Understanding Urinary Tract Infections (UTIs)

Understanding Urinary Tract Infections (UTIs)

Urinary tract infections (UTIs) are extremely common in healthy women. While UTIs do occur in men, women are much more prone to them. Approximately 1 in every 2 women will suffer from a UTI in her lifetime.

Commonly known as bladder infections, UTIs have a tendency to come back. According to R. Mark Ellerkmann, MD, Director of the Center for Urogynecology at Mercy Medical Center in Baltimore, Md, a six-month study showed that 27% of UTIs recurred once and 3% recurred more than once in college age women.

Fortunately, recurrence appears to be more of a painful annoyance than a serious health risk. “There is no evidence that recurrent UTI leads to health problems,” says Dr. Ellerkmann.

What causes UTIs?

Bacteria usually cause infections of the urinary tract. 80% of these infections can be traced to the common intestinal bacteria Escherichia coli. Normally, harmful bacteria are washed out of the body through the flow of urine. A recent study reveals the process by which bacteria evade this normal process of elimination.

A team of researchers from the University of Basel and ETH Zurich found that bacteria attach to proteins called FimH that live on the surface of the urinary tract. A bacterium latches onto FimH through a sophisticated locking mechanism. FimH holds on tightly to the bacterium, which prevents it from being flushed out with the urine. It then travels up the urinary tract into the bladder.

The anatomy of women explains their higher susceptibility to UTIs. A woman’s urethra is shorter than a man’s, which makes it easier and faster for bacteria to travel to the bladder. In addition, the opening of a woman’s urethra is very close to the anus and vagina, which are sources of opportunistic bacteria like E. coli.

Signs that you might have a UTI are pain during and after urination, the constant urge to urinate, more frequent urination, pink or blood-tinged urine, fever, chills, and mild pain in the upper abdomen or back.

Risk Factors

There are a number of factors that Ellerkmann says may increase your risk of recurrent UTIs:

  • Sexual activity
  • Sexual intercourse with a new sex partner during the past year
  • Use of a diaphragm with spermicide or spermicide-coated condoms
  • Contracting a first UTI at or before 15 years of age
  • Having a mother with a history of UTIs

How to Minimize Your Risk

Here are a few ways to prevent a UTI from coming back over and over again:


Amy Howell, PhD, a research scientist at Rutgers University, has spent years studying the effects of cranberries on urinary tract health. Her research indicates that the consumption of cranberries may avert recurrent UTIs.

“Cranberries help prevent UTIs because they contain active plant components called proanthocyanidins (PACs),” says Howell. “In 1998, my lab published our discovery in The New England Journal of Medicine showing that PACs in cranberries help prevent certain uropathogenic E. coli from adhering to bladder cells.”

An easy way to get enough PACs is to drink cranberry juice cocktail. Howell suggests drinking a 10-ounce glass, which is the amount shown to be effective against UTIs in clinical trials.

Ellerkmann recommends cranberry extract, which is a concentrated formulation taken in pill form.


Probiotics are live bacteria and yeasts that are beneficial to your body. “There is some evidence that vaginal and oral probiotics may be helpful in patients experiencing recurrent UTIs,” says Ellerkmann.

How do probiotics prevent UTIs? According to Ellerkmann, those containing a strain of friendly bacteria called lactobacilli produce hydrogen peroxide, which prevents harmful bacteria from adhering to the urinary tract surface and thwarts their growth. Other types of probiotics produce lactic acid, which makes the pH of the vagina more acidic. Acidic environments are unattractive to opportunistic bacteria like E. coli.

While probiotics show promise in preventing recurrent UTIs, Ellerkmann believes more studies are needed to prove their efficacy.

Wipe front to back.

Because of the close proximity of the anus and vagina, it’s all too easy for harmful bacteria to travel from one to the other, then travel up the urethra. Wiping front to back decreases this risk.


D-Mannose is a naturally-occurring sugar that can be found in cranberries, peaches, apples, other berries, and some plants. Ellerkmann says there is evidence that it may prevent some bacteria from adhering to the lining of the bladder. Its mechanism of prevention is similar to that of PACs.

Avoid irritating feminine products, such as douches and deodorants.

Chemicals in these products may irritate the urethra and bladder. Ellerkmann warns that douches may actually increase UTI risk by eliminating the “good” bacteria and yeasts that live in the vagina.

Vaginal Estrogen (for post-menopausal women)

After menopause, the vaginal pH rises and becomes alkaline. Uropathogens such as E. coli are attracted to alkaline environments. Therefore in post-menopausal women, opportunistic bacteria are more likely to travel from the anus to the vagina and urethra.

Like some probiotics, vaginal estrogen lowers the vaginal pH. “Estrogen promotes and brings about a more acidic vaginal pH, making the vagina a less favorable environment for colonization by uropathogens like E. coli,” says Ellerkmann.


Article sources:

Amy Howell, PhD, Associate Research Scientist, Marucci Center for Blueberry Cranberry Research, Rutgers University, Chatsworth, NJ

Mayo Clinic, “Cystitis”

News release, University of Basel

Mark Ellerkmann, MD, FACOG, Director, Center for Urogynecology, Mercy Medical Center, Baltimore, Md













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