The Patient: Andrea, a 33-year old software engineer.

Why she came to see me: Two weeks before walking into my office, Andrea had been feeling fantastic. Recently back from her honeymoon, she and her husband had just started training for their first triathlon—an endeavor that had her on the trails or in the water five to six days a week. In the last week, however, she’d begun experiencing a range of disconcerting symptoms, from vaginal itching and irritation to an increased urge to urinate that was often accompanied by pain.

At first these symptoms seemed “mild,” but her face disclosed what she quickly reported: They’d intensified to the point that the mere thought of going pee left her anxious. Certainly, no stranger to urinary tract infections, Andrea was determined to prevent future infections so that she could compete in the upcoming race with her husband…and relish her life as a newlywed.

How I evaluated her: I started off with an in-office urine test. Besides looking for bacteria itself, I also look for the presence of white cells (which indicate an infection), red cells (which indicate blood in the urine—another sign of an infection), and nitrites (which indicate bacteria in the urine). In addition, I sent her urine sample off to be cultured, including a sensitivity test to determine the best antibiotic if results indeed show abnormal bacteria growth.

I also checked Andrea’s kidneys by doing a kidney punch (also called a Murphey’s percussion test), which is a gentle punch to the area near where her kidneys are. Tenderness or and/or pain indicates a person may have a kidney infection. (UTI’s can become kidney infections if not treated promptly.) No pain after the thump means no kidney infection.

Because she complained of vaginal itchiness and irritation, I sent in a vaginal culture too.

Finally, I conducted an in-depth discussion of Andrea’s lifestyle and general well-being.

What my evaluation revealed: While Andrea’s kidneys weren’t tender (a telltale sign of infection), her urine culture revealed an infection with E. Coli. Formally known as Escherichia coli, it’s a bacterium we’re exposed to daily. However, when our immune systems are impaired—due to stress or illness—E. Coli can multiply and cause infections. This includes urinary tract infections, a condition that drives 8.1 million visits to the doctor every year and which, as I assumed, Andrea was suffering from.

More prevalent among women than men, UTIs are frequently accompanied by the very symptoms she was experiencing, from a powerful, unrelenting urge to urinate to acute pain with urination. Dehydration—a common side effect of intense physical training—as well as the frequent sex Andrea and her new husband had enjoyed on their honeymoon and beyond, may have also contributed to her present urinary tract infection in that it can cause irritation to the urethra and vagina.

The good news? Her vaginal culture was normal, meaning she didn’t have an overgrowth of yeast or bacteria there.

How I addressed the problem: For her acute infection—the UTI—I prescribed a combination of natural and Western medicine, utilizing “the best of both worlds.” Urinary tract infections that have gone on for too long—usually greater than 4 days—are very difficult to treat with natural medicine alone, and sometimes an antibiotic is necessary to completely resolve the problem. (Most UTIs that I treat within that 4-day window can be successfully treated with just natural medicines.)

  • Antibiotics: I gave her a prescription for an antibiotic that was shown to be sensitive to eradicating the bacteria found on her culture.
  • Botanicals: I prescribed several botanicals in the form of a tincture consisting of uva ursi (a diuretic), kava (an antispasmodic), goldenrod (an anti-inflammatory), and berberine (a natural antimicrobial). These herbs are known to support the extermination of a bladder infection.
  • Probiotics: I gave her a combination of lactobacilli and bifidobacter bacteria, taken orally, to replenish healthy flora in her intestines.
  • Marshmallow root tea: Drinking three cups a day to help rebuild and soothe the mucus membranes of her bladder and urethra.
  • Fruit extracts: I encouraged her to take one cranberry capsule a day to keep her urine acidic—thus preventing bacteria from thriving—and one teaspoon of D-mannose as well. A natural sugar found in pineapples and cranberries, D-mannose can further assist with the removal of bacteria from one’s urethra and bladder by making the mucous membranes of the urethra more resistant to bacterial adhesion, thereby blocking bacteria from climbing up the urethra into the bladder.

One of Andrea’s biggest complaints with the treatments she’d received for UTIs in the past was that she would often get them after sex. She would take antibiotics to solve the problem only to return to the health center a few weeks later with the same symptoms. To that end, we also took a look at her lifestyle. While her life was, as she described it, “wonderful,” a surplus of stress—classically defined as anything that shakes up the nervous system and that can be negative (like a loss) or positive (like a new marriage)—may weaken immune function and increase one’s vulnerability to illness and infection.

I urged her to pair her demanding triathlon training with more relaxing “yin” exercises such as gentle yoga, stretching and walking, which have long been known to diminish stress and anxiety. I also advised her to increase her water intake to compensate for the fluid loss she likely experiences during training.

To decrease the possibility of tissue irritation, I urged her to use a natural lubricant with sex and to avoid using soap directly on her urethra (no matter how sweaty she may feel after training) as soap can alter the pH of a woman’s vulvar tissue, create irritation and potentially allow unwanted bacteria to flourish.

I further encouraged her to wait at least 20 minutes before urinating after sex to allow her engorged tissues to resume their relaxed state. Urinating too soon after intimate relations can prevent bacteria from being adequately flushed from the urethra.

The patient’s progress: Andrea resolved her acute UTI. Months later when I saw her for a different issue, she reported that she and her husband had returned to their healthy, happy life without any recurrence of UTI symptoms. Which, of course, was quite clear: She had that new-bride glow and boatloads of energy.

To learn more, visit Dr. Laurie Steelsmith’s website,, or click her to read her most recent book, Growing Younger Every Day: The Three Essential Steps for Creating Youthful Hormone Balance at Any Age.

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