What are urinary tract infections?
Urinary tract infections (UTIs for short) are bacterial infections of the urethra, bladder and/or
kidneys that cause burning sensations when peeing, abdominal/pelvic pain, the constant feeling
of needing to pee, and cloudy or bloody pee with a strong odor. Approximately half of women
will experience a UTI in their lifetime, with 27% experiencing a second UTI within 6 months of
their first (1). UTIs are caused by bacteria from your genitals entering your urethra. This can occur due to sexual contact, wiping habits when toileting, a weakened immune system or disrupted bladder and/vaginal biome .
This is why you often hear the advice ‘pee straight after sex’, because peeing can flush potentially harmful bacteria out of your urethra. Women have a shorter urethra than men, meaning the bacteria has less distance to travel to cause an infection, which is why UTIs are more common in women.
Can emotions cause UTIs?
There are no emotions that can cause you to contract a UTI, only genital bacteria can
do this. However, long-term psychological stress, which encompasses negative feelings of
anxiety, sadness, worry, guilt and anger, can make you more susceptible to developing UTIs.
When we feel stressed, our body releases a bunch of hormones, including cortisol. Cortisol
triggers a whole host of physiological reactions, including reducing the diversity and richness of
our urinary microbiome (2). The urinary microbiome describes the community of microorganisms that live within your urine in your bladder. There are many microorganisms in the world with various different purposes, and the ones living in your urine are there to help protect you from bacterial infection. Research has shown that women who are experiencing chronic stress, have less diverse and rich urinary microbiomes, and are subsequently at higher risk for developing a UTI. In essence, being chronically stressed can make it more difficult for your bladder to fight infections.
The UTI- stress cycle
Living with UTIs can make you feel sad, anxious and embarrassed, as well as lowering your
self-esteem and leading to social withdrawal (3). If you are struggling with UTIs and are feeling
any or all of these emotions, this is completely normal. As a result, a vicious cycle is born; UTI
increases chronic stress, consequently your urinary microbiome is vulnerable, and you contract
another UTI, which leads to further chronic stress,and then the cycle repeats itself.
Treatment
Treatments for UTIs include painkillers and courses of antibiotics. For 90% of people these
treatments are effective, however for 10% this medication alone is not sufficient at treating and
preventing the symptoms of UTIs (4). It is important for individuals experiencing chronic UTIs to
prioritize their mental health as well as their physical health. When depleted and unwell, it can be hard to know what to do for the best. Simplistic suggestions don't quite cut it. Getting personalised and tailored support can make all of the difference.
Being informed and supported is fundamental. Live UTI Free has some brilliant resources and provides support to many women experiencing ongoing chronic UTI.
Dr Sula has recently been featured in the iPaper for commentary on living with chronic UTI and the impact on mental health.
References
(1) Medina, M., & Castillo-Pino, E. (2019). An introduction to the epidemiology and burden of urinary
tract infections. Therapeutic advances in urology, 11, 1756287219832172.
https://doi.org/10.1177/1756287219832172
(2) Wu, P., Chen, Y., Zhao, J., Zhang, G., Chen, J., Wang, J., & Zhang, H. (2017). Urinary
microbiome and psychological factors in women with overactive bladder. Frontiers in cellular and
infection microbiology, 7, 488.
(3) Coyne, K. S., Wein, A. J., Tubaro, A., Sexton, C. C., Thompson, C. L., Kopp, Z. S., & Aiyer, L. P.
(2009). The burden of lower urinary tract symptoms: evaluating the effect of LUTS on
health‐related quality of life, anxiety and depression: EpiLUTS. BJU international, 103, 4-11.
(4) Alanazi M. Q. (2021). Clinical Efficacy and Cost Analysis of Antibiotics for Treatment of
Uncomplicated Urinary Tract Infections in the Emergency Department of a Tertiary Hospital in
Saudi Arabia. Therapeutics and clinical risk management, 17, 1209–1217.
https://doi.org/10.2147/TCRM.S334886