Managing Women's Urogenital Health

Suffering from cystitis, thrush or bacterial vaginosis? Find out how to alleviate your pain and discomfort naturally.

Managing Women's Urogenital Health photo

From bacterial vaginosis to chronic urinary tract infections, women’s urogenital problems can be painful and life limiting. Nutrition and lifestyle changes can help optimise women’s urogenital health and wellbeing and alleviate symptoms.

Urinary tract infections, thrush, and bacterial vaginosis are some of the most common health issues affecting women. The term ‘urogenital health’ covers any condition relating to the urinary tract and genital region, including:

  • Cystitis
  • Bacterial vaginosis
  • Interstitial cystitis (IC)
  • Bladder Pain Syndrome (BPS)
  • Thrush
  • Vulvodynia

Cystitis, Interstitial Cystitis, and Bladder Pain Syndrome

Cystitis is the medical name for inflammation of the bladder. A bacterial urinary tract infection is usually the cause of this inflammation, with E. Coli species commonly responsible for cystitis.

Symptoms include pain when peeing, urgency to pee, only passing a small amount of urine, and lower abdominal pain. Drinking lots of water and other self-help measures can help, but in some cases antibiotics may be needed to clear the infection.

Interstitial cystitis, also known as Bladder Pain Syndrome (BPS), is a chronic form of inflammation and pain not typically caused by bacterial infection.1 It mostly affects women aged over 30 but can affect men and women of any age.

Symptoms of Bladder Pain Syndrome

  • Intense pelvic area pain
  • Sudden urgency to pee
  • Needing to pee frequently through the night
  • Blood in urine (haematuria)
  • Pain in the lower abdomen as the bladder is filling up, which is relieved by peeing
  • Pain in other areas such as the vagina, vulva, rectum, and lower back

These symptoms can come and go with weeks and months of remission between flare-ups. It is important to see a GP if there is blood in your urine as this can be a sign of infection.

What causes Bladder Pain Syndrome?

In some cases, BPS can be caused by a previously undetected bacterial infection. As the symptoms of BPS relate to many other conditions, testing is important to investigate other potential underlying causes such as:

  • Pelvic floor dysfunction: the pelvic floor muscles need to be able to relax for normal urination to happen. Muscle spasms in the pelvic floor interrupt the muscular co-ordination needed for normal urination, and can lead to pain, incomplete urination, and urinary urgency.2 Tension in the pelvic floor muscles also contributes to pain in the rectum, perineum, vulva, and vagina. Disrupted nerve signalling between the muscles can stimulate mast cells in the bladder wall to release proinflammatory substances, leading to localised bladder inflammation and further pain.
  • Chronic constipation and/or Irritable Bowel Syndrome (IBS): the bladder and bowel have closely related nerve pathways and bowel conditions can affect both bladder and pelvic floor function. Neural crosstalk between the organs means that constipation and IBS can contribute to BPS.2 The microbial imbalance in the gut microbiome seen in constipation and IBS also increases the risk of bacterial imbalance in the urinary tract, predisposing it to infection.
  • Medication side effects: certain medications can impact bowel function, which in turn can contribute to symptoms of BPS.

Bacterial vaginosis and thrush

Bacterial vaginosis (BV) develops when the natural bacterial balance in the vaginal tract is disturbed. A normal vaginal microbiome is dominated by Lactobacilli species which maintain a slightly acidic pH level, inhibiting the growth of potentially harmful microbes. In BV, this balance is disrupted, allowing the pH to rise and species such as Gardnerella vaginalis – the most common BV pathogen - to proliferate.

The vaginal microbiome can be affected by sexual activity, when using perfumed hygiene products, douching, or by hormonal fluctuations during pregnancy and menopause.

Many women have no symptoms of BV. The most common symptom is a change to the normal vaginal discharge: in BV, discharge becomes watery, grey, and has a fishy odour.

Thrush also causes changes to vaginal discharge, but with thrush discharge becomes thicker and may look like cottage cheese. Unlike BV, thrush is caused by yeast overgrowth in the vaginal tract.


Vulvodynia

Vulvodynia describes chronic pain in the vulva, the area just outside the vagina.3 Symptoms include burning, stinging, sore sensations, and pain during sex, even though the vulva looks normal. These symptoms may occur alongside BPS, IBS, and vaginismus (involuntary tightening and spasming of muscles in the vagina).

The cause of vulvodynia often relates to nerve damage in the vulva caused by:

  • Childbirth
  • Surgery
  • Trapped nerves
  • A history of severe thrush infections

In some cases, the exact cause remains unclear. However, it is important to understand that vulvodynia has nothing to do with personal hygiene and is not contagious.

The role of the microbiome

Women’s urogenital health is closely connected to the health of the gut and vaginal microbiomes. Any imbalances (known as ‘dysbiosis’) in these microbial communities can allow pathogenic species of bacteria and yeasts to proliferate and translocate between the different areas, causing symptoms.

The vaginal microbiome has a lower diversity than the gut microbiome because of the dominance of Lactobacilli species. Lactobacilli and their metabolites keep in check the other species within the vagina such as Candida, Gardnerella, Actinobacteria, Prevotella, Veillonellaceae, Streptococcus, Proteobacteria, Bifidobacteria, Bacteroides, and Burkholderiales.4 The levels and composition of these microbe communities varies over the course of the menstrual cycle and during pregnancy and menopause and between different ethnicities.4

Bacterial vaginosis has been shown to be responsive to the use of probiotic supplements. One review concludes that the use of Lactobacillus acidophilus, Lactobacillus Rhamnosus GR-1, and Lactobacillus fermentum RC-14 at a dose of at least 10 CFU/day for 2 months provided the best results for managing BV.5

Probiotics for BV can be used alongside antibiotic treatments. A small-scale study of 125 premenopausal women diagnosed with BV showed that a combination of antibiotics and probiotics provided better outcomes than antibiotics alone, with 88% of the antibiotic/probiotic group demonstrating full remission of BV symptoms compared to 40% in the antibiotic/placebo group.6

Recurrent UTI’s may also benefit from probiotic supplementation. The research into using probiotics for UTIs is mixed, however there is evidence that probiotics can be as effective as antibiotics, without increasing the problem of antibiotic resistance.7


The impact of perimenopause and menopause

The hormonal shifts of perimenopause and menopause have a significant impact on women’s urogenital health. During perimenopause, oestrogen fluctuations and elevated levels of follicle stimulating hormone can increase the risk of vaginal candida overgrowth and thrush. As perimenopause progresses and oestrogen levels decline, the vaginal lining gets thinner and more sensitive, and loss of collagen and elastin affects the muscular structure. Pelvic floor muscles can weaken too, affecting bladder and bowel function and increasing the risk of prolapse.

Nutrition and lifestyle support for urogenital health

Nutrition and lifestyle changes can help optimise urogenital health at any stage in a woman’s life. These steps work alongside mainstream medical treatments and may help alleviate symptoms and strengthen protection against infection.

Anti-inflammatory foods

UTI’s, BV, and cystitis all involve inflammation. Incorporating anti-inflammatory foods into the diet on a regular basis provides the body with the nutrients it needs to help manage inflammation and repair damaged cells.

Anti-inflammatory foods include:

  • Berries: blueberries, cherries, strawberries, raspberries, cranberries, haskap berries, and blackberries
  • Oily fish: salmon, sardines, mackerel, anchovy, trout, and herring are rich in omega-3 oils that form anti-inflammatory prostaglandin molecules
  • Herbs and spices: turmeric, ginger, cinnamon, rosemary, black pepper
  • Nuts and seeds: good sources of omega-3 and omega-6 oils

Phytoestrogens

During perimenopause and menopause, phytoestrogen compounds can help the body adapt to fluctuating oestrogen levels. Plant-based oestrogens latch onto oestrogen receptors, helping modulate the oestrogen response, providing a weaker response when normal oestrogen is high, and a gentle boost when it is low.

The top 6 sources of phytoestrogens are:

  1. Ground flaxseeds
  2. Red clover sprouts
  3. Fermented soya products
  4. Broccoli
  5. Alfalfa and mung bean sprouts
  6. Chickpeas

Cranberry extract

Cranberry extract has a long history of use for managing UTI’s as it reduces the ability of E. Coli to cling to the bladder wall. The juice is usually sweetened with sugar which can feed pathogenic bacteria, so opt for unsweetened juice or cranberry extract supplements.

d-Mannose

In a study of 308 women with a history of recurrent UTI’s, d-mannose powder was shown to significantly reduce the risk of recurrent UTI and was comparable to antibiotic treatment.8

Prebiotic and Probiotic foods

Prebiotic foods such as oats, stewed apple, banana, asparagus, onions, and garlic provide soluble fibre for gut bacteria to feed and ferment on. Probiotic foods are foods that naturally contain species of beneficial bacteria to support the levels and diversity of our own gut microbiome. These include sauerkraut, kefir, kimchi, and natural yoghurt.

Mindfulness Based Stress Reduction (MBSR)

A small-scale randomized controlled trial has demonstrated that MBSR techniques may be a helpful adjunctive therapy for women managing BPS (Bladder Pain Syndrome).9 As BPS is a chronic and painful condition, a regular MBSR practice can foster a sense of empowerment and strengthen the ability to cope with symptoms.

Yoga

Hatha Yoga can be useful for increasing bodily awareness, coping with ongoing stress and chronic pain, and improving the tone and strength of the pelvic floor.10 Women with pelvic floor dysfunction, lower back or genital area pain, and urinary incontinence may benefit from a tailored Hatha yoga programme to support symptom management.

Summary

Urogenital conditions can be painful, distressing, and life limiting. Chronic conditions have a significant impact on work life and personal relationships, and the exact cause of many of these issues can be hard to find. Nutrition and lifestyle changes offer simple steps that can alleviate symptoms and help prevent conditions from recurring.

NHS. Bladder Pain Syndrome (interstitial cystitis). [internet] [18 Feb 2022] Available from https://www.nhs.uk/conditions/interstitial-cystitis/

Gupta P, et al. A multidisciplinary approach to the evaluation and management of interstitial cystitis/bladder pain syndrome: an ideal model of care. Transl Androl Urol. [internet] 2015. 4(6):611-9. Available from doi: 10.3978/j.issn.2223-4683.2015.10.10.

NHS. Vulvodynia (vulvar pain). [internet] [24 May 2019]. Available from https://www.nhs.uk/conditions/vulvodynia/

Chen, X, et al. The Female Vaginal Microbiome in Health and Bacterial Vaginosis. Front. Cell. Infect. Microbiol. [internet] 2021. 11:631972 Available from doi.org/10.3389/fcimb.2021.631972

Homayouni A, et al. Effects of probiotics on the recurrence of bacterial vaginosis: a review. J Low Genit Tract Dis. [internet] 2014. 18(1):79-86. Available from doi:10.1097/LGT.0b013e31829156ec

Anukam K, et al. Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral probiotic Lactobacillus Rhamnosus GR-1 and Lactobacillus Reuterii RC-14: randomized, double-blind, placebo-controlled trial. Microbes Infect. [internet] 2006. 8(6):1450-1454. Available from doi:10.1016/j.micinf.2006.01.003

Beerepoot MA, et al. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med. [internet] 2012. 172(9):704-712. Available from doi:10.1001/archinternmed.2012.777

Kranjčec, B., Papeš, D., Altarac, S. D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World J Urol. [internet] 2014. 32(1):79-84. Available from doi:10.1007/s00345-013-1091-6

Kanter, G., et al. Mindfulness-based stress reduction as a novel treatment for interstitial cystitis/bladder pain syndrome: a randomized controlled trial. Int Urogynecol J [internet] 2016. 27:1705–1711. Available from doi.org/10.1007/s00192-016-3022-8

Ripoll, E., Mahowald, D. Hatha Yoga therapy management of urologic disorders. World J Urol. [internet] 2022. 20:306–309. Available from doi.org/10.1007/s00345-002-0296-x