What is an UTI?
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Here's how Prof. Graziottin answers this question from her patients:
First of all, Urinary Tract Infections (UTI) are caused mostly by Uropathogenic Escherichia Coli (UPEC). What does it mean? The name is clear, this germ can attack the bladder, the urethra and also the kidney, causing very very serious infections of increasing severity
This UPEC, Uropathogenic Escherichia Coli, is a member of a big family, more than 100 brothers, so to speak. They live very happily. They live happily in our gut without causing any harm. However, when the UPEC reaches the urinary tract, it can attack the urinary cells (say the urothelium and later the bladder and the urethral wall) with a very specific damaging strategy.
What we know now is that the UPEC can attack the bladder via three major pathways:
- The first is via the perineal area, attacking the vagina first, and the bladder second. This pathway is more frequent in situations when the woman has low or no estrogens, for example, when she has no periods because she has psychological emotional problems or eating disorders, or when she is lactating, or after the menopause. In all these three conditions, where the level of estrogens is very low in the tissue, we have a major change in the microbiota in the vulva, in the vagina, and in the bladder, and this microbiome becomes more vulnerable to the attack from the Escherichia coli uropathogenic.
Important: the bladder has its own natural protective microbiome. In healthy conditions, one-third of the bacteria are similar to the vaginal Lactobacilli!
Physicians should carefully evaluate the clinical situation. When non-contraindicated, estrogens and testosterone therapy in the vagina (with testosterone applied in the upper part of the vagina) is the first effective strategy aiming at restoring the protective Lactobacilli in the vagina.
- Second, the Uropathogenic Escherichia coli, which is specialized in attacking the bladder may attack via the reactivation of the so-called “intracellular bacterial communities” (IBCs). What does it mean? During the first or second or third attack of cystitis, Escherichia coli takes away the coat, attacks the cells that line the inner part of the bladder and the urethra, enter into the cell, and become resident. These become resident intracellular bacterial communities that are almost dormant, but become very aggressive, for example, 24-72 hours after intercourse, causing post-coital cystitis.
- They can also attack the bladder through the bowel wall, They can attack through the bowel wall when the woman complains of irritable bowel syndrome, diarrhea, constipation, food intolerance to lactose or gluten, or after antibiotics. In all these cases, we have gut dysbiosis, and because we said this will damage also the wall of the bowel and cause the so-called leaky gut syndrome, say, we have a passage of germs through the bowel wall, and this via the lymphatics or the blood can attack the bladder and the urethra.
So, three major pathways, the first through the perineal area, attacking first the vagina and then the bladder, this is particularly relevant when estrogens are low. Second, through the reactivation of Escherichia coli already inside the bladder wall, and third, through the bowel when we have gut symptoms.
A good collaboration with a competent gastroenterologist is, therefore, key to addressing this component of the infection of the bladder stemming from the bowel.
