“Fake” UTIs: Alternative Facts or Reality?

**By Una Lee, MD**

Fake news has invaded our newsfeeds. There are even courses on how to tell fake news from legitimate news. But a fake urinary tract infection (UTI)? Is that even a thing? In fact, this fake is for real. A fake UTI is when a women (or man) experiences symptoms that seem exactly like a bladder infection, but are not caused by bacteria.  The fake version mimics a real UTI, but is not due to an underlying infection. It is more common for both real and fake UTIs to happen in women, but they can happen to men as well.

So what’s behind these fake UTIs? Sometime urinary symptoms like urgency, frequency, burning, urinary pain or discomfort are due to other causes, such as inflammation or irritation of the urinary tract. Increased sensitivity of the nerves that inhabit the urethra and bladder can occur when bladder irritants such as caffeine or alcohol, sexual activity, dehydration and stress are in the picture, or it can simply happen out of the blue. These ramped up nerve signals can cause the strong feeling like you have to urinate, even when your bladder is not full, and after you just went to the bathroom a few minutes ago.  These signals can also cause discomfort around that area of the body and can range from mild to horrible.

StormWhat can you do when this happens?  You can be evaluated for a real UTI, where a urinalysis and urine culture will determine if there’s been an overgrowth of harmful bacteria in your urine.  If the urine culture is positive, then appropriate antibiotics can be taken for treatment of a real UTI. However, when the urine culture comes back negative (even when it may have visually appeared positive), the patient may still be experiencing symptoms that are very real. I have discussed this phenomena with my patients who suffer from these fake UTIs, for which the suffering is not only real, but a frustrating event in their lives. Add to that a delay that sometimes occurs getting the results of a urine culture, and if it’s negative, the need for a solution intensifies.

Now the question is: how do you treat a fake UTI? The key is supporting your body so it can heal from what is an inflammatory process happening in your urinary tract. Your immune system can rise to the occasion if helped to do so, by alleviating the process at the root of the problem. Steps to take include increasing water intake; getting adequate, good-quality sleep; eating nourishing foods; managing one’s stress and avoiding activities that are irritating to this sensitive area of the body.

But beyond basic health measures, some women take probiotics, some of which are formulated to promote urinary health, that provide live microorganisms thought to be “good bugs.” Lactobacillus, the active cultures in yogurt, are another example of good bugs that may sound familiar, known to promote healthy intestinal flora. (But keep in mind: probiotics are largely unregulated by the U.S. Food and Drug Administration, and most lack proven scientific results.) Some women find whole cranberry or cranberry supplements helpful, as there are natural elements in cranberry that have been used for thousands of years to support urinary tract health. On the other hand, some women find cranberry juice and cranberry products irritating and it can make them feel worse.

For more immediate symptom relief, an old standby in your medicine cabinet may help. Pyridium also known as “Azo” (active ingredient is phenazopyridine) is a urinary analgesic that is an over-the-counter medication that turns your urine bright orange and can help take the discomfort away temporarily and help you get through the day. Some recent studies showed that ibuprofen worked as well as antibiotics in the treatment of uncomplicated UTIs, though women who took ibuprofen felt symptoms longer and showed an increased risk of kidney infection. But in the case of fake UTIs, ibuprofen could be helpful for reducing inflammation and associated symptoms. Not to mention that in this age of increasing resistance to antibiotics, we need to be judicious in their use. Antibiotics kill the bad bacteria and the good bacteria, disrupting the natural flora of our bodies. Understanding the delicate balance and function of microorganisms is important for maintaining our body’s natural defenses.

So if a fake UTI suddenly becomes a bigger problem in your life than fake news, know there are ways to fight back. Nothing is more real than your good health!

Lee_UnaUna Lee, MD is a urologist specializing in urogynecology at Virginia Mason Medical Center in Seattle. Dr. Lee says she is constantly inspired by the strength and resilience of women in her care. She hopes to alleviate the stress of conditions like real and fake UTIs by bringing a deeper understanding of these sensitive body parts.

Preventing Urinary Tract Infections: Can You Go Natural?

**By Una Lee, MD**

If you have ever had a urinary tract infection (UTI), you know how debilitating and miserable it is. You also know that the usual treatment is a course of antibiotics. Some frequent sufferers may have tried antibiotics as a preventive measure, such as taking a low-dose antibiotic daily, or after sexual activity, when women are more vulnerable to UTIs. While studies have shown preventive antibiotics are safe and effective, there are some promising non-antibiotic options to consider for keeping UTIs at bay.

  • UTIReview your personal risk factors. UTIs occur for a variety of reasons that can’t always be prevented, but it can’t hurt to think about what you could change to reduce your risk. Do you always wipe front to back after using the toilet? Are you using a spermicide, some of which are known to kill the “good” bacteria and let an infection take over? Are you drinking enough non-caffeinated fluid? Whatever the case don’t get too stressed: scientific evidence supports that different biological factors simply make some women more vulnerable to UTIs. There are also different times in a woman’s life when she may be more susceptible, which makes healthy habits even more important.
  • Vaginal estrogen. For women who are approaching menopause, in the middle of it or beyond, their innate defenses can be altered by declining hormone levels in the vaginal area. Treatment with a low dose topical (not oral or patch-based) estrogen can help strengthen vaginal and urinary tract tissues, making them more resilient to infection.
  • Probiotics/lactobacillus/acidophilus. There is some clinical data that restoring vaginal lactobacillus is beneficial. Probiotics have theoretical benefits in that they support healthy microorganisms that may help prevent UTIs. More research is needed, but it seems to be positive so far.
  • Cranberry had been used for hundreds of years for urinary relief and treatment. The active ingredient in cranberry is the proanthocyanidins (PACs). The PACs prevent the bacteria from sticking to the walls of the bladder. Not all cranberry products and formulations are the same, and they aren’t regulated by the FDA. There is good scientific evidence that supports the use of cranberry, but if it doesn’t seem to be helping then check the amount of PACs: 36 milligrams of PACs has been shown as effective in reducing the frequency of UTIs.
  • Vitamin C. Vitamin C is thought to have an effect on UTIs by acidifying the urine, which may be deadly to infection-causing bacteria.
  • Methanamine is a prescription medication that works by making the urine inhospitable to bacteria. Because it is an antiseptic, not an antibiotic, it can help prevent a UTI, but not treat one.
  • D-mannose. More research is needed on this nutritional supplement, but the biologic mechanism, which is thought to prevent bacteria from sticking to the walls of the urinary tract, looks promising.
  • Chinese herbal medicine. While Chinese herbal medications have been used for thousands of years, the data using Western medicine standards is not conclusive in support of them preventing UTIs.
  • Natural supplements. There are many natural and botanical supplements that have ingredients that may ease urinary discomfort, and these supplements generally do no harm. The efficacy of various supplements in the prevention of UTIs has not been rigorously scientifically studied. The most commonly used natural supplements are Vaccinium macrocarpon (a species of cranberry), cranberry-lingonberry, Berberine sulfate (a plant alkaloid), and the herb uva ursi (bearberry leaf).

    Una Lee, MD

    Una Lee, MD

  • Vaccine therapy. Vaccines to prevent UTIs are in development in clinical trials, but not yet ready for prime time.

Frequent UTIs cause tremendous distress in one’s life and have a huge impact on health care costs. So for people who are interested in reducing their exposure to antibiotics, it’s good to know there are natural and non-antibiotic options that may help prevent UTIs and improve your health.

Una Lee, MD, is board certified in Urology and subspecialty certified in Female Pelvic Medicine and Reconstructive Surgery at Virginia Mason. 


How to Avoid UTIs

StormWhen I first realize the burning in the area of my bladder isn’t going away, a clip from the movie “The Perfect Storm” starts playing in my head. It’s when George Clooney, the doomed fishing boat’s captain looks out at the eerily calm horizon and says matter-of-factly: “It’s not going to let us out.” He’s referring to the deadly storm that is moments away from engulfing the hapless boat, like the bacteria that I know is overwhelming my urinary tract.

If like me you’re a veteran from the war on urinary tract infection (UTI), you already know how quickly they come on. Bacteria get introduced into the urethra all kinds of ways we’d normally not mention in polite company – like forgetting to wipe front to back and having sex. Virginia Mason urologist Ksenija Stefanovic, MD, PhD, has a couple more causes worth mentioning: new sexual partners (the more partners, the greater the risk) and the use of spermicide, as with a diaphragm, for birth control. Spermicides can disrupt normal bacteria in the vagina and urinary tract, leaving the area open to attack.

I believe my last vacation UTI was caused by a similar chemical disruption: a marathon soak in a chlorinated hot tub. Because I’m a UTI frequent flyer, my doctor’s office was able to phone in a prescription for antibiotics where I was vacationing. However you might not have this option if it’s your first UTI, your symptoms aren’t straightforward, or if you’re running a fever and/or have low back pain (the latter an indication the kidneys may be involved, which is more serious).

So what really is the message in this tedious personal UTI history? Prevention, my fellow sufferers, and perhaps some tips to save our UTI-free sisters from ever knowing that bladder-in-a-vice feeling. Here’s what you can do:

  • Drink water like you mean it. I know, pretty obvious: drinking plenty of water flushes the urinary tract and keeps bacteria at bay. But if you’re like me and regard plain water with a yawn, the reminder is necessary.
  • Go after the glow. Most women have heard the one about urinating after sex, but it bears repeating because it’s such a frequent cause of UTIs. By going afterward, any bacteria that have been nudged into the urinary tract will be washed away before they have a chance to stir up trouble.
  • Beware the “summer breeze.” Scented feminine hygiene products can actually irritate the urinary tract, making it vulnerable to attack. If you’re suspicious of a soap, spray or other smelly product you use, dump it.
  • Embrace cranberry. Cranberry is thought to decrease the risk of UTI by preventing the binding of bacteria to healthy cells. Also, cranberry makes urine more acidic, which may have an antibacterial effect. While drinking pure, unsweetened cranberry juice is one source, I found cranberry extract in a gel capsule to be much more convenient – and a lot less bitter. Remember: it only works as a preventive measure. Cranberry can’t cure a UTI once it has developed.

Finally, a reminder from Dr. Stefanovic: If you are prescribed antibiotics for a UTI, be sure to take the full course of medication, even if you’re feeling better.

So go forth, my sisters, to work, play and vacation in good urinary health. And leave the perfect storm to Mr. Clooney and the boys.