Tickly, Phantom, Burning Pee a UTI chat with Dr. Abby Drucker

Have you ever rushed to the bathroom with the urge to pee only to find that there's only a few measly trickles? 

or have you sat down on the toilet to find that your pee is burning and irritating as it comes out?

You may have a bladder infection. Also referred to as a Urinary Tract Infection or a UTI.

If you've ever experienced this, you're not alone. It's estimated that around 60% of women will have at least one UTI in their lifetime. 

And we become more prone to UTI's as we enter our post-menopausal lives.

And whilst both men and women can experience a UTI, women are 30x more likely to develop a UTI (we'll get into why in the episode).

Join Dr. Denise Poulos, her daughter Val (the girl & her gyno-mom), and their special guest, Dr. Abbey Drucker, as they delve into:

What's causing UTI's and what can we do about them?



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Learn more about our special guest: Dr. Abbey Drucker

https://www.childrensnebraska.org/provider/abigail-c-drucker-md/

Resources:

https://www.notsoprivateparts.net/show-notes

Transcript

Listener Experiences:

I just wanted to give an overarching idea of my experience with UTIs, of which have had many, and  many varied types of UTIs, or they feel different.  The most impactful symptoms I've personally experienced is an overarching  discomfort and pain throughout my lower back and abdomen,  and bloating.

And of course, there is the incredible discomfort and pain while peeing and the urgency to pee every moment, even if you don't have to.  It's very, very uncomfortable and it has definitely affected my work.  At points in time I might be on the road and unable to  quickly access the bathroom.

It can be very, very inconvenient and painful. 

 My experience with having a UTI is pretty normal with the symptoms that you read online.  The frequent feeling of having to go to the bathroom and then sitting on the toilet and not much comes out,  very frustrating.  Also the  sense of burning or itchiness, also very unpleasant.  It's nice that we get  those symptoms, not saying it's Nice, because they're not nice, but it's good that we get those symptoms so we can get checked right away and get it solved.

Although they're very uncomfortable and not fun at all. At least we know that we need to get checked and get that medicine to help us out and make us feel better.

Intro:

Does any of this sound familiar to you?  It sure does to me. In fact, I even had a UTI while I was editing this episode.  So what is causing urinary tract infections and what can we do to support ourselves through them or get rid of them?  Luckily, in today's episode, we're going to find out. 
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NSPP Theme Song:

When you know your body, you feel empowered. Open conversation, safe space, sharing stories, knowledge.  Learning together,  growing and knowing not so private parts.

Just a girl and her gyno mom, let's get into it.

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  Acknowledgement of Country:

We would like to begin today's episode by acknowledging the traditional owners of the land in which we dreamed about, created, and recorded this podcast.  The Gadigal people, the Bedigal people, the Potawatomi people, and Peoria people. We pay our respect to elders past and present and acknowledge First Nations peoples continual culture and contributions they make to the life of these regions.  

Medical Disclaimer:

Whilst in this this episode, we will be hearing from medical experts. Please consider this to be personal medical advice. If you have a condition that needs treatment. Please see your own physician to be properly evaluated, counseled and treated

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Getting into the Episode:

 Today we are thrilled to welcome Dr. Abigail Drucker. Dr. Drucker is an obstetrician gynecologist based in Omaha, Nebraska. There she works out of the children's Nebraska hospital.

I will let my mom introduce her a bit more because the two of them. Go back. 

Yes, I got to meet Abby when she was finishing her residency and was looking to train in urogynecology. So I quickly made her an offer and asked her, please come to the Chicago area and train with us. And she worked with us for 3 years, and Abby is 1 of the smartest.

Physicians I've ever met. She has not only a great bedside manner, but she had some amazing ways of explaining difficult medical problems to patients in simple terms.  She's also an incredible surgeon.  And she does amazing advocacy work.

Now we're both very involved in ACOG, the American College of OBGYN.  I know Abby's involved at least at her state level and it's really important to advocate with our legislators for laws that make sense for women's health, and ongoing to let legislators understand  what their laws really do to us.

Right back at you. Thank you so much for including me. I'm so excited to be here.  I just have to say, I've listened to a couple of podcasts. I think you're fantastic. I love the concept of just talking about women's health issues that sometimes we are.

Maybe a little bit too taboo or maybe a little bit scared to talk about with our friends and family. And so I love taking the stigma off it. And my gosh, Denise, right back at you, I couldn't ask for a better mentor in terms of surgical techniques, just life in general. You're a good one. 

First thing I want to get to know you a bit better. Should I call you Dr. Drucker or Abby?

No, please call me Abby. Thanks for asking.

Okay. Well, Abby. I would love to know what inspired you to become a gynecologist and work in this field.   

I think that kind of getting back into medical school, which is kind of like, so you begin medical school and you go through  the basics of how all your body systems work, what can go wrong, what practicing as different types of physicians would look like.

And so you kind of get to try on different fields for size, right? See what fits you.  I always really loved the idea of  procedures and surgery and doing things with my hands. That really was something that was important to me.  I always thought I was going to be a vascular surgeon actually.

And then I got into my surgical rotation.  I loved it. It was fascinating, but, and no offense to any of the people that I trained with, but the surgeons were just terrible, terrible people. So like unhappy with their lives, they seem like, and granted that was a select group of residents who I'm sure were working 120 hours a week and never got to see their families and all that.

But so that was  my first foray into surgery.  I was like, Holy crap. Maybe this is not the right option for me. And then my next rotation was my OBGYN rotation.  That I loved because the patients were fascinating and interesting. The surgery was interesting.  Most importantly, the doctors that I got to hang out with were just cool people.

They had a great sense of humor.  They were really just people that you felt like you could hang out with as friends.  So if you're looking at a personality type, I felt really drawn to OBGYNs in general.   As I've gone through training and my career.  I've had the opportunity to learn from wonderful mentors like your mom and I have loved every step along the way as currently now,  I'm actually practicing as a pediatric and adolescent gynecologist.

I get to see kids, and primarily teenagers, and I get to talk about, kind of like, I feel like the stuff that you guys are talking about. Just the stuff of  what periods are like, what's normal versus what's not normal. What's the junk that can happen with periods, right? Because periods are a really big deal  especially to teenagers and young women.

Then really  looking at   how periods impact people that live with chronic medical issues, right?  So people that maybe live with,  diabetes may experience different. period symptoms or have different reproductive outcomes than people that don't live with diabetes. People with intellectual and, developmental disabilities may live with and experience periods differently than people who don't have those chronic health issues.

And so really  approaching it from a medical standpoint has really  opened a different side of my brain.  I love to talk to teenagers about  reproductive health how all that stuff works and sex and things like that.  I feel like they have a really good Educational background and how their bodies work and that's a really fun group of people to talk about because they don't let anything like they I don't have a filter.

I get to do some interesting surgeries in terms of people born with different congenital anomalies, or like our uteruses don't necessarily form as what we would consider to be typical, and that can be associated with other different,  malformations of urinary tract and bowel tract.

I get to do some interesting surgeries and really work in, a multidisciplinary care team with different types of doctors. And so I think it's just like, it's just fun.  I love the fact that, being an obstetrician gynecologist or a gynecologist in particular, I mean, what other, Type of doctor gets to care for just a group of people over their entire lifespan, right?

Like we care for kids, pregnancy, teenage, I mean, like everything, both medically and surgically. So it really gives you a chance to explore different arenas and keep yourself challenged.

  I was just thinking while you were talking, if I was a teenager and I was put in the shoes of being in an exam room and you came in as my gynecologist, I feel like you have such a warm presence and already I'd feel unabashed to  be asking my questions.

If I was a teenager, a lot of the times I feel, especially back then, anytime something is wrong when you're a young girl.

Mm-Hmm.

with anything below the belt. Yeah. I feel like automatically I go to oh my God, something is either really wrong with me.

Yeah. Or I'm pregnant, I'm really gross.  Yeah. Or I'm pregnant or I have an STD. Yes. I can't imagine anytime anything happens. My first thought is normally. Oh, my God, I have an STD. That's not saying that STDs are bad in any way, because I know that they're quite common, but more so just you don't know what's coming.

And all you've heard is all this  negative talk of everything bad that can happen to you with everything going on downstairs. I feel like having an open space to come and chat with someone that cares so much about it It makes it seem normal. It's all so normal.

Well, thank you for saying that like it's so important because there's so much stigma around Reproductive health and female reproductive health in general and I think that that stigma really unfortunately Creates a barrier for people going in to be able to seek care because the first step is just getting in the door and I'm always surprised at  the  Kind of like anxiety still that people have to overcome to just get in the door and talk to me I'm so grateful that they do But no, I think you're not alone.

I think it's a really common thing 

Oh, I would say that a large portion of my friends do not go to the gynecologist And I think a big reason is they don't want to take time off work with the doctor They think the regular doctor can handle it, which maybe a lot of times they can. The other one is just, they feel uncomfortable.

They don't want to take time off work to go somewhere to have someone be  looking at parts where we've been made to think are  so intimate and so personal to us, where you wouldn't feel weird going to a doctor and having them look at a mole on your back.  There's such a taboo about that area.

 
 

UTI Myth Busters:

 I thought we could kick off our conversation about UTIs. With a little game of myth busters, because I find that lots of times women pass information around to each other about ways to stay safe in this world or to excel in this world. And in passing around this information, we can sometimes pass along things that aren't necessarily true.

I think we do this in good faith because we're just trying to help each other out. I definitely do this.

I've written down a few things that I've heard over the years about UTIs.  I would love to hear,  if it's true or false, or if it's a bit more complicated than that. 

Feel free to play along and try to guess or have a think to yourself.

Think if you've heard any of these before, or if you've heard any other ones, then please send them in because we can do a follow up.

Okay. Number one to Abby.  True or false. Peeing after sex is a good way to avoid UTIs. 

 I'm gonna say true.   

Mom, true or false, you should wipe from front to back.

I don't think it makes that much difference. 

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 You can get a UTI from holding in your urine for too long.   

I'm gonna say false. And I know that we're not supposed to explain this stuff.

But  if you are a normally voiding woman, I don't believe  that's going to contribute to a UTI. Certainly if you're unable to void and we're in this condition of like urinary retention, that can, but if I have to go, if I have to use the toilet now and I'm going to put it off for 15 minutes, I don't think that's going to make a difference.

I agree.

Sorry, I'm not following the rules. But I want it right. We

want to get it right.  I like your explaining.  Also just for us average girlies, voiding, I've learned recently, it's expelling your urine. That's the fancy word

for peeing. Yeah, but we're not supposed to say peeing and pooping.

So we say voiding and defecating.  Oh, it's very fancy. 

So next time you want to be fancy and you got to go use the ladies room when you're out to dinner, just be like, excuse me, I have to void.

Okay, mom, up for you. Only women can get UTIs.

False. 

Abby, it's bad to have sex when you have a UTI. 

I mean, I think it would hurt.

But I'm going to say false because I took, bad in what way? I don't think it's going to make it worse, but going to be pleasant. 

Okay, and I guess the tag on that is I've heard you can give it to your partner. Oh, no, false. False. Okay.  Mom, drinking cranberry juice is a good way to get rid of UTIs. It can be.

  A UTI will go away on its own.  I'm going to say false, because if there's enough bacteria there to cause an infection, we need to treat it.   

Have either of you heard any of those before? Do you feel that they're true? Were those ridiculous to you?

Or do you feel like that's something you can understand that people would think? 

No, we hear those all the time.

Every day.  Great questions. 

Now that we've been starting to talk a lot about UTIs, first, I just want to say a UTI is a urinary tract infection.  We'll call it UTI throughout this, just because I think it's an easier abbreviation than saying all of that.

And it's pretty much the same thing as bladder infection, because a lot of times I have people like, Oh, so you had your, as your culture, you had a bladder infection last week. No, I had UTI.  People think they're different things. They're not. So bladder infection, UTI, the terms are used interchangeably.

But UTI stands for urinary tract infection. So it could also mean a kidney infection, which is way more serious, but most of the time people talk about UTI, they mean your bladder has an infection. 

Maybe you covered it, but what is a UTI? I'm feeling from what you said.  It's bacteria. What is that bacteria?

Is it meant to be there and it overgrew? Is it not meant to be there? Where did it come from if it's not meant to be there?

An infection means that there's bacteria growing in a place that it shouldn't be.   When we talk about a urinary tract infection, Denise is totally right.

Like your urinary tract involves your kidneys, that filter your blood and create your urine, your waste product, right? And then they filter down through tubes called ureters, get into the bladder, the bladder stores your urine or your waste product. You can have a urinary tract infection anywhere along that tract, but by far and away the most common places to have that bacteria living is inside the bladder.

How did it get there?  That's a great question. In most people, so when we're talking about women's health, for most people, we all have bacteria that live on our skin, right? The vulva, which is the outside area that involves the labia, the opening of the vagina, the urethra, which is the tube that drains the bladder, that's a spot that has a fair amount of bacteria living there normally, right, like more than your elbow, let's say.

Because there's more bacteria there, and because as women there's  a shorter dis it's real estate, right? So there's a shorter distance for that bacteria to be able to travel to get into the bladder. That's why women are a little bit more predisposed or higher risk to developing a bladder infection.

or is what we're calling it today, a UTI.   What's the most common type of bacteria? Usually like gut type bacteria, right? Because our anus, where we poop through, where we defecate through, is right there. And so the most common bacteria that's just naturally around is something called E. coli. that's kind of the common, or most common bad actor that causes urinary tract infections or UTIs in women.

Okay, and is E. coli, it's commonly coming from our fecal matter, but  It could be coming from other sources too,  if E. coli is living on something and then you've touched it to your vulva,  can that be a way you can contract a UTI or normally is it from fecal matter? And that's as simple as it is. Well, there's some E.

coli living on your skin around the area,  even someone would come in and apologize. Oh, my gosh, I try and wipe, I clean myself, I shower after I poop.  No, it doesn't mean you're not a clean person that bacteria is living on its skin around the anus, which is really close to our vaginal opening, close to our penis.

Your bladder opening.  It's just there and it takes more of the bacteria being there to cause an infection.

I would say, I love the question, like the, the Myth Buster question of wiping front to back, because like by far and away, like I still see moms of their kids that are like, I've told her to wipe front to back and it's not, again, I think we're kind of  placing the blame on  we're all seeking for answers about why something happened.

Right. And I think with UTIs, like we're trying to seek blame, essentially, like, oh, I didn't do something right.  As someone who is trying to wipe from, like, front to back,  on an airplane toilet, it's not possible, right?  None of us are dirty. It's just the idea that the vulva has more bacteria, likely E.

coli, that live down there naturally as compared to our elbow.  That is a place where bacterial, just the more bacteria that's there, and if you have a little, and we'll talk about this I think a little bit later, kind of about how,  our female sex hormones change, like particularly estrogen as we get older, is a variety of different kind of  gatekeepers that help to keep that bacteria out or keep those bacteria levels low.

But we all have bacteria there, and so we're not doing anything wrong. We just have A really close neighbor that allows that bacteria to be able to have a little bit shorter of  an access lane to be able to get into our bladder and cause it to grow and perpetuate and cause an infection.

What I'm hearing is it's totally normal.

You're not doing anything wrong. 

You're not grossed. A UTI every once in a while, you're not

doing anything wrong.  Okay. Yeah, I think it's really rare for a woman not to get, uh, UTI

in

her lifetime.

I, growing up, so funny that you work with teenagers. I made up this term, probably when I was a teenager, called Tickly Pee Syndrome.

We nicknamed it TPS and that's how I always referred to my UTI. I think it's because I didn't want to admit to having a UTI, but it sounded so much easier to be like, Oh yeah, it's just TPS. It made it feel so normalized.  Even some of my friends use that and didn't know it wasn't a real medical term.

It just stands for tickly pea syndrome. I'm the daughter of a doctor. Okay.  Okay. Because for me, I would say having UTIs in my lifetime,  that that is the most common thing is I get this feeling of I really have to pee even though I've either just went, so I know I don't have to pee because I just went, or I go to go pee and  there's two trickles and I'm like, what?

I felt like I had to pee so bad.  That's a symptom that I have. I would say that's what I associate with tickly pee syndrome or UTI.  What are some other symptoms? That people would have when they're having a is,  is that the main 1

1 of the most common is having to run and not having much year in there.

They just have this intense urge, even without very much urine in your bladder. The other is burning. Most women complain of burning, but that's not if you don't have burning, you can still have a bladder infection. That's not necessarily for all women.   It's the frequency. Some women notice an odor. Like, oh, man, it really stinks   in our older ladies,  the real elderly, not old like me, but really old, we'll hear mental status changes, or sometimes people get burning in their arms because they really are getting kind of these toxins running through their bloodstream.

For most women with a UTI or bladder infections, it just stays in your bladder. But for some, the toxins can travel and they get more symptoms throughout their body.

Is there a way to know for certain that you have a UTI? Let's say you're having feelings and you think, oh, I went to the bathroom.

I tried to pee and nothing came out and it's all tickly down there. Do you have to go to the doctor, or are there ways you can tell if you have a UTI on your own?

As a doctor,  I would recommend if those symptoms are there, and if you,  hydrate yourself, try to, flush yourself out a little bit, and those are still persisting, I think that I would recommend visiting the doctor, because I love your description of TPS.

There are a lot of other things that could potentially be causing those symptoms other than bacteria living in the bladder, right? The reason that we get , those  typical UTI type symptoms like Denise described is because the bacteria are living in the bladder and that bacteria is causing the UTI.

Like the bladder doesn't like that, right? They don't want bacteria in there. And so that's causing the nerves of the bladder muscle to  spasm and contract, make us feel like we always have to go to the bathroom, but then nothing comes out. Certainly there can be other things that could cause that though.

If you're having symptoms like that, I think it's a good idea to go to the doctor and get a test. test. Usually what would happen is that they can do  an initial test to just what's called like a urine dip, right? So we just kind of look at your urine,  we pass a little paper into it and it turns fancy colors depending on what different  metabolites or breakdowns of products are in the urine.

And that can give us kind of a clue that you might have bacteria in the urine, but the true test. to get an infection diagnosis or a UTI diagnosis is that somebody, this is kind of gross to think about, but this is what they do. They take your urine  they take it to the lab and they try to grow whatever bacteria is there.

They'll be able to tell you, yeah, you got E. coli and you got a lot of it. Or you have different types of bacteria that may not be so typical, in which case we might treat you differently. So I think that, yes, if you have those symptoms, don't not pay attention to them. We may recommend as physicians that you drink water, try to hydrate a little bit, but I think it's always a good idea to have an appointment with a physician or a healthcare provider to make sure that we're treating you appropriately, whether it be for a UTI versus something else.

Then 1 thing as a physician, and I bet Abby will agree is when women keep going to urgent care centers  and they, so we did a quickie dip test, which has a lot of false positives. So it may say, oh, you have a lot of white blood cells in your urine. That may or may not be a bladder infection.  They get an antibiotic, and then the culture comes back 4 days later, 3 days later, and it wasn't really an infection.

So they already took, of course, the antibiotics. Then they go again to a different urgent care. Maybe the 3rd time they go to call the primary care and say, hey, I just have 2 urgent care. Can you call an antibiotic? And now they've been at 3 antibiotics in 6 weeks.  And guess what, they kill all their good flora, and then they get a really nasty bacteria that's hard to treat.

So we don't like women just to get treated by symptoms or the quick dip test or keep doing that by establishing care with. Someone who's going to really check out is this really bacterial bladder infection. Do you keep getting bacteria or do you still have symptoms after bacteria is cleared and inflammation not better yet?

That's why we want to establish care with women with we don't want you to self treat. We don't want you to take the antibiotics you found from your grandma at her house and slept over or let her from your sons. ear infection, you know, that we want to make sure we know what's going on because then what else happens?

You take amoxicillin that you had someone had laying around from an ear infection and guess what happens when you take amoxicillin? You get a yeast. You get a yeast infection. What does that do? It can cause tickly pee syndrome. Everything is kind of itchy and burny and you're peeing more and it's not bacteria anymore.

That is the worst cycle of all.

It's terrible. And it happens all the time.  I realized that it's like, it's a pain to get off work. I realized that it's a pain to make an appointment, but I do think if this is  a cycle that you're starting to see yourself go into, it's. See a doctor. It's well worth it to get it figured out.

Before we go on, when you're talking about the P dip test, it reminded me of a memory because being the daughter of a doctor, I used to go to my mom's office when I was little just to hang out during the day on summer vacation and I remember once, I don't know why I was back there or what I was doing, but somehow I spilled a dip test, someone's urine sample.

One, on myself, so I  assumed that it was  very infected urine that was going to infect me. So one, I was hit by this,  I thought I was going to turn into Spider Man, but worse. Like I was hit and I thought, I was going to say, it's going to give you special powers. Wow. Maybe it did.  But then two, I remember my mom was so mad.

And she made me go to the patient and explain that I spilled it,  and that she needed to do another one, and it was because I was running around in the back being bad.  Yes, I love it. That's a foundational memory that you have.


So you should be going to your doctor to establish that you have a UTI.

And then, what is the most likely step if, yes, you've went, you've done this dip test, there is E. coli growing and it's showing that you could have a UTI? What would be the next step?

They'll call you in an antibiotic.

There probably are over the counter things that you can buy that you can dip your own urine and see if it looks like you may have a UTI. I really am a big proponent of actually seeing the doctor to go the step further and get the culture test Because that's going to tell you several important things  It's going to tell you what type of bacteria that you have and it's also going to tell you what the most Appropriate antibiotic selection would be because when they're growing your urine and they're trying to grow bacteria out of it They're also testing little samples of different antibiotics Thanks to see what guy kills that bacteria the fastest.

When you go see a doctor, they will call you after a couple, they may say, yeah, it looks like you have a UTI. Let's see.  Let's assume that, let's get you started on an antibiotic because you're having symptoms and don't feel so great. So hopefully we'll start kind of turning the corner from a symptom standpoint quickly, but when we call you in the next couple days, we're going to be able to tell you, you have an E.

coli infection and yes, this was the best antibiotic for, to treat that particular strain of UTI or of that particular strain of E. coli.  Or they may call you and say, Hey, guess what? You have a funky bacteria and we have to change you to this. different type of antibiotic because we know that it is a special actor against your bacteria.

They will call and follow up. They will make sure that you are on an appropriate antibiotic. It's super important even though you start feeling better hopefully after the first few days. It's super important to finish the entire course of antibiotic that your physician provides you because you want to make sure that that bacteria is not only down to a level that's making you feel better, but also gone, like fully treated so that it's gone and not allowed to grow back.

I feel you always hear about antibiotic resistance, which I feel like I got fearful of because of course  everyone's getting UTIs. Everyone wants to go out.  And you know that you can't drink when you're on antibiotics. So I feel like once the symptoms are away, they're like, Oh, good. I'm gone. And then bad.

But people used to pass on their antibiotics to other people.  Not condoning this, we're just telling how it happened.   Then I remember someone being like, Oh, you're probably going to get antibiotic resistance  my thought was if there's like some fighters left in there, then they'll grow and that's  absolutely.

Yeah.

You let what you left was the few fighters that can fight the antibiotic and still live through it. And then you didn't fully kill them off, so they gain strength and reproduce. Yeah.

But one of the other things that's really important too, as I alluded to a little bit earlier, is that when you take the antibiotic, the bacteria may all be gone, but that doesn't mean that inflammation you had is resolved yet.

So a lot of them are complain like, Oh, my antibiotics not gone yet, and they may either then take someone else's antibiotic or end up going to urgent care and getting another prescription when they really don't have an infection yet, they are simply just their symptoms haven't totally resolved.  I like to use, I don't Abby the elbow.

I use the knee a lot when I talk about UTIs.  If you fall and skin your knee and the scab falls off, your first few days you have to wear a band aid cause it's bleeding and gooey. And then you have a scab and you don't need a band aid anymore. Then the band aid falls off and your skin's whole. It's not bleeding anymore, but it doesn't feel good yet, right?

It doesn't feel good yet. It's still kind of fragile and sensitive. So your bladder is very much like that. So the bacteria is gone. Your scab falls off, but you don't, it's not feeling great. You may still have some tickling or some frequency. It doesn't mean that the impact didn't work or that you're still infected.

Okay. So take all the antibiotics. That you were prescribed and go to the doctor. Because they are going to know what the bacteria is, and test what antibiotic is going to work best on it. So they're not just taking the 1 size fits all

unless someone spills assessment. 

Doesn't happen anymore.

Okay. Is it true that once you've had one UTI, you're more likely to get another one? Because I feel that girls bond to this thing of they've had one, they've never had one before, and suddenly they've had one and now they have one or two a year for the next five years. 

Is that true do you think Abbey?

I would say probably like I did this I did look this up for you and I think that there is a statistic out there that for healthy menstruating like reproductive age sexually active young women if you have a UTI you have one UTI you have about a 25 percent or some percent increased risk of having another UTI within the next year or so.

I don't know that it necessarily   is something that means that there's anything wrong or bad with you. I think it just goes back to the fact of real estate, right?  We've got a lot of normal, healthy bacteria there. It's a short drive to get access to the urinary tract. I don't know that necessarily like having one UTI sets you up for a miserable next five years with recurrent UTIs.

But yes, if you've had one, chances are over the general population, you're probably a little bit higher risk  to have another one than prior. 

There is also some genetics to it.  Bacteria has to not only be in your bladder, but has to stick to the bladder wall and interact with the cells to cause the UTI.

It's not what they just live in the urine.  That's probably a genetic factor. Some of us have bladder walls that let bacteria stick easier than others. Some of us what's going on with your hormones at that time of your life, which we talked about before, but I think, especially in women who are.  In their menopause years, they're no longer menstruating.

If they get 1 UTI, they may get 2 or 3 or 4 in a row. And my theory of that is going back to the falling and scabbing your knees. You fall apart your knee. That scab falls off. Your skin is not kind of raw and fragile. It may even bleed a little bit to touch. And your main barrier to infection is really good, solid, strong skin.

Right? So, when the bladder is still raw, it might be a little, the walls are kind of oozy and inflamed. I think bacteria can stick better. So you're more prone in the first little while of getting a couple in a row. And so in some ways we've got to really try and keep them infection free for several months so their body can fight infection again.

I love that description because I think we're always  brought up to think like, oh, urine is sterile, right? There should be never any bacteria in our urine. And so if we treat it and get that UTI to go away, it shouldn't come back. But I love that description because probably there is a

especially in our older post menopausal ladies, there very well could be a little bit of the gait left down to allow a little bit of bacteria to get in. And if you haven't fully healed your barriers and your protectors from your first UTI, chances are really high that you could certainly get another one.

You could, re injure that scab.

Speaking of post menopausal women,  I have heard that it's more common to get UTIs. When you're postmenopausal, why is that? So

estrogen  fountain of youth. Listen, I have to say that I'm really kind of pissed about, okay.

So we always used to have, I remember when I was working with Denise and we had a drug rep that would come in, that was like the vaginal estrogen guy. And I always used to. to make a joke of  Oh my God, I'm gonna start rubbing stuff on my face as a face cream. And he would laugh at me like crazy. And now when you go on Instagram,  he's using it as a face cream.

I feel like I invented that. I'm going to find that guy again and be like, I know it was you.

Estrogen is like our fountain of youth. It has so much power. So many good purposes and especially when we talk about vulvar health, vulvar bacterial balance, estrogen tends to keep that area a little bit more,  acidic.

If it's more acidic, there's less, it kind of keeps that bacterial balance in check. And so when we lose that estrogen. We just grow a little bit more bacteria again. It's not anything having to do with cleanliness. It's just our balance at that stage of life.

Estrogen does so much for the vulva, the vaginal opening, the urethra opening, and our bladder and urethra are made when our uterus and vagina are made as embryos.

And they're all really dependent.  When we're young, and in our years, we're having our periods, our opening, I would say it's kind of like a shag carpet is filling the opening. It's really plush and the shag carpet is really thick and nice and keeps it fall. And then you go through menopause, and it's typically a year and a half later, when women start to get symptoms, it falls.

Really flat. Like I said, it's like a cheap contractor grade furber carpet. So those of you that have bought houses may not understand that. It's

like, if a kid drops a Lego on the carpet, would you rather step on the carpet, the Lego on the carpet on a plush shag carpeting, or would you rather step on the Lego on  a cheap contractor grade carpeting?

Yeah. So it's a really flat carpet. It's not thick. Your urethral opening tends to be kind of turned open. Not only, so it lets the gate in. There's a lot less blood supply to the urethra after menopause. And what does blood do? Besides all the healing factors, the white blood cells that by bacteria, you're not getting as many flowing around the area.

A lot of it is the pH that the pH changes dramatically. and also when the vagina and urethra are drier.  So just think about if you have really bad chapped lips, right?  Think of getting a crack and maybe get a little crusty tiny infection in that crack because your lips are so chapped and unhealthy.

Well, that's how urethras and vaginas get without estrogen.

Estrogen is the fountain of youth. Mm-Hmm. . So if you are postmenopausal and you're coming in for UTIs or maybe recurrent UTIs, is hormone replacement therapy gonna be the number one thing that you're recommending?

Ask your doctor about it.  Hormone replacement therapy tends to refer to.

systemic estrogen that's working to help primarily with hot flashes, night sweats, those types of things. I don't believe that we have enough data to say that systemic hormone replacement therapy will necessarily in everyone help with UTIs, but also just like the vaginal dryness and irritation. And so I vulva requires a little bit of special tender care in terms of loss of estrogen because it's so sensitive to estrogen stimulation.

Oftentimes we'll talk about local estrogen creams that you would apply, or those can also come in the form of  ovules, like little suppositories that you would insert inside the vagina or even rings that you wear inside the vagina. But I'm  just, in my bias, a little bit more,  favorable for local vulvar symptoms of using local vulvar estrogen replacement.

Yeah.   I know I've read an article at some point that about 85 percent of women who are taking  Systemic estrogen, a pill or a patch. Still, I'm not getting enough to the vulva and need, or could use some estrogen cream

so it's a cream and I would be rubbing it. On my vulva area, or I'd be putting a suppository up into my vagina and it would be giving me estrogen, but only to that area.

That's what I'm getting. Yeah, so I wouldn't expect it to help with hot flashes. necessarily, because it's not getting a whole lot of systemic absorption, that would be an interesting podcast to do too, but it's really working locally to help soothe those tissues and provide local estrogen supplementation.

Store blood flow, moisture, thickness, pH.

Again, all good things for a face cream.  All good things. 

Is there a good way to prevent UTIs? Because I know we're talking about, they're normal, we have that bacteria on us already. But they're also unpleasant, and I know that we don't like getting them.

Is there a way you can avoid getting a UTI? Or are they just a fact of our lives?

Well, some of it is there are some ways we talked about,  says a woman, if you're going through menopause, getting an estrogen before everything dries up and changes too badly to keep it healthy and not everyone can do that.

There's some women who just don't have medical reasons, but it can't take estrogen. So I'm not talking about everyone, but constipation is a huge one. Oh, and people don't really associate that. People come see me for their bladder, and I'll spend the hour talking about pooping instead. Like, but I came for my bladder.

Constipation is one of the most common,  Fixable  risk factors or modifiable risk factors for UTIs, and if you're constipated, your rectum gets really distended, it stretches the blood vessels in the area, and so not just as it may cause your anal sphincter, I'll get too technical, that muscle around your anal opening, may by reflex, relax because the rectum is distended, and it thinks you're trying to poop.

It's more open bacteria getting out quicker. It's also stretching some of the blood vessels and that thin wall between the rectum and vagina and helping bacteria to spread through blood vessels locally, getting into the bladder more quickly.  Constipation is not good for us.

I would say growing up, if you come to my mom with anything, she's going to say, do you have to poop  and it used to upset us so much because you would come to her, I swear, with  a headache and she'd be like, well, When was the last time you pooped?

I have to say, thanks to your mom, I have carried that on to the next generation.  Just as estrogen is the fountain of youth, constipation is the root of all evil.

I love it. I love it. Oh my gosh. I  used to be a never pooper. We're going to have a poop episode next season. And my mom, when she found out, like, I think almost disowned me.

My daughter really likes Miralax because it's purple. Oh.  Love it. And so we, yeah, it's, it's a thing. 

I know we should go to the doctor, because we've talked about that.  Are there any over the counter things that work, or you would recommend, or work a little? I know we talked about cranberry juice, or cranberry pills, I know that's common with my friends.

I've before, don't know if this is right or not, just drinking tons of water because my mom has told me to on that and flushed it out. So I just drink  so much water in one day that hopefully. Did you just say your mom told you that and you're not sure if it's right? Well, I don't want to put you under the bus if it's wrong.

Okay. Well, we'll ask Abby then.  But do those two things work and are there things you can do over the counter? Another one in Australia is called uracil and it's sort of a powder. I'll look up what it is. Later, and you put it into your water and you drink it. I don't know what it's doing. But that I've taken before and it has also gotten rid of my UTI.

So I love the fact that you are taking something that you don't know what it's doing and you're hoping that it helps.  Fair. But it did. 

All right, this is the first time I'm hearing this. Okay. 

Listen, I think that  the way I approach it, right, like if you think conceptually,  If I have bacteria that are getting into my bladder, they are starting to irritate my bladder muscle and that's giving me symptoms.

And I don't want to allow this  small group of bad actors to continue to propagate and grow on themselves and give me a fricking headache. full out bladder infection. I think you're totally right. I think that drinking a lot of water because water helps to filtrate the kidneys and then that flushes everything out.

I think that that can be a really good way to hopefully help feel better because I also don't like to go to the doctor and so yeah, I will push a lot of water in order to help. Prevent myself from having to make an appointment to do that.

One phrase we always had in our medical training, and I'm sure Abby's heard this.

It had more to do with what we do in surgery, but it was. Dilution is the solution to pollution.

Oh, I like it.

You want to dilute the bacteria, flush them out, don't give them a chance to grow, just over dilute them.

So water, water, water. Yeah,

water, water, water, push

it out. I think that there is some data looking at cranberry.

My understanding of that is not that it, like, if you have a full blown infection with a lot of bacteria in there, I don't want to give the impression that cranberry is going to treat that.  My understanding of the literature is that cranberry has. an enzyme in it or like a little portion of it that helps to okay, so sorry, this is kind of a gross description, but  E.

coli, which is the most common bad actor causing bladder infections, have  a little tail attached to them. And so they use that tail to connect to each other and grow and propagate and form this big colony. So what cranberry does is it breaks that tail. And so it prevents the E. coli's ability from sticking together  and not sticking to the bladder wall.

Yeah, forming like a fun group together, right? You're like, no, disperse, get out of here. So that's how cranberry works. So I think that using cranberry can be helpful with  some of those early symptoms. I don't know that I would necessarily rely on it to treat  a full blown bladder infection over an antibiotic.

One of the props of cranberry and the reason everyone knows about cranberry, like it was a wise tale, but then it got really, really popular that cranberry,  producers are really pretty big money group, and they actually supported some medical studies and did a lot of advertising, but so one of the problems with cranberry is it's really acidic and it can make you feel like you have UTI.

It can cause burning and make you go frequently because of the acid and then it's super sugary. Yeah, a ton of sugar is sour. It will look like you get apple juice and you can get. Blueberry,  orange juice. But when you get cranberry, oh, this is cranberry cocktail. There's no pure cranberry juice out there because they have to sweeten it.

That's why it's called a cocktail. Even a low sugar has a lot of sugar.  Some of our gals are diabetics and if they keep drinking sugar, they're going to get more UTIs and they're chugging cranberry juice and it's really sugary or there's so much you're peeing every five minutes. My UTI is not better, but it's the acid from the cranberry.

So I do kind of like cranberry capsules better than the juice for that reason. But Also, blueberries actually been studying are more effective, so why don't, why do we not know about that? Because blueberry farmers are like little small farmers in Michigan and Oregon, and they don't have, they're not in with a big karma of ocean spray.

Seriously. So, blueberries, which are antioxidants, and we know about those potentially being anti cancer, and there's really good for you.  I don't like blueberries. I wish I did, but they're way better at breaking up the bacteria bladder than cranberry is.

Fascinating.

You know what's even better? I can't believe there's a cranberry mafia out there.

There is. You know, what's even better? Lingonberries.  Now,  I've seen lingonberry preserves at Ikea and I've seen lingonberries in European restaurants for their breakfast brunch, but I've never found lingonberries, fresh ones, in the United States. I feel like that's not an

American thing.

Yeah. One of my patients told me you can get them in Door County, Wisconsin in August.

But they're not real common, but they're even, they're the best thing for UTS.

Okay, well now we know. Everyone, let's go to Door County this August road trip.  Let's get some lingonberries. 

First, if everyone feels okay with it,  Have you ever had a UTI?

Cause I feel like if two super cool doctor chicks, just tell us they've had one, we won't feel so embarrassed. 

Oh, I definitely, so I had one when I was an intern and  this as most horrible experience because I was rotating in the surgical ICU  and. There was an orthopedic resident, an anesthesia intern, and myself, I didn't take turns.

And it was the worst month of my life.  They were really, really sick patients, and the nurses would get so mad if you didn't answer in five seconds.  And so the nurse paged me and paged me. I'm like, give me five seconds. I have to pee. And she's like, I'm reporting you. Like, Oh my God,  I really, really, really, I like, I have to pee.

She's like, you just peed. I'm like, I know  it's TPS,

but I had to go. 

It was terrible. Yeah. Did you know what it was back then? Yeah, I knew right away.

I had one when I was pregnant with my first kid. And,  not to be too graphic, but the adage of, like, pissing razor blades? Accurate.  Terrible.

I knew right away.  I need an antibiotic now.  Got treated and was fine, but yeah, like you, you know, you know, when you know, 

Oh yeah, for me, I'm lucky I don't have that burning. It's like, I go to the bathroom and there's one trickle of pee. I'm like, Oh, there she is.

TPS.  I think just to close up,  do either of you, Abby, you can go first, just a takeaway from this conversation or something that you hope, if listeners only hear this at the end, this is what they'll take away. 

I'm always looking for like farms to buy in northern Michigan, and I think I'm going to do like a lingonberry farm.

Okay. I think that's great.

And have your office right on it. And then if people do get a UTI, you can just send them, they can pick their own lingonberries. Pick your own,  grow, grow to well.  I love it. I love it. Well, you were on with the estrogen face cream.   

My tip is, please go get checked.

If you think you have UTI, please don't take your friends antibiotics. Please finish your antibiotics when they're prescribed, take the whole batch, and don't be constipated. It's bad, bad, bad, bad, bad for you. Those are much more

medically intuitive type of patients.  We didn't say that to be medical. I agree.

Well, thank you so much, Abby. We're so appreciative to you for coming and joining us in this conversation, and I feel my mom is right, because you do break things down in such an easy to understand way. I love all the analogies that both of you shared throughout this conversation.  I also feel if people are afraid to go in the doctor, I would never be afraid to go to you because you make everything seem like it's normal, which it is and explain it so well.

Thanks for taking the time to have a chat with us. Thank you. This was so much

fun.

  Community Shout Out:

In this second season of Not So private parts, we are proud to highlight a different community. Shout out throughout each episode.  Our community shout out is a chance to hear about some incredible women's health organizations or individuals who are doing amazing. Crucial. Advocacy education and support work for their community. I feel very inspired by all the incredible individuals and organizations out there that are doing such amazing work and boots on ground work for women to feel cared for and supported in their community.  Our fabulous guests, Dr.

Abby Drucker tipped me on to our first community. Shout out for season two, which is access period.  Here is Kristin Lowery from access period, to tell you a bit more about what they do and why it's so important.   

Access Period provides free period products to people who need them in Nebraska. There are no restrictions on who can receive products and they're available at access points throughout the state through other non profit partners and schools. Our goal is to end period poverty in Nebraska through making products easily accessible and ending the stigma surrounding menstruation.

Learn more at  www.accessperiod.com

 ​
Closing:

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The gorgeous voice that you heard singing in the beginning was an incredible gal and pal I know, Raley Mauck, and the super cool logo you're seeing was designed by Karin Buffie.