Treating bladder infections naturally – How do I prevent recurring infections? (Part 2)

byIsabel Lüdi September 2, 2024 0 comments

Isabel Lüdi-Roth, Nursing Specialist

Unfortunately, it is very common for a bladder infection not to be a one-off occurrence, but for the next infection to follow soon after. This is referred to as recurrent or chronic cystitis. It occurs several times a year – in some women, even every few weeks – and is consequently very distressing.

Recurrent cystitis – a negative cycle

Urinary tract infections have a negative impact on quality of life; e.g. on sleep, productivity in private life and at work or on sex life. According to a study*, burning is one of the most damaging stimuli for the brain. A woman in the middle of a urinary tract infection can hardly think about anything else. Another study shows that women with recurrent urinary tract infections experience many negative emotions such as worry, frustration or anger. In most cases, every single infection is still treated with antibiotics. As already mentioned, antibiotics not only attack the undesirable bacteria in the urinary tract, but also the beneficial bacteria in the intestinal, bladder and vaginal flora that are important for health. This can trigger a negative cycle with recurring bladder infections.

Healthy bowel – healthy vagina – healthy bladder

An intact gut and vaginal microbiome is a prerequisite for a healthy bladder; all microbiomes are interconnected. It has not been known for long that the bladder also has its own microbiome, the urobiome. For many decades it was assumed that the bladder and urinary tract were sterile under normal circumstances, but this is not the case. The gut microbiome regulates the largest part of our immune system, which is also important for defence against bladder infections. The condition of the vaginal flora also plays a significant role in susceptibility to urinary tract infections. The vaginal mucosa is colonised with Döderlein bacteria (lactic acid bacteria, lactobacilli), which produce lactic acid. This leads to a slightly acidic pH value of between 3.8 and 4.5. An intact vaginal microbiome and an acidic environment prevent the colonisation of pathogenic germs in the vagina and also prevent the risk of bladder infections. A healthy vaginal flora also protects against bladder infections and if certain bacteria are missing in the gut, this also upsets the vaginal flora. If the vaginal flora is disturbed, harmful bacteria can first develop in the vagina and from there enter the urinary tract. Antibiotics therefore promote the risk of recurring urinary tract infections!

Gardnerella and Escherichia coli – a newly discovered duo

A more recent explanation for recurrent bladder infections is that Gardnerella vaginalis bacteria, which are found in the vagina, enter the bladder and “activate” Escheria coli bacteria there. It is not uncommon for women with frequent bladder infections to also suffer from recurring vaginal infections (vaginosis). The bacterium Gardnerella vaginalis has long been recognised as a cause of vaginal infections. What is new is the realisation that it can also be indirectly responsible for recurrent bladder infections. Although gardnerella alone do not cause any symptoms in the bladder, they can open the door, so to speak, to Escherichia coli, the most common pathogen causing cystitis, and thus cause an infection. In the vagina as well as in the bladder, bacteria can nestle comfortably in resistant biofilms. They are protected from antibiotics in this slimy coating and the immune system has difficulty reaching them. Some of these bacteria always survive and can multiply again. In the bladder, Escheria coli can form biofilms on the bladder wall and also settle in the bladder wall cells. If the bacterium Gardnerella vaginalis then enters the bladder from the vagina (e.g. during sex), it penetrates this biofilm and also attacks the epithelial cells of the bladder. This releases the E. coli bacteria and the bladder infection flares up again. Unfortunately, these biofilms are very stubborn. It is important to support the microbiomes of the gut, vagina and bladder (and not to weaken them again and again with antibiotics).

Hormones and their influence on the bladder mucosa

A disturbed microbiome of the gut, vagina and bladder can have various causes, e.g. this increases during the menopause. There is a connection between the female hormone balance and urinary tract infections. The main factors involved are

Oestrogens (estriol)/progesterone
Cortisol (stress hormone, has an immunosuppressive effect)

Women in the menopause, starting in the perimenopause, the early menopause, are often affected by urinary tract and vaginal infections. The initial cause is oestrogen dominance as a result of insufficient progesterone production. The result is a regression of the mucous membranes, both in the vagina and in the urinary tract, so that the natural bacterial flora becomes unbalanced and the mucous membranes become more vulnerable, not only to bacteria but also to fungi. Oestrogen deficiency in the later menopause leads to poorer blood flow to the mucous membranes in the urinary tract, bladder and vagina, making them thinner and drier. This is mainly due to an estriol deficiency. Estriol is one of the oestrogens and is responsible for healthy mucous membranes, among other things. The pH value of the vaginal flora also changes and the previously slightly acidic environment changes and rises to 6 to 7.

Support the microbiome

Whether the dysbiosis is caused by antibiotics or by the menopause or other hormonal fluctuations, we can support the bladder by taking measures to support the intestinal and vaginal microbiome. Integrating probiotic foods such as fermented vegetables into the daily menu and taking probiotics and ferments are suitable for this. There are also special ones for the vaginal microbiome, either for topical application or ingestion. But how do the bacteria find their way from the gut into the vagina? Interestingly, there is a “mucus route” from the anus to the vagina, along which the bacteria enter the vagina. Women going through the menopause may find it helpful to apply a cream containing estriol to the vagina and especially around the urethra. However, this must be prescribed by a doctor.

Prevent recurring bladder infections

Drink enough: around 30 millilitres per kilo of body weight per day, preferably until early evening and then no more, in 2-3 dl portions (not a little at a time)
Release water regularly: do not wait until the bladder is full, always empty the bladder completely
After sex: Dissolve water to flush out germs that could lead to an infection. You can also re-acidify the vaginal environment with special gels or ovules (semen is slightly alkaline)
After menstruation: The vaginal environment can also be acidified after menstruation; our blood is also slightly alkaline
Clean from front to back: Always wipe from the vagina to the anus
Wear cotton underwear and wash it at 60°.
No excessive intimate hygiene: it is best to wash with water only, possibly with a washing lotion specially designed for the female intimate area
If possible, do not wear panty liners as they obstruct the “mucus route”
Avoid environmental toxins / xenobiotics (they also affect the hormonal balance): choose high-quality care products, avoid perfumed pads, pay attention to your diet, etc.
Diet: lots of fermented, anti-inflammatory and immune-boosting foods, lots of vegetables (including raw vegetables), avoid ready-made products and sugar, as little gluten, dairy products, coffee, black tea, nicotine and fizzy drinks as possible.
Keep your abdomen warm: e.g. change into wet swimwear immediately, use something insulating when sitting on a cold surface
Stress reduction: an important issue for the psyche (psychosomatics, gut-brain axis; stress promotes an imbalance of the gut microbes), the nervous system (tension; urge to urinate), the immune system (infections are harder to fight off)
Probiotics and enzymes: for the gut, vagina and bladder
D-Mannose: Low dosage, daily intake (e.g. 1 sachet of 4 g)
OPC from grape seeds: 3 capsules daily (900mg grape seed extract) or chokeberry extract: 3 capsules daily (1500mg chokeberry extract)
Acidifying the vaginal environment (e.g. with vitamin C vaginal suppositories, lactic acid vaginally)
Oestrogen (estriol) cream vaginally and around the urethra (especially after the menopause)*.
“Vaccination” (Uro-Vaxom)*

(*with medical prescription)

Uro-Vaxom

An immunotherapeutic agent (Uro-Vaxom) can be used for the prophylaxis of recurrent lower urinary tract infections so that the body learns to react better to the germs that can trigger cystitis. It consists of live, immune-active fractions from selected Escherichia coli strains, which stimulate cellular and humoral immunity in the body, resulting in an increased local immune response in the urinary tract. (90 days on – 90 days off – 7th / 8th / 9th month, the first 10 days of each month).

Good for the mucous membranes and the immune system:

Vitamin A
Vitamin D (immunoregulatory, co-factor in mucous membranes to form defence bodies)
Vitamin C (acidifies urine, has an antibacterial and immunostimulant effect)
Zinc (immunostimulant, for intact mucous membranes)
Omega-3 fatty acids (anti-inflammatory, needed for membrane construction, good for the mucous membranes)
Selenium (has an effect on the immune system, among other things)
Magnesium (has an effect on the immune system, among other things)
Essential amino acids (have an effect on the immune system, among other things)
Turmeric (regulates the moisture balance in the vagina, among other things)
Probiotics / Ferments
Vitamin B complex
Linseed (mucilage-forming)

Differential diagnoses for recurrent cystitis

There are some conditions with similar symptoms to recurrent cystitis that should be considered, and which are very often overlooked for years!

Interstitial cystitis (non-infectious, probably autoimmune cystitis associated with pain and a strong urge to urinate)
Trigenum cystitis (non-infectious, chronic cystitis in the area of the triangle of the urethral orifice and the two ureteral orifices associated with a constant urge to urinate and burning sensation)
Urethral pain syndrome / urethral syndrome (constant urge to urinate, burning sensation in the urethral area, frequent voiding of small amounts of urine, even at night, possibly painful urination)
Irritable bladder / overactive bladder (sudden, urgent urge to urinate despite the bladder being only slightly full, frequent bladder emptying in small amounts)

A specialist in urology or often even better in urogynaecology (gynaecologists with urological training, they have a better understanding of the female anatomy) is usually required to diagnose these conditions. Tell the doctor exactly when and what symptoms you have been suffering from and keep a micturition log for a few days beforehand (when and how often water is released and in what quantities).

Vaginal infections (caused by fungi or bacteria)

Vaginal infections can also rarely be confused with cystitis, but these are usually associated with vaginal discharge.

Pelvic floor training

People often only think about pelvic floor training after pregnancy or during the menopause, perhaps even when they have incontinence problems. However, the muscles of the pelvic floor are important and central throughout life, especially when it comes to recurrent bladder infections! Find a specialist who can introduce you to a varied pelvic floor training programme that you can then do regularly. The pelvic floor can not only be too weak, but also tense, and this is possibly even more often the case with constant bladder problems. A good training programme will therefore not only teach you to train this muscle region, but also to consciously relax it. Chronic stress also needs to be mentioned again here; if we are constantly stressed, this also has a negative effect on the pelvic floor (tension) and we have more urge to urinate. We can do our nervous system, pelvic floor and bladder a favour with exercises that stimulate the “relaxation nerve” vagus nerve.

Psychosomatics

Finally, I would like to take a very brief detour into psychosomatics. On the one hand, recurring bladder infections are stressful for the psyche, but on the other hand, it is also possible that our body sends us “messages from the soul” to draw our attention to injuries, traumas or emotions that have not yet healed. Bladder problems can, for example, have to do with issues such as “not being able to let go, tears that have not been cried, emotions that have not been experienced to the end, being controlled, pressure; professional, in relationships or self-imposed, problems with crossing boundaries, not being able to set boundaries” etc. It may sound strange, but you can start a “conversation” with your bladder; what is it trying to tell you? It is also important to learn to relax and rest and to calm the autonomic nervous system; there are some easy-to-use and effective ways to do this (e.g. stimulation of the vagus nerve). The influence of the psyche on the immune system and the nervous system and vice versa (psychoneuroimmunology) should not be forgotten when it comes to bladder problems. It is worth taking a closer look at these topics.

I hope that this information will help you and that in future you will have your bladder under control and not your bladder you!