Urinary tract infection and menopause: what you need to know

Bladder infection (cystitis) happens when bacteria, often from the skin or rectum, enter the urethra, and infect the wall of the bladder. Because women have a much shorter urethra than men, they are far more susceptible to bladder infection. 

As your oestrogen levels decrease around menopause, this can cause issues that make you even more susceptible. Oestrogen keeps tissues and mucous membranes in the vagina and urethra moist and muscles strong. When oestrogen levels fall, these tissues become thinner, drier and less acidic, and the muscles of the urinary tract weaker, making it easier for bacteria to enter the bladder through the vagina and urethra. This can result in bladder infections. 

In addition, a balanced oestrogen level helps keep the healthy bacteria in the vagina and bladder balanced. These bacteria protect against infections. Low oestrogen reduces the amount of healthy bacteria, making you more susceptible to infection, and it can also cause the pelvic floor to collapse. 

Oestrogen stimulates the production of collagen, which keeps pelvic floor muscles (and muscles and joints in general) strong and elastic. Less oestrogen means less collagen and elastin are produced, causing the pelvic floor to weaken and the bladder to drop down (pelvic organ prolapse). As a result, your bladder sometimes may not empty fully when you go to the toilet. The urine left behind can become prone to infection. 

Many women experience a host of symptoms as they go through menopause, such as hot flashes, sleep problems and mood swings. 

Urinary tract infection symptoms most commonly cause problems such as: 

• Pain or burning sensation when passing urine 
• Increased need to urinate 
• Need to urinate even though the bladder is empty 
• Cloudy urine or urine with an unusual odour 
• Bloody urine 
• Lower abdominal discomfort or groin pain 
• Fever and/or night sweats 

Women are more prone to UTIs than men, in particular after menopause. In perimenopause, 36 percent of women suffer from recurrent UTIs. This percentage increases to 55 in postmenopause. UTIs are even more common in women over the age of 65.  

If UTIs are caused by declining oestrogen levels, pelvic floor prolapse, bladder prolapse, diabetes and/or loss of healthy bacteria in the vaginal flora, antibiotics are not always the most effective solution in the long term. Antibiotics kill harmful bacteria, but they don't address the root cause of the problem. What’s more, the more often you use antibiotics, the greater the risk that bacteria will become resistant, making new infections more likely. Making lifestyle and dietary adjustments is a more effective way of preventing infection. 

There is no way to avoid menopause. However, this doesn’t mean you have to live with recurrent UTIs and their symptoms. You can prevent them by changing your lifestyle. When that isn’t enough, there are options available, such as hormone therapy. 

• Drink a lot of water. Drink plenty of water, at least two to three litres a day. Drinking water helps flush out bacteria from your urinary tract and helps prevent infection. A study was conducted where every day, one group of menopausal women drank their usual amount of fluids plus an additional 1.5 litres of water, while another group drank just their usual amount of fluids. The results showed that the women who drank an additional 1.5 litres of water had fewer episodes of recurrent bladder infection.  
• Improve gut health. The gut microbiome can affect urinary tract health. Research has shown than having a large amount of good bacteria in the gut can reduce the risk of bladder infection. Foods that are high in probiotics (e.g., kimchi, sauerkraut, yoghurt and kefir) and prebiotics (e.g., wheat bran, whole grain products, vegetables and fruit) support your intestinal flora. Eat slowly and chew well. This will help your body to absorb the nutrients. 
• Avoid foods that irritate the gut. Certain foods, such as acidic foods, may promote inflammation. Avoid acidifying foods, such as coffee, alcohol, soy, sugars and fast carbohydrates, cheese and meat. 
• Take a shower instead of a bath. The presence of soap and shampoo in the bath water makes it easier for water and germs to enter the vagina and urinary tract. 
• Avoid using soap and intimate hygiene products. You should wash your vulva with warm water. You don't need to use soap. 
• Urinate after sex. During sex, bacteria can enter your urethra, raising your chances of getting an infection. Peeing after sex may help to flush bacteria out of the urethra, thereby helping to prevent a UTI. Tip: drinking a large glass of water makes it easier to urinate. 
• Consider taking a D-mannose supplement. Research has shown that D-mannose works to treat or prevent UTIs. D-mannose is a kind of sugar that is related to glucose. It's found in small amounts in foods such as lentils, berries, pineapple and mushrooms. Taking a D-mannose supplement can also provide effective urinary support. 
• Explore medical options, such as hormone therapy. Do you suffer from recurrent UTIs? A local HRT (vaginal oestrogen) can be beneficial in preventing UTIs after menopause. Talk to a doctor to find out what options are available to you. More about hormone therapy.