How To Prevent Recurrent UTI With Ruth Kriz

After living with a recurrent or chronic UTI for months, years, or longer, understanding how to prevent recurrent UTI can be invaluable. 

As you’re probably familiar, breaking the cycle of UTI can be extraordinarily difficult. However, the more knowledge you have about your UTI circumstances, the more successful you may find your treatment to be. 

Ruth Kriz, APRN, helps us understand a variety of factors that can contribute to recurrent UTI in part 4 of our video interview. Included are topics about how UTIs begin and how factors such as biofilm, sexual partners, and systemic infections impact recurrent UTI treatment

Watch the interview or read the full transcript below to learn more. 

Jump To Section:

• Ruth Kriz Video 4 Transcript: How To Prevent Recurrent UTI  >>>>
• Bacterial Colonization: Urethritis, Trigonitis, and Interstitial Cystitis  >>>>
• Methods to Prevent Recurrent UTI  >>>>
• How Bladder Irritants Impact Recurrent UTI  >>>>
• Signs of Healing from Recurrent UTI  >>>>

Melissa: We’re in touch with thousands of people and recurrent and chronic UTI sufferers are constantly told things like wipe from front to back, which is pretty basic information once you get to that point. There has to be more that we can do in order to prevent future UTIs and help the bladder heal, so maybe you can share some of your thoughts on that?  

Ruth: Certainly there is more to it than from wiping front to back. Let’s go back to how infections start anyway. Infection equals number of organisms, times virulence of organism, divided by resistance of host. So when they say wipe front to back they’re trying to reduce the number of organisms that can find their way into the urethra and ascend. 

We’ve all been told as women that we have very short urethras and so somehow by this bad design process we are just always going to get UTIs and just go learn to live with it. But there are some things that can be done that would help prevent bacteria from ascending the urethra and getting into the bladder itself. 

First of all let’s think a little bit about anatomy. People who are constipated have a mega colon. It gets over stretched and it puts pressure on the bladder neck and that pressure prevents you from completely emptying your bladder. Therefore then too much urine sits there and propagates the growth of the bacteria. So not getting constipated is a very first basic step. You want your bladder to be able to empty completely. 

Ruth: The next thing is it takes about three hours for bacteria to colonize the urethra and once it colonizes the urethra it can easily get into the bladder itself. The place where the bladder joins to the urethra is kind of funnel shape or a triangle, and therefore many of us initially were told we had urethritis because we had inflammation, irritation, of the urethra. 

Then we were told we had trigonitis because that trigone area was inflamed, and then we were diagnosed with interstitial cystitis because the inflammation had now spread to the bladder wall. So based on the anatomy of where the infection had slowly but steadily spread we got different diagnoses. 

How to Prevent Urethral Colonization

Ruth: Okay so how do you keep the urethra from colonizing? Well first of all if it takes three hours for the bacteria to colonize. We should be emptying our bladders during waking hours at least every three hours.  Just very basic. And you should be drinking enough fluids every day that you feel like you do need to empty your bladder at least every three hours and if you don’t have that then you’re not drinking enough fluid. 

I know if you drink less you have to urinate less frequently and therefore you might have less pain, if urinating triggers pain at the end of urination, or during urination, and so you tend to avoid it. That’s kind of a bad idea just from the standpoint that if you don’t void frequently enough you are more likely to have more bacteria colonizing and therefore getting into the bladder. 

We have the opposite problem of people drinking too much, this is seldom discussed. We’re told if you have a urinary tract infection you should drink drink drink drink drink and flush the infection out of your system. 

Now that may work as an initial step for some people but if you’re on an antibiotic it is possible to over dilute the urine. And once again you’re only getting a sub-therapeutic dose of the antibiotic and it’s not going to work as well. So there needs to be a balance there. You know, we say drinking sufficiently that you need to void every two to three hours is helpful. 

How to Prevent Recurrent UTI Through Vaginal Health

Ruth: Let’s talk about intercourse. There are some positions in which the urethra can be more irritated and you and your partner need to find positions that minimize some of that mechanical inflammation. Then simply both partners washing up well before, drinking a lot of fluid before, urinating before, urinating afterwards, is going to help prevent any ascending bacteria from getting into the bladder. 

Let’s talk about probiotics. Probiotics are the good guys. They normally live in your gut – they’re an important part of the immune system. They actually produce a small amount of hydrogen peroxide in their life cycle which helps, it has an antiviral and an antibacterial effect. 

They’re the most important source of your vitamin K that is needed to make some of the TAT complexes that break down extra fibrin. So having enough probiotics in your GI tract can actually help you break down the biofilms. So the probiotics are really important. 

Now we also know that they help prevent urinary tract infections. There was a study done way back in the early 1980s, in which they had a group of postmenopausal chronic UTI women douching with probiotics once a week. Messy, messy, but there was a 76% reduction of chronic UTIs in that population. Well to my knowledge nobody ever followed up on that study. But it’s always stuck in my head. 

I didn’t understand how it worked until recently. I watched a webinar put on by Pathnostics lab in which Dr. Alan Wolf, who was instrumental with the urinary biome project, shared some of the findings. It turns out that some of the probiotics such as Lactobacillus crispatus were found in a higher percentage of women without any urinary symptoms, and Lactobacillus gasseri was found in a higher population of women with overactive bladders. 

The Importance of Understanding Your Test Results

Ruth: Now they didn’t have any data on chronic UTIs, they didn’t have any data on interstitial cystitis, but I will tell you that when he showed what bacteria they did find in small percentages it was totally different than what I’m finding in my chronic UTI and IC population. 

So just because seven percent of the women had Enterococcus in their urine doesn’t mean that if your test comes back with Enterococcus, which is the most prevalent organism that both Dr. Fugazzotto found with his broth cultures and I’m finding with DNA testing, just because it comes back with Enterococcus, doesn’t mean that this is a normal urinary pathogen to be found. 

So we have to be careful how some of that data gets interpreted. Not only that but when I treat and eradicate that pathogen, the bladder symptoms go away and resolve as long as we don’t have other pathogens there as well. So you have to be careful how you use some of that urinary biome data but it does inform us that some of these healthy bacteria probably have a role in preventing some of the other pathogens from colonizing the bladder. 

You see this in the nasal passage, so there are a number of bacteria that are normal and healthy there and actually prevent people from getting MRSA or prevent them from getting the flu or prevent them from getting other known infections that are circulating. And those bacteria are healthy and appropriate. So when you take a probiotic orally or vaginally those should help protect the urinary tract from ascending infections.  

Melissa:  Do you think one works better than the other? The oral or the vaginal suppository probiotic?

Ruth:  They kind of all find their way to the right place eventually. I will say that because so many patients have been on so many oral antibiotics and have just disrupted their vaginal environment that is a helpful test to do. 

Along with the urine, MicrogenDX does the vaginal testing, Pathnostics does not. And by testing the vaginal environment you can see if you’re seeding bad bacteria into the bladder on an ongoing basis. I’ve had many patients that until we addressed the dysbiosis or the bad balance of bacteria in the vaginal tract, we were not able to stop the urinary tract infections. 

This is particularly true of postmenopausal women because that vaginal tissue that should be moist and have healthy little hills and valleys called rugae, where the good guys like to hang out, due to the lack of estrogen those tissues become thin and dry and don’t support good bacterial growth. 

Instead they support the growth of pathogens and so sometimes some vaginal estrogen will restore that healthy environment so the healthy bacteria the Lactobacillus and Bifidus can colonize and therefore continue to protect the urinary tract. 

Addressing Biofilms

Melissa: Okay that kind of leads us into the question of how to break the cycle of recurrent UTI. You’ve mentioned balancing an imbalanced vaginal microbiome. Are there other ways that we can try to break the cycle or to prevent the next UTI?

Ruth: I think this is a good chance to dispel a myth someone with a recurrent UTI is getting re-infected each time. The most likely scenario is that you have a biofilm problem, that the bacteria have never been fully eradicated and that periodically, like any biofilm when it reaches a certain size, pieces of it break off to go form a new colony somewhere else and are free-floating in the urine. 

Or your own thrombin / anti-thrombin complexes have been successful in breaking down a piece of the biofilm or you’re taking a biofilm disruptor. Certain things like Xylitol, which is a natural sweetener, is known to have good biofilm disruption properties. So just through the normal life cycle of the bacteria they will shed anyway.

People with recurrent UTIs are most likely having a biofilm infection that periodically surfaces, it’s not a re-infection. 

Taking a biofilm disruptor, and hopefully you can get the testing to tell you which one is the best one for you based on your genetics, and breaking down the biofilm so that the infections found can be adequately treated and the bladder wall can heal, so you don’t have an environment that fosters the continuation of these biofilm communities, will ultimately prevent recurrent UTIs. And getting the sexual partner tested also could be a part of this. 

Sexual Partners and Recurrent UTI

Ruth: I will say that about 50% of my patients tell me that they flare after intercourse and of those 50% percent, when we check the sexual partner and we check the male’s semen (not the urine), are coming back with the same infections that the female IC or recurrent UTI patient has. 

Whether they are symptomatic or not, many men have a low-grade chronic prostatitis. They may not have any symptoms but for the sake of the one they love they will get treated and for some women that is the way to break that cycle. 

Melissa: Are there certain things to look for to know when you should think about testing your partner?  

Ruth: Probably the biggest sign is that you flare after intercourse. If you have symptoms within the first couple hours it’s probably just the mechanics and the physical contact. If you have a significant flare 24 to 48 hours afterwards that almost certainly is reinfection.  

Melissa: Okay that’s good to know. When it comes to healing the bladder are there things that we can actually actively do to help rebuild or is it more a matter of eradicating infection?  

Ruth: The body’s going to repair itself. That’s a given. Now I want to sidetrack just a tiny bit because I think this is a good time to talk about some of the other factors that are ongoing irritants that may prevent some of this repair taking place. The biggest one that I’m finding is mold toxins.

How Mold Toxicity Contributes to Chronic and Recurrent UTI

Ruth: Mold toxins are not the same as finding fungal infections in the urine itself. These are chemical substances put out by mold that a person environmentally has been subjected to. It could have been years ago. 

It could be their current work or housing situation, they may not have even realized that they were being subjected, because sometimes these mold toxins are behind a wall where there’s been a leak in a pipe or in a roof that leaked. And these molds are still in places that are not visible but they’re still producing toxins that get into the environment. 

Mold toxins depress the immune system, they are huge bladder irritants and I’m finding them about 10% of the time. A pretty significant number of my patients, particularly those where we’ve cleared up the infections and that doesn’t seem to be a player anymore but they’re still experiencing urinary tract symptoms. 

Mold toxins also get into the nerves, so sometimes when people have other symptoms like the vulvodynia or their symptoms don’t tend to wax and wane like they would with the bladder wall infection, but the nerves going to the bladder are inflamed, their symptoms tend to be more consistent 24/7, they’re not diet dependent and no matter what they do, it doesn’t seem to make any difference – those are people that I would very much suspect could have a mold toxin issue. 

There’s a way of detoxing those mold toxins. It takes six months, nine months usually, occasionally as long as a year. But people are noticing great improvements in their urinary symptoms just when they start, just from dealing with the mold to begin with. 

How Tick-Borne Infections Contribute to Chronic and Recurrent UTI

Ruth: The other thing that can cause some of the chronic symptoms that need to be thought about are tick-borne infections. Once again, in 10-15% of my patients, whether they can remember ever getting a tick bite or not, I am finding Lyme and some of the other infections that ticks carry, particular Babesia, are getting into the bladder wall. 

We did have some patients with bladder biopsy specimens – two different labs tested them for the tick-borne infections – and all three came back positive for Lyme and two of the three came back with Babesia, identified with DNA testing. And being in the bladder wall, that will continue to cause bladder destruction. 

The DNA testing won’t find it because the tick borne infections stay embedded in the bladder wall and don’t spill out into the urine. So sometimes being able to address some of the other reasons as to why the bladder wall is not happy and that the nerves have become infected with either tick-borne infections or have mold toxins, can resolve some of the things that seem to linger on, symptom-wise for some people, not everybody. 

Melissa: That also leads us to another question on other possible irritants, so things like bath bombs or washes or diet, coffee, alcohol. What are your thoughts on those? 

Ruth: Oh absolutely, if it bothers your bladder don’t do it. There are known irritants. I mean I remember when I worked in pediatrics. Little girls and bubble baths we’re not good friends. And so anything that’s going to add to that. Hot tubs are particularly nasty, and a lot of people picking up infections from hot tubs – I don’t trust them. 

So anything that’s going to add to the infectious load or chemical irritation, some of the fresheners and washes, you have to be very careful of. If they alter the pH they destroy some of the normal skin bacteria that should be there. Your genital area is not sterile and there are healthy bacteria that should be there. 

When someone gets diagnosed with interstitial cystitis they are handed a sheet of paper called an IC diet.  I have to give Dr. Larrian Gillespie credit for listening to her patients and believing them that there were certain foods that made their symptoms worse. 

I remember presenting it to my doctor and he said oh I believe people should eat anything they want and you shouldn’t be restricted by a diet and my thought was if it keeps me out of pain I will never eat one of these foods again. So some people are more diet sensitive than others. 

Some people say that the big irritants like alcohol and caffeine bother them but other foods don’t. Other people have one grape and they can be up all week long. I was one of those. It took me a while before I could eat a grape again without panicking that it was going to send me off the edge. 

Dietary Restrictions as a Symptom Management Tool

Ruth: But I think it’s a symptom management tool and there’s nothing magic about it. It’s not going to fix the problem. 

If you eat something that’s on that diet and your bladder complains about it you have bought yourself another day or two of misery but it’s not like you’ve set back your progress by months at a time and the world is going to come to an end. And I think you also need to try various things to see what is your problem or not. 

I had things on the IC diet that gave my bladder no problem at all and I had other foods that were not on the diet that would send me off the planet with pain and urgency and frequency. And I would be up most of the night and get out the ice packs and any other tools I had in my arsenal to manage the flare. 

I just simply took a piece of paper put it on the refrigerator, drew a line down the middle with a smiley face on one side and a frowning face on the other. And as I discovered which foods I could and couldn’t have I developed my own list. 

And so if you are diet sensitive you might want to do that and you might be surprised there would be foods that you’ve been avoiding that you don’t have to and you might also discover some foods that maybe you shouldn’t be eating because your bladder thinks it’s a bad idea. 

Melissa: Do you have patients that have been able to go back to eating whatever they want after treating the infection? 

Ruth: Absolutely everybody. Matter of fact, that’s one of the early signs. People, when they start treating the infections, depending upon how much is there and how much damage to the bladder wall, start noticing some very small but definitive progress. I will talk to them and they’ll say well I used to get up four times a night and now I only get up once or twice. 

They might say I didn’t used to be able to eat this food but now I can tolerate small amounts. I’m going a little bit longer between my flares and when they do happen they aren’t as bad as they used to be and they don’t last as long. So all of those are encouraging signs that you’re on the right track. 

It’s not going to be a straight line progress. It’s a little dance, two steps forward, one step back, occasionally one step forward and two steps back. But if you take the long view that if you look at where you are now and you look at where you were three months ago or six months ago or a year ago it’s very rare for people not to be able to see progress. 

And whether or not you believe that interstitial cystitis is an infection or not, your body cannot appreciate the infections being there. So if you find infection there is no compelling reason to not treat it.  

Coping with Setbacks

Melissa: The setbacks can be one of the things that makes it so hard to keep going with treatment and most people do tend to experience that from what we’ve heard. In your opinion, how long does treatment take on average?  

Ruth:  Oh goodness, everybody’s different. If I can start working with a patient within the first couple months usually we can turn around in a couple of months. If it’s been a couple of years it’s probably going to take longer. And this is really important – if someone has mold or tick-borne infections it’ll take longer. 

If somebody has one of those genetic hypercoagulation mutations in which they don’t break down biofilms as well as other people and those include Leiden factor V PAI-1, which stands for plasminogen activator inhibitor one, which is the one I find most commonly by the way, or Lipoprotein A, which is a form of bad LDL cholesterol that isn’t generally tested for on a lipid panel, then we’re talking about a longer course because we have more biofilms to break down. And generally they have more infection.  

Melissa: That makes sense. So the longer you’ve been suffering, the longer treatment might take in general?

Ruth: In general, but it also depends on how fast we can move. People who are able to do bladder instillations with the biofilm disruptor directly in the bladder tend to move faster than people who can’t and are depending upon the oral course. 

The Importance of Retesting to Prevent Recurrent UTI

Ruth: People who are following the test, treat, retest, retreat, make faster progress than people who maybe feel good after they’ve treated, don’t retest, allow the remaining infections to wall back off in the biofilm, go back to square one where their symptoms are really bad before they retest and then retreat. 

So if you if you get the bugs on the run, you get the biofilms broken down and you keep hitting it, with the infections that are there, of course you’re going to make faster progress and you can get through it sooner than if you only test based on when your symptoms have returned a month or two later. They’re so bad that you say oh I guess I better retest.   

Melissa: It’s a compelling reason to retest, that’s for sure. 

Ruth: I know that it’s hard to get your mind around that I should test when I’m not having symptoms but that also will be helpful especially if you take a biofilm disruptor. If you’re not staying on one because of your genetics, take a biofilm disruptor for a couple, for a week, a couple of days before you retest and see what else you can chase out of that biofilm to be found and treat it.  

How to Treat Future Acute UTIs

Melissa: If someone has recovered from a recurrent or chronic UTI and then years later they experience another UTI, what steps should they take then?

Ruth: Treat it as if you would treat an acute UTI, unless you have the genetics that make you prone to making really extravagant biofilms. I think if you have those genetics you need to stay on a biofilm disruptor the rest of your life because that’s going to prevent any infection you get, whether it’s urinary or anywhere else in your body, from walling off in a biofilm. 

The second compelling reason is that if you are making extra fibrin in response to inflammation, and we all get it from lots of sources on an ongoing basis, that extra fibrin will be deposited in your blood vessels, particularly the arteries and start narrowing them and set you up in the long term for cardiovascular disease. 

Most of you who have those genetics have family members, parents, grandparents, aunts and uncles who have cardiovascular disease. And so that’s one indication that you might be prone to having one of those genetic issues and to take a biofilm disruptor geared to which genetics are involved, because they aren’t all the same, will prevent you from getting another chronic infection as well as reduce your risk in the long term of cardiovascular disease.

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Acknowledgements

Understanding how recurrent UTI develops can be a key step in understanding how to prevent recurrent UTI. Developing a treatment and prevention plan unique to your body and health can be important in preventing future UTIs. We want to thank Ruth Kriz for generously donating her time to speak with us and share her knowledge with the UTI community. 

Watch the rest of our video series with Ruth Kriz, APRN, or subscribe to Live UTI Free on YouTube.

1. Chronic UTI And IC Testing
2. Biofilms and Antibiotic Resistant UTI
3. Antibiotic Bladder Instillations And Other Chronic UTI Treatment Methods

To get answers to commonly asked questions about chronic and recurrent UTI, visit our FAQ page. Share your questions in the comments below, or reach out to our team directly.