And what underwear material is best to wear? 

It is often thought that cotton underwear and “breathable” fabrics can be helpful, but these are often recommended more for vulvitis and vulvar yeast conditions rather than for UTI prevention.
--R. Mark Ellerkmann, Director, Urogynecology Center at Mercy 

Dr. Ellerkmann treats pelvic organ prolapse, interstitial cystitis, recurrent urinary tract infections, fecal incontinence, overactive bladder, pelvic floor dysfunction and the special gynecologic needs of aging and handicapped women.