Ruth Kriz on Comprehensive Testing and Treatment of Chronic UTI

After living with a recurrent or chronic UTI for months, years, or longer, understanding how to prevent recurrent UTI can be invaluable to you. Ruth Kriz, APRN is familiar with this from both a personal and clinical perspective.

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 is a nurse practitioner who was diagnosed with interstitial cystitis (IC) while in her early 30s. She was told she needed to learn to live with it, that IC was chronic, degenerative, and incurable. Over time, Ruth learned that the true cause of her IC was an infection, and she went on to make a complete recovery.

This experience set her on a 40 year path to sort out the root causes of IC and how to treat it.

In our four-part interview with Ruth Kriz, she shares the history behind how she became involved in treating IC patients and how alternatives to standard urine culture have helped her successfully diagnose and treat patients with IC.

Additionally, antibiotic resistance is a common and valid concern for many. Ruth lays out some of the factors that contribute to resistance, including the role of biofilm and steps we can take to overcome these hurdles while dealing with UTI.

There are so many layers to our interview with Ruth, so let’s hop right in! Watch the video series on our YouTube channel or read the summaries below.

Jump To Section:

• Chronic UTI and IC Testing with Ruth Kriz  >>>>
• Genetic Factors that Contribute to Chronic UTI  >>>>
• More on Biofilms and Chronic UTI  >>>>
• Ruth Kriz’s Approach to Treating Chronic UTI  >>>>
• Alternatives to Oral Antibiotics  >>>>
• Habits to Prevent Recurrent UTI with Ruth Kriz  >>>>

According to Ruth Kriz, and as we’ve gathered from chronic UTI and IC patients, there is a lot of confusion concerning terminology between chronic or recurrent UTI and interstitial cystitis.

When people get urinary tract infections they have pain, burning, frequency, urgency, so they go to their practitioner. A dipstick is done looking for leukocytes and nitrites and those can be highly inaccurate. Based on that they are often given an antibiotic. Sometimes a culture is sent,  sometimes it’s not.

The diagnostic problem we have in these situations is that if the culture is positive, you’re given an antibiotic. If the culture or dipstick is negative, you’re told they don’t have an infection and no antibiotic is prescribed. 

While this approach may seem clear and straightforward, cultures miss a substantial amount of infections. They favor fast-growing bacteria, such as E. coli, and miss a wide range of other organisms. 

If there’s a fungal component that is found on a culture plate, they throw it away and report it as contaminated. Whereas with the DNA testing we know that there are multiple pathogens and some of those can be fungal as well as bacterial.  

When a Diagnosis of IC is Made

Interstitial cystitis comes into the picture when cultures repeatedly come back negative. The patient is told that they may have IC, and typically a cystoscopy is recommended. If the urologist is able to see damage or inflammation in the urethra or bladder wall, labels such as IC, urethritis, or trigonitis are given.

In Ruth Kriz’s opinion, all of these labels are just a continuum of bladder wall damage, as an infection can take place years before the bladder wall is sufficiently damaged to the point of diagnosing IC. 

IC is often considered a diagnosis of exclusion. If a patient has tests to rule out bladder cancer, bladder stones, oxalate crystals and other conditions that can cause urinary symptoms, the IC label is then applied. 

The IC diagnosis doesn’t tell you the cause of your symptoms, only that it’s not ‘these’ conditions.

Have you ever wondered why you’re so prone to develop UTIs or find them difficult to treat while other people seem to clear them without issue?

Ruth has, and her curiosity led her to look into some genetic components in her patients where she discovered some commonalities.

Genetic Mutation	Impact on Chronic UTI
Vitamin D Receptor mutation	Vitamin D at an optimal level helps the bladder wall to secrete a protein that has a key role in preventing UTI. People with this mutation are unable to hold onto vitamin D, so vitamin D3 needs to be continually supplemented.
Cysteine Beta Synthase (CBS) mutation	When present, the body is unable to properly break down specific chemicals. Instead of CBS being broken down into cysteine and taurine, it breaks down into excess ammonia. Excess ammonia has been demonstrated to destroy the gag layer of the bladder wall, as commonly seen in IC. Ornithine is a supplement that can be used to help lower the ammonia levels and reduce damage.
Hypercoagulation mutations	Mutations such as Factor V Leiden and plasminogen activator inhibitor 1, or PAI-1, inhibit those affected from effectively breaking down biofilm. One of the components of biofilm is fibrin, of which people with hypercoagulation mutations often make in excess. Biofilm keeps bacteria adhered to the bladder wall, and makes it difficult for antibiotics to penetrate.

"While there isn’t any way to confirm whether or not you’re dealing with a biofilm infection, if a test reports multiple pathogens, that’s a pretty good sign you have a biofilm community. The problem with biofilms and cultures is that if they find more than two pathogens, they report it as contaminated." Ruth Kriz, APRN

For disrupting biofilms to help clear an infection, there is not a one-size-fits-all approach that Ruth Kriz uses. It’s typically about 20% of the population that have genetic mutations for hypercoagulation, which contributes to biofilm. 

However, instead of 20%, Ruth has found that 55-60% of her patients have these mutations. Depending upon whether or not you have one of these genetic issues dictates which approach to biofilm disrupting may be appropriate for you. 

Some of the biofilm disruptors are enzymes that break down the fibrin, while some of them have substances that prevent the bacteria themselves from making their own biofilms. So it can be fairly complex figuring out which biofilm disruptor your body needs.  

As far as concerns around how disrupting biofilms may affect the rest of your body, Ruth does not have many. She recommends disruptors to almost all of her patients. For those with hypercoagulation mutations, the disruptor is helping your body to function more optimally overall. 

Biofilms are involved in any infection, so people who have other chronic infections may benefit from a biofilm disruptor in that way as well. She believes the benefits far outweigh any risks.

Check out the video at the beginning of this section to hear Ruth explain how biofilms contribute to antibiotic resistance UTI.

As Ruth Kriz mentioned when discussing interstitial cystitis, things have causes. If the root cause is not addressed and eliminated, then the problem will remain. 

For these chronic infections that have spent a lot of time going undiagnosed and untreated, the bacteria have had a chance to invade the bladder wall. This invasion causes swelling, pressure on the nerves, and pain. 

This can be a multi-layered condition, so Ruth first focuses on diminishing the infectious load so the bladder wall can begin to repair itself. This takes about four months after the bacterial load has been reduced. 

Ruth’s approach is to identify the big player – the infection with the highest amount and target it first. By selecting an antibiotic that is best for the majority of the infection that’s currently outside of the biofilm, most of the infection will be knocked back.

Once that big player has been knocked back, not completely eliminated, more bacteria will have emerged from the biofilm. Again, she identifies which bacteria is the biggest player at the moment, and targets it. This approach necessitates that each infection is treated as it comes out of the bladder wall or biofilm. 

Ruth Kriz does not use a long-term antibiotic approach, but treats the infection layer by layer, because it is constantly shifting. If one specific antibiotic is given long term and it doesn’t cover the other potential organisms, then it’s not going to work. 

Potential Risks of Long-Term Antibiotics

Aside from possibly missing some organisms that are involved in a chronic infection, long-term antibiotics impact the gut flora. Ruth isn’t sure if the benefits outweigh the risks, as that’s something to consider with every decision she makes with her patients. 

When you test and treat and retest and treat you are essentially giving your body an antibiotic holiday and the gut flora has a chance to repopulate. So taking drug holidays or antibiotic holidays does allow that repopulation to take place in a healthier way than to be on one antibiotic continuously month after month after month after month.  

What about preventive or prophylactic antibiotics, do they come with the same risks?

For most of Ruth Kriz’s patients, she reports that when they have used antibiotics prophylactically they see some improvement, and then the antibiotics stop being effective. This is because the bacteria have been exposed to a less than therapeutic dose of an antibiotic and have now developed resistance. 

It’s important to advocate for a full course of antibiotics for other infections to prevent drug resistant strains.

“I do have concerns about only using oral antibiotics, particularly when we have someone whose infections are deeply embedded long term. I'm not naive to think that they're harmless. I know there are consequences, but we come back to the benefit-risk problem.” Ruth Kriz, APRN

For patients who are unable to tolerate oral antibiotics, Ruth has adopted an alternative treatment method. She has been working with a compounding pharmacy for eight years to compound IV antibiotics into bladder instillations.

You may have heard about antibiotic instillations before, but that was likely the standard one-size-fits-all Gentamicin bladder instillations completed one to two times a week in your doctor’s office. This approach only targets Gram-negative bacteria and is not performed often enough to be considered a treatment dose. 

The bladder instillations that Ruth Kriz uses are instilled through a very small pediatric catheter and are completed twice a day for up to two weeks. 

Because the antibiotics are compounded, they are typically antibiotics your bacteria have never seen before. They do not have the risks of disrupting the gut flora, and there are very generally few side effects because the antibiotics stay contained in the bladder. 

The antibiotic instillations are often combined with a biofilm disruptor. This can help the antibiotic to work better and faster because the biofilms are being broken down and the antibiotic is right there in high concentration. 

This can be optimal when compared to having to be absorbed, metabolized, and then cleared through the bladder as oral antibiotics do.

Although antibiotic instillations have many benefits, they do have a few limitations. It is most helpful to hold the fluid in your bladder for as long as possible. When dealing with a UTI, this can be difficult. It can also be inconvenient to have to perform the instills twice per day.

We all know the classic recommendations for preventing UTI in females: wipe front to back, urinate after sex, drink plenty of water, etc. This basic advice aside, what more can you do to prevent future UTI?

Ruth takes us back to the beginning of infections. Infection is determined by the number of organisms, the destructiveness of the organisms, and the resistance of the person infected. 

If we take steps to limit the amount of bacteria near the urethra, such as wiping front to back, then we are decreasing the amount of organisms in the area. 

To limit both the amount of organisms and prevent them from colonizing the bladder, Ruth recommends drinking enough fluids to empty your bladder every three hours throughout the day. If you’re not needing to empty your bladder every three hours, you aren’t drinking enough fluids. 

However, it is possible to over drink, especially while taking antibiotics. While it’s important to regularly empty the bladder, you don’t want to over dilute the antibiotics in the urine by drinking excessively. This would create a less than therapeutic dose of antibiotics, so it’s important to find a balance. 

Prevent Recurrent UTI Through Vaginal Health

If you’ve browsed other articles on our site, you’re likely familiar with how probiotics can impact not only the gut, but vaginal and bladder health as well. 

Not only can probiotics help to replenish beneficial bacteria in the body, but according to Ruth Kriz they also produce a small amount of hydrogen peroxide in their life cycle. Hydrogen peroxide has both antiviral and antibacterial effects. 

Probiotics are also a source of vitamin K. Why is vitamin K important in preventing UTIs? It is needed in some of the processes of breaking down extra fibrin, which means it helps to break down biofilm. 

In a study completed in the early 1980s, a group of postmenopausal women with chronic UTI douched with probiotics once a week. That group experienced a 76% reduction of chronic UTI. Unfortunately, this study has never been followed up or recreated. 

We’re often asked what probiotics are most beneficial, and whether or not we can have an excess of these ‘good’ bacteria. Ruth points out a study completed by researchers who were involved in the initial discovery of the urinary microbiome. 

According to their recent findings, probiotics such as Lactobacillus crispatus were found in a high percentage of women without any urinary symptoms. On the flip side, Lactobacillus gasseri was found in a high population of women with overactive bladder. 

We’re still learning a lot about the urinary microbiome, but these findings show us that more is not always better when it comes to specific strains of probiotics.

The Link Between Bladder and Vaginal Microbiomes

Vaginal and bladder health are significantly interlinked. To get a deeper look into what may be occuring for your individual situation, Ruth recommends testing both a urine sample and a vaginal swab when you’re symptomatic. 

For many patients of Ruth’s, until they addressed the imbalance in the vagina, the UTIs were unable to be successfully treated. This relationship between the two regions can be especially important for post-menopausal women.

Ruth shares an abundance more of information in our interview including the issue of re-infection versus a dormant/active infection and sexual partners and UTI. She also digs into other systemic or whole-body infections such as tick-borne infections or mold toxicity. 

We can’t recommend enough watching the video interview for yourself to hear Ruth Kriz’s experiences and recommendations. 

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Acknowledgements

Understanding how recurrent UTI develops and how important a role your body has in responding to the infection 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. For more from Ruth, you can download her Q&A discussion. As a reminder, Live UTI Free does not endorse a specific approach to treating chronic or recurrent UTI.

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