The dreaded urinary tract infection, also known as a UTI, is something many of us are all too familiar with. But should we be working out with one?
Few things in life are as uncomfortable and low-grade miserable as a urinary tract infection – also known as the dreaded UTI. You’re not ill as such and you’re not in danger, yet everything becomes a chore – whether that’s going to the shop, wearing jeans or working out. Given how common UTIs are (around 50% of women have one during their lifetime) and how many of us are physically active (61.5% of women, according to government figures), it follows that many of us will have exercised with a UTI at some point in our life.
They say that you should never run if you’ve got symptoms below the neck – meaning that if you have a head cold, you’re fine to work out and if you’ve got a chesty cough, you should take a break. But when it comes to issues further down the body, there’s very little common advice. If you’ve got a race coming up or training plan that you’re following, you might not want to take a week off, and that’s where you need to be careful. As with injuries, knowing when to move and when to rest is important – and it’s something experts and rule books can’t really decide for you.
Symptoms can include: a painful burning sensation while urinating, needing to urinate frequently and with more urgency (yet sometimes, with very little urine actually coming out), or pain in the lower stomach or back (just underneath the ribs). The real danger lies in leaving a UTI untreated, as it could lead to developing a high or very low temperature – and in extreme cases, lead to kidney failure.
So, should we be working out with a UTI, and what’s the best way to treat it if we do develop one? First, let’s take a look at what the root cause of this infection is.
First things first, like many health conditions, UTIs are the subject of misinformation and conjecture. “There are many myths about UTIs that are completely untrue,” says Dr Deborah Lee from Dr Fox Online Pharmacy. The mythical causes of a UTI include: poor hygiene, not peeing regularly, holding your urine in all day, tight clothing and panty liners. There is also a myth that cloudy, smelly urine must mean that you have an infection. These are all simply false.
While UTIs can be caused by dehydration and a weak immune system, women are more likely to develop a UTI than men because “women have shorter urinary tracts than men,” explains Dr Nicky Keay, chief medical officer of Forth. Here’s why:
The true culprit of a UTI is actually E.coli – the bacteria that causes food poisoning. Dr Lee explains: “UTIs are eight times more common in women than in men. This is likely to be due to the fact that the urethra – the passageway from the bladder into the outside world – is very short in women, but much longer in men as it runs the whole length of the penis.”
Because of that, it’s “all too easy for bacteria associated with opening your bowels to find its way inside the urethra”. That E.coli can be transferred from rubbing, wiping or sexual activity, Dr Lee says. That means that you could be the cleanest person in the world and still be at risk if you’re scrubbing too vigorously down there – and in the wrong direction.
It’s also worth pointing out that stress can play a massive role in the frequency of infections. While we don’t exactly know why that might be, stress does lead to increased levels of the stress hormone cortisol – which can have a dampening effect on the immune system. Dr Lee suggests too that when we’re stressed, we tend to urinate more and that stress can alter our perception of pain – increasing the sensation of discomfort and bladder symptoms which eventually “add up to an overactive bladder”.
Stress has also been associated with interstitial cystitis, a poorly understood condition that results from having a chronically inflamed bladder. As the NHS advises, if you keep getting infections, it’s really important that you assess and address any causes of stress in your life – whether it’s mental, emotional or physical.
If you always try to urinate after having sex, hats off to you – that’s exactly what we should all be doing. Urinating after sex flushes out any bacteria which may have crept in while you were getting busy.
A 1990 study compared 468 students who had UTI symptoms with 1,484 healthy women without symptoms. Researchers found that around half of the former group actually had UTIs and that the women in that group were more likely to have never, or rarely, passed urine immediately after having sex.
Some women may have one UTI per decade, while others seem to get one every other week. There are quite a few factors that can make some of us more prone than others, including:
- Anatomical differences: some women have shorter urethra-to-anus measurements, meaning that bacteria has a shorter distance to travel.
- Bacterial vaginosis: if you’re prone to BV, your vaginal pH tends to be more favourable towards E.coli.
- Genetics: some women possess the P1 antigen, which means that some organisms find it easier to attach to the inside of the bladder wall.
- Pregnancy: the pressure from a growing womb can increase the risk.
- Diabetes: glucose in the urine makes it a more favourable environment for bacteria. If you keep getting UTIs, ask for a glucose test.
- Being sexually active: the number of partners and frequency can increase the risk, and it’s important to note that STIs (such as chlamydia) present similar urinary symptoms.
- Menopause: lowered estrogen levels can make the vagina a lot more sensitive.
To work out or not to work out
While Dr Lee says that “it’s fine to work out with a UTI if you feel up to it,” she caveats that with the fact that sweating a lot can lead to dehydration, and “this can make a UTI worse.” It’s also probably worth understanding what caused your infection in the first place. For example, if you’re regularly doing long runs that last over two hours in the lead up to a marathon and you’re not taking on fluids during or after, your UTI might be linked to continuous dehydration and stress.
If you’re going to work out, think about how well you really feel and whether you can afford to either take a few days off or choose a slower, more restorative form of movement that won’t have you getting extra sweaty. Chances are, you can. Choose yin yoga or a mobility class over cardio. If you do want to continue with your regular regime, however, concentrate on rehydrating during and after your session.
It’s also worth pointing out that exercise is thought to reduce your risk of contracting a UTI. A 2016 study published in the journal Medicine & Science in Sports & Exercise followed a group of 19,000 people over a year, recording how many times they submitted antibiotic prescriptions. Compared to those who did no exercise, people who regularly worked out were less likely to get a prescription for Rx, an antibiotic used to treat UTIs. The biggest benefits were seen by those who did low-to-medium levels of exercise such as walking or cycling.
Why might that be? Well again, it could be the fact that those of us who work out are more likely to drink more and pee more – meaning that we’re constantly flushing any bugs out of our system.
The bottom line is: go with how you feel, and whether you’ve got a UTI or not, prioritise hydration. A small consolation is that your fitness regime could be stopping you from getting more UTIs in general.
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In one 12-month study, regularly drinking cranberry juice was found to reduce UTI rates by 35%. Dr Lee flags the fact that the dropout rate in the study was high, however, “suggesting women may not find cranberry juice very palatable”. She also warns that studies of this kind tend to be inconsistent, “using different brands with different sugar levels and additives.”
The NHS doesn’t recommend drinking the stuff as it states that “taking cystitis sachets or cranberry products has not been shown to help ease symptoms of UTIs” and in 2012, the Cochrane data review team reviewed the available evidence and concluded that cranberry juice should not be recommended for UTI prevention. However, Dr Keay maintains that cranberry juice “really does work” to make us feel better – so if you find that it does ease your symptoms or it’s a tastier way of drinking more fluids, then go for it (but try to go for a no added sugar alternative).
I know what you’re thinking: cranberry juice! Who hasn’t chugged two litres of Ocean Spray in the hope of “flushing out” the infection? But just how effective is cranberry juice in treating a UTI?
Despite years of relying on the tart juice, Dr Lee says that studies have shown conflicting results for the efficacy of cranberries on UTIs. While she points out that there “may be some overall benefit from the regular consumption of cranberry juice in reducing the frequency of UTIs”, studies have failed to show that cranberry juice has any real impact on actually treating the infection.
But that doesn’t mean that cranberry juice is totally useless if you’re currently struggling with a burning itch. Cranberries have been shown to contain properties that may reduce UTI symptoms as the berry contains a substance that helps to stop harmful bacteria from attaching to the bladder wall, while also producing hydrogen peroxide, which has an antibacterial effect. Cranberries also reduce the pH of your urine, making it less favourable to other bacteria while their antioxidant properties reduce inflammation and oxidative stress.
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Dr Keay says that the rules are simple: “stay well-hydrated, eat a balanced diet including fresh fruit and vegetables, and follow good genital hygiene practice.” Practicing good hygiene doesn’t just mean urinating after sex, as we know that other factors can play a role in the development of infections. To avoid a future of itching and burning pain, follow Dr Lee’s 10 top tips for preventing and treating an infection:
1. Get a proper diagnosis. This is important. You can only treat a UTI when you know it is one. Contact your GP and take a midstream sample of urine into the clinic (don’t worry, they’ve seen it all before).
2. Don’t use perfumed products on your vaginal area. All soaps, gels and hygiene products contain additives and preservatives which can cause local skin irritation and affect the skin’s pH levels – altering the normal skin flora. Use fragrance-free products only.
3. Never wax or shave near your urethra.
4. When you urinate, wipe front to back – never the other way around.
5. Always urinate immediately after sex.
6. Get an STI test. Always remember: urinary symptoms may be a sign of an STI. If you have been at risk (ie if you’ve recently had sex with someone new) it’s always best to have an STI check. The sooner any infection is diagnosed and treated, the better the outcome.
7. Drink more water. In a 2018 randomised controlled trial, 140 pre-menopausal women with recurrent UTIs were assigned to a group either drinking an extra 1.5L water per day or no change in water consumption, for 12 months. The group who drank more water had a 50% reduction in recurrent UTIs.
8. Take probiotics. Probiotics are live bacteria which can improve the health of your digestive tract. There has been much interest in the role of the gut microbiome in the development of UTIs because urinary tract infections are believed to arise from bacteria found in the gut. A 2003 study in the American Journal of Clinical Nutrition found that a significant reduction in UTIs was associated with the regular consumption of fruit juices (notably berry juices) and fermented milk products containing probiotics (when drunk at least three times a week). A more recent 2016 study in the Journal of European Urology found that 60% of women with recurrent UTIs who took probiotics three times a day for 20 days and repeated that cycle three times were still symptom-free six months after.
9. Take antibiotics if they’re prescribed.
10. Reduce stress. This is often overlooked in a busy consultation, but if you are getting recurrent UTIs, it is extremely important to think about your stress levels and your lifestyle. What can you do to reduce your stress levels? By adopting a healthy regime, including eating fresh food, getting ample exercise and plenty of sleep, plus learning to practise relaxation or meditation techniques, you will find that your symptoms improve.
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Miranda Larbi is the editor of Strong Women and Strong Women Training Club. A qualified personal trainer and vegan runner, she can usually be found training for the next marathon, seeking out vegan treats or cycling across London on a pond-green Tokyo bike.