Chronic UTIs - A New Way to Test That Pee!
Urinary Tract Infections (UTIs) are pretty common - approximately 40 - 60% of women will experience at least one in their lifetime. Painful, uncomfortable and annoying, but most of the time, easily resolved. However, an acute UTI can turn into a chronic UTI if left untreated, misdiagnosed or undertreated. Estimates are that 25% of women will experience chronic or recurrent UTIs. Chronic UTIs are defined as 2 or more bladder infections in 6 months or 3 or more in one year. But one of the major barriers to effective treatment is getting an accurate diagnosis. Let’s explore what’s really happening with chronic UTIs, how to effectively test for it and what treatment is available.
The Bladder Microbiome
Everyone is pretty familiar with probiotics these days and no one disputes the existence of the gut microbiome. But did you know that the bladder also has its own microbiome? It’s true - urine is NOT sterile. Multiple studies now conclude that the bladder - and therefore urine - contains a unique set of various bacterial species. The most common being Lactobacillus, Corynebacterium, Streptococcus, Actinomyces & Staphylococcus. Some species are protective and help with overall bladder health, while others are associated with urinary symptoms such as urgency or burning with urination.
What’s the Connection with Chronic UTIs?
Chronic UTIs can have many of the same symptoms as acute UTIs, but frustratingly, when urine samples are sent for cultures, they often come back as normal. Essentially, when the lab attempts to look for the presence of bacteria, none are found. Patients are often told that their results are normal and diagnosed with labels such as interstitial cystitis, overactive bladder syndrome, bladder pain syndrome, pelvic pain syndrome, etc. But we know that urine isn’t sterile and there is a bladder microbiome so what gives? The answer lies in HOW we test.
Testing for Chronic UTIs
A standard urine culture is a test where a small sample of urine is collected and then bacterial growth is encouraged over a certain period of time. If minimal or no growth is observed after the prescribed period of time, the sample is deemed normal. But a standard culture is not designed to catch everything that could be present in urine. It uses a very small amount of urine, has a higher threshold for total amount of bacteria present, uses a growth medium that only catches certain types of bacteria and only looks for growth within a 24 hour period. More recent technology such as expanded quantitative urine cultures (EQUC) is capable of growing a much more diverse range of bacteria yielding more in-depth results.
Comparison of a Standard Urine Culture (left) and an EQUC (right). Note both the presence of growth using EQUC and the diversity of species present.
Furthermore, an even newer form of testing involves PCR analysis that looks for actual genetic evidence of which bacterial strains are present in the urine. Additional research has shown that PCR testing can:
Identify bacteria in appx. 90% of no growth standard urine cultures
Assess for eight antibiotic resistance genes
Be 99.9% accurate at identifying all possible microorganisms
This test can determine what types of bacteria are present, how much of the total microbiome they constitute, detect the presence of antibiotic resistant genes and determine which antibiotics the specific bacterial strains are sensitive to. Another study found that participants who had chronic UTI symptoms only had positive urine culture results 30% of the time, while PCR results came back positive 100% of the time!
Bladder Biofilms - Necessary to Treat
Now you know all about the bladder microbiome and PCR testing, but why do some people with chronic UTIs suffer with symptoms for so long even with long-term antibiotic treatment? The answer is biofilms and it’s kinda gross. Once bacteria set up shop within the bladder they begin to embed within the bladder lining and can actually move into the cells. Bacteria then begin to produce a biofilm to anchor themselves in place & avoid immune system attack. A biofilm is an extracellular matrix produced by at least two microorganisms residing together consisting of proteins, polysaccharides, DNA and metalloids. You already know some common biofilms like plaque on your teeth and that slimy film that can build up on a boat or in your sink.
Drawing of a bladder demonstrating bacteria present within the urine and embedding within the lining via a biofilm
Once a biofilm is created it decreases the effectiveness of the immune system and evades external antibiotics/antimicrobials. It’s a great way for bacteria to ensure their own survival, but causes you some serious health problems. Ever wonder why flare-ups happen with a chronic UTI? Flare ups are when bacteria go through phases of multiplying and penetrating deeper into the lining - building up their biofilm and causing a low-grade immune response. If we want to effectively treat chronic UTIs then we MUST address the biofilm factor.
Treatment Solutions for Chronic UTIs
The treatment goal is to constantly open up a biofilm while simultaneously killing the contents, i.e. bacteria. We need both - break up the biofilm and kill what’s in it. How we accomplish that can depend on where you live and what your healthcare practitioner has access to. Breaking up a biofilm involves using substances only available through a compounding pharmacy. The pharmacy creates a Bismuth-Thiol Complex that attracts the metalloid structure and breaks open the biofilm. Subsequently, your health care provider can use antibiotic or natural antimicrobial therapies to then kill the bacteria. It’s important to work with a skilled provider as long-term use of these substances needs to be closely monitored clinically and through blood work.
Relief is Possible
So there you have it - feel like you have a UTI, but all the tests are coming back normal? Constantly being told that it’s in your head, just do more physio, clean up your diet or you’re just too stressed? Don’t settle for long-term, debilitating symptoms - be your best health advocate. You owe it to yourself to check exactly what’s happening with the bladder microbiome and try this modern treatment approach.