When bladder symptoms first strike, every IC/BPS patient usually assumes that they have a bladder infection. A quick visit to your doctor, along with a urine dipstick test and/or culture, usually proves that no infection is involved. Yet, for the often confused patient running to the restroom every 15 minutes, it’s hard to understand how this could NOT be infection. Many IC’ers have assumed they were struggling with recurring infection for years only to discover, after the fact, that their symptoms were being driven by tight pelvic floor muscles or related conditions.

Yet, it is an undeniable fact that UTI’s do occur. From swimming to sex, there is always a chance that bacteria can be introduced to the bladder. In fact, an estimated 50 to 60% of women will experience a UTI.(1) Throw in the increased risk of infection when catheterized, having a bladder instillation or cystoscopy with hydrodistention, we could argue that IC patients may be at more risk of UTI.  Distinctive symptoms of a UTI that differ from an IC flare include: mild fever, cloudy urine with an odor, visible blood in the urine, nausea, urine leakage and pain or burning while urinating.(2,3)

The only definitive way to determine whether you have a UTI is with urine testing. At-home dipstick test strips are your first line of defense. This simple OTC test involves a small strip of paper. Simple urinate on it and wait to see if the pads change color. Urine dipstick tests look for the presence of leukocytes (white blood cells) and nitrites, the latter of which is only produced by infection. If you have positive nitrites, infection is likely. If only leukocytes are present, that does not suggest active infection, rather bladder irritation and an IC flare. Unfortunately, dip stick tests can provide false positive and negative results. If you have positive nitrites, take a picture of the test strip and contact your doctor, explaining that you believe you have a UTI.

The next step is usually a urine culture, aka a simple pee in a cup test. A laboratory will then try to grow out pathogenic bacteria from your urine. If successful, they can identify the type of infection present. They should also perform an antibiotic sensitivity test to identify an effective antibiotic for the bacteria they identify.

Next Generation DNA Urine tests are the clear future for urine testing. Rather than trying to grow out a bacteria, they isolate bacterial DNA from a small urine sample, providing a real time look at what is living in the bladder. Next Gen testing can also identify fungal infections (candida), viral infections and, most importantly, antibiotic resistance genes present. This is the “go to” method for complex, difficult to identify infections and is growing in use throughout healthcare, especially by infectious disease specialists.

UTI Risk Factors

Any person of any gender and any age can get a UTI. Women are more prone to UTI because of our shorter urethra. Bacteria have a short distance to travel into the bladder when compared to a male urethra. Aging and the loss of estrogen results in a thinning of the protective mucosal barrier of the bladder wall, making it more vulnerable to infection (aka Genitourinary Syndrome of Menopause). A history of kidney and bladder stones can increase the risk of UTI because stones are often covered with diverse populations of bacteria. If they are sharp, they can abrade tissue and introduce bacteria directly into the bladder wall. The overuse of antibiotics can damage the urinary biome, favoring more pathogenic bacteria and dangerous infection. The use of catheters and medical instruments can physically push bacteria into the bladder if they are not sterile. Pregnancy, diabetes, HIV, chemotherapy and urinary retention also increases the risk of UTI.

Treatment for UTIs

More and more bacteria, including those that cause UTI, are becoming drug resistant, including some “superbugs” which are resistant to every antibiotic available. Thus, the days of prescribing a broad spectrum antibiotic by phone are past. Doctors and hospitals now follow “antibiotic stewardship” programs to prevent the overuse of these medications by verifying that an infection is indeed present first.

There are a few different kinds of antibiotics are typically used to treat UTIs. These include the following:(4)

  • Trimethoprim/sulfamethoxazole (Bactrim, Septra, others)
  • Fosfomycin (Monurol)
  • Nitrofurantoin (Macrodantin, Macrobid)
  • Cephalexin (Keflex)
  • Ceftriaxone

Please note that some common antibiotics are no longer suggested for simple UTI. Cipro and levaquin, fluoroquinolone antibiotics, now have major FDA warnings for the risk of severe side effects, such as: aortic aneurysm.(5) The FDA says that the risk of the medication far outweighs the benefits.

Suggested Reading: Ten reasons why you should not self medication with antibiotics if you have an IC flare 

Recurring UTI’s

If someone has two infections in six months or three infections in a year, they fall under the diagnosis of “recurring UTI’s.” These cases require special care not only to identify the bacteria and any drug resistance it may have, but also to address any underlying risk factors. It is important to track the bacteria over time. Is it the same bacteria (i.e. e-coli) which suggests that it could be very drug resistant or is it different bacteria each time, which suggests that the immune system may be struggling? In these cases, the use of Next Gen DNA Urine testing is more helpful than a typical urine culture.

Some doctors may suggest using a low-dose antibiotic over time though this has become controversial in light of the growing levels of antibiotic resistance. Estrogen atrophy patients are usually prescribed topical estrogen in addition to an antibiotic to improve the quality and health of their skin.

UTI Prevention

The goal with UTI prevention is to make your bladder and urinary tract area an inhospitable place for bacteria to grow and these tips may also help prevent IC flares, so it’s a win-win!

  1. First is to drink plenty of water. Many sources will tell you to drink water and cranberry juice both, but cranberry juice is irritating