Recurring UTI's? Here is what you need to know.

You know that sharp, unmistakable sting when you try to urinate — the burning, the urgency, the dread of yet another infection. For many women, a urinary tract infection (UTI) is a temporary discomfort. But for others, it becomes something deeper — a constant cycle of flare-ups, antibiotics, temporary relief, and relapse. Over time, this pattern doesn’t just affect the bladder; it can impact the entire body, mood, and sense of wellbeing.

Chronic UTIs are not “just unlucky.” They’re a signal — a sign that something within the body’s intricate microbial and immune systems is out of balance. Understanding why they happen and how to restore harmony is the first step towards lasting relief.

What Actually Causes a UTI?

A urinary tract infection occurs when bacteria (most commonly Escherichia coli or E. coli, which normally live in the gut) enter the urinary tract and begin to multiply. Normally, our bodies are well equipped to defend against these microbes — the flow of urine helps flush them out, while beneficial bacteria and the bladder’s protective lining act as natural barriers.

However, when these defences are disrupted, infection can take hold and persist.

1. Microbiome Disruption

Your gut and vaginal microbiomes form part of your first line of defence against urinary infections. Beneficial bacteria like Lactobacillus maintain a slightly acidic environment that prevents pathogenic bacteria from thriving. But antibiotic use, hormonal contraception, stress, and dietary factors can all reduce these protective species, leaving the urinary tract more vulnerable.

2. Biofilms and Persistent Bacteria

Certain bacteria form biofilms — thin, sticky layers that attach to the bladder wall. Within these biofilms, bacteria can hide from both the immune system and antibiotics. Even when symptoms improve temporarily, the infection can re-emerge once conditions become favourable again.

3. Bladder Lining Vulnerability

The bladder’s mucosal barrier, called the glycosaminoglycan (GAG) layer, prevents bacteria from binding to the bladder wall. Chronic inflammation or recurrent infections can damage this layer, making future infections easier to trigger.

4. Lifestyle Factors

Infrequent urination, low hydration, constipation, and diets high in sugar can all create an environment where bacteria thrive. These are often overlooked but easily modifiable contributors.

5. Sexual partner

If your infection keeps coming back after sex, the chances are it’s not you, its him. Your partner may be asymptomatic but carry pathogenic bacteria in their semen which repeatedly reinfect you.

Why do UTIs Increase During Menopause?

Many women notice that UTIs become more frequent around menopause — and this isn’t a coincidence. Estrogen plays a vital role in protecting the urinary and vaginal systems, and its decline during perimenopause and menopause weakens several of the body’s natural defences.

• Tissue Changes:

  Estrogen keeps the vaginal and urethral tissues thick, elastic, and well-lubricated. When estrogen drops, tissues become thinner and more fragile, making it easier for bacteria to enter the urinary tract.

• Vaginal Microbiome Shifts:

  Estrogen supports Lactobacillus species, which maintain a healthy, acidic vaginal environment. As estrogen declines, Lactobacillus levels fall, the pH rises, and pathogenic bacteria can gain a foothold.

• Reduced Bladder Protection:

  The bladder wall itself has estrogen receptors. Lower hormone levels can lead to decreased blood flow and resilience in the bladder tissue, which may slow healing after infection and reduce overall resistance to bacteria.

• Altered Immune Balance:

  Menopause can also influence immune regulation, leading to less effective mucosal immunity. Combined with microbiome and tissue changes, this creates the perfect conditions for recurrent infection.

The importance of testing and finding the real cause

For years, many women with recurrent UTIs have been told their urine cultures are “clear” — yet their symptoms persist. This can be frustrating and disheartening, but the problem often lies not with the person, but with the testing method.

Traditional urine cultures, used in most GP and hospital settings, were developed decades ago. They typically identify only a narrow range of bacteria and rely on those microbes growing under specific laboratory conditions. Many organisms that cause chronic or low-grade infections don’t grow well in these cultures — meaning results often come back negative even when infection is present.

As a result, many chronic UTIs go undiagnosed or are misclassified as “non-infectious bladder pain” or “interstitial cystitis.”

Modern molecular testing has transformed how we detect urinary pathogens.

This allows us to:

• Detect a much wider range of bacteria and fungi, including those that don’t grow in standard cultures.

• Identify mixed infections (where more than one pathogen is involved).

• Determine antibiotic resistance genes, helping to tailor treatment and avoid unnecessary or ineffective antibiotics.

• Detect low-grade infections that may be driving chronic symptoms even when conventional tests show “no infection.”

By understanding exactly which microbes are present, we can create precise, targeted treatment strategies rather than relying on broad-spectrum antibiotics that may further disrupt the microbiome. If you suspect, the source of pathogens is your partner, its essential that they get tested too.

How to address chronic UTI’s

Once testing has identified the specific pathogens and underlying drivers, treatment can be personalised. A functional medicine approach focuses on restoring balance, strengthening natural defences, and preventing recurrence and may incorporate the following steps.

1. Restore Microbiome Balance

• Targeted probiotics such as Lactobacillus crispatus and L. rhamnosus can help repopulate beneficial bacteria in both the gut and vagina.

• Prebiotic fibres like inulin or partially hydrolysed guar gum feed these microbes, promoting long-term resilience.

• Dietary support with diverse, fibre-rich foods encourages microbial diversity and reduces inflammation.

2. Support Bladder Integrity

• D-mannose helps prevent E. coli from adhering to bladder walls.

• N-acetyl glucosamine (NAG) and aloe vera extract can help repair and soothe the bladder lining.

• Quercetin, vitamin D, and omega-3 fatty acids can reduce inflammation and improve tissue healing.

3. Address Hormonal and Immune Health

• Supporting estrogen balance (through bioidentical hormone therapy or phytoestrogen-rich foods like flaxseed) can restore tissue health and microbiome balance.

• Nutrients like zinc, vitamin D, and curcumin strengthen immune regulation and reduce systemic inflammation.

Chronic UTIs aren’t simply random or unavoidable — they’re a signal of imbalance in the body’s microbial, hormonal, and immune ecosystems. During menopause, hormonal shifts make these infections more likely, but modern testing and a functional, evidence-based approach mean you don’t have to suffer .

If you’ve been struggling with recurring UTIs, unexplained bladder discomfort, or negative test results despite ongoing symptoms — you’re not alone.

I work with clients to create comprehensive protocols that address both the infection and the underlying imbalances — from microbiome repair and bladder support to hormonal and immune resilience.

If you’re ready to move beyond temporary fixes I’d love to help. Book an introductory call to find out how a tailored functional approach could be the missing piece in your recovery.

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