Stress can cause a UTI, but usually indirectly. When stress is implicated in a urinary tract infection (UTI), there are several mechanisms by which this can occur, from depleted immunity to constriction of the bladder wall.
What causes a UTI?
A UTI is a condition whereby the tissues that line the urinary tract are colonised by disruptive bacteria, most often Escherichia coli (E. coli) and friends. These bacteria are normally found in a healthy digestive tract. It is unclear why they appear in the urinary tract.
UTIs usually result in uncomfortable or painful symptoms that disrupt life, sometimes significantly.
Signs and symptoms of a UTI
Depending what part of the urinary tract is affected and who is affected, symptoms may vary. For example, in the elderly, confusion and dizziness may be the only clue, but this is an unusual symptom in a younger person. Usually UTI symptoms are straightforward and easy to identify. A urine test can confirm the diagnosis.
Common UTI symptoms include:
- Increase in urinary frequency
- Urgency
- Burning or stinging
- Cloudy urine
- Low urine volume
- Strong-smelling urine
- Dark coloured urine
- Waking in the night to urinate
- Urinary incontinence (leaks)
In a more severe UTI, the infection can travel to the kidneys, causing lower back pain and blood in the urine. While UTIs can be serious, these infections can often be successfully treated and prevented with a few targeted measures and a little insider knowledge of how the urinary tract works.
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Chronic/embedded UTI
Some people are prone to UTIs, and may have repeated treatment-resistant episodes, or even constant symptoms. This is known as chronic or embedded UTI, and is different to a one-off UTI, which is known as an acute UTI. Usually acute UTIs can be treated quickly with antibiotics or herbal medicine.
Common contributors to UTIs include:
- Dehydration
- Poor sexual hygiene (‘double dipping’ anal to vaginal penetration, not urinating after sex)
- Bacteria transmitted from a sexual partner
- Structural issues such as kidney stones or anatomical abnormalities that restrict urine flow
- Spermicides that kill protective bacteria on contact
- Low estrogen levels associated with menopause, testosterone therapy, certain cancer drugs and estrogen-blocking drugs
The link between stress and UTIs
There is a strong link between bladder function and stress. A scared person (or animal) may involuntarily urinate. Another good example is that kids in stressful situations at home or school wet the bed more often. A stressed person’s bladder may become dysfunctional in some way.
While stress is normal and healthy – it is a superpower that allows us to get things done with extra force or energy, as the situation requires it – we are designed to go in and out of stressful situations. Many people live with a high degree of stress for long periods of time, and we see more urinary tract issues in these people.
The impact of adrenaline and cortisol on UTI
Our two stress hormones are cortisol and adrenaline. Adrenaline is short-acting – that feeling when you get a fright, but it passes if the danger isn’t real. Boo! Cortisol is slower to kick in but longer acting and appears when the stressor is real and you need those extra powers for a bit longer.
If a person is living with chronic stress, the body doesn’t get a break to recuperate – the phase we call ‘rest and digest’. The constant cortisol has a lot of negative impacts on all body systems, and over time, degrades sleep quality, the immune system, digestion, and our sense of wellness and peace. No body does well on chronic cortisol.
Chronic stress may not directly cause a UTI, but it can certainly contribute via several mechanisms. Reduced immunity through disrupted sleep, for example, means our resources for fighting pathogens are degraded. Sleep is when our immune system regenerates, but cortisol keeps us awake, anxious and easily disturbed.
Cortisol also inhibits the abundance of special sugars in the urinary tract and vagina (glycogen) that act as a food source for protective species of bacteria, lactobacilli. Once lactobacilli are starved out, disruptive bacteria have much less competition and easily increase in number.
Stress hormones and the bladder
There are also direct impacts of cortisol on the bladder itself. When humans are stressed, we urinate more often. Why?
One of the roles of cortisol is to constrict blood vessels and increase blood pressure, heart rate and muscle tension. This constriction can, in a way, tighten the muscles around the bladder, squeezing the bladder, encouraging more frequent trips to the bathroom.
But, that’s not the only reason. The lining of the bladder is full of receptors and different types of cells, all of which have unique and important roles to play in healthy bladder function. In the cascade of events following prolonged cortisol exposure, these cells and receptors become overactivated.1
A great example of a chemical messenger that directly affects the bladder is histamine, which most people associate with allergies like hay fever. Histamine is implicated in many bladder conditions such as interstitial cystitis (IC) and overactive bladder syndrome. In fact, one of the main treatments for IC is – alongside other medication – antihistamines.
The bladder is highly responsive to histamine, and even releases its own histamine, which plays a role in activating the sensation of bladder fullness2. In people with IC, this bladder fullness mechanism is hypersensitive, resulting in the urge for more frequent urination and other symptoms that at first glance appear to be infection-related. Not all bladder symptoms are infections, despite the similar symptoms.
Chronic stress can change the way the bladder responds to stimuli like urine, resulting in hypersensitivity and inflammation, and ultimately, dysfunction. This dysfunction can result in a diagnosis of IC or overactive bladder syndrome.
But, urinary tract symptoms can be extremely stressful and disruptive to work, school and relationships, so the reverse is also true. Stress and urinary tract symptoms go hand in hand.
The chicken and egg of stress-related bladder behaviours
Anyone who has a history of urinary tract or bladder symptoms understands the distressing mental game of ‘how far away from a bathroom am I?’. Unfortunately feeling stressed and anxious about bladder symptoms can actually perpetuate and worsen the symptoms.
Chronic stress can be deeply connected to UTIs and other bladder conditions. What’s clear is that chronic stress and a healthy urinary tract are not very compatible. Luckily, there’s plenty of actions that support a healthy urinary tract and minimise or avoid symptoms.
Managing stress for a healthy urinary tract
If there was ever a reason to actively work on deliberate de-stressing, avoiding crippling urinary tract symptoms is high on that list.
Learning how to actively manage cortisol levels during stressful periods in our lives is one of the most important things many of us will ever do. It is an active choice and one that you are in control of.
While it might feel like your body is betraying you and your symptoms are completely random and out of your control, there are some very clear ways to make positive changes. The goal is to protect our bodies and minds from the dangerous impacts of prolonged stress.
Easy to say, not as easy to do, but here we have some legitimately doable tips and tricks for maximising your de-stressing capacities each day.
4 tips for active de-stressing that don’t cost a cent
#1. Breathing exercises work!
Do something unusual (but easy) to flip your brain out of its rotation of worries. For example, find a free video online for 10 minutes of Wim Hof breathing.
These types of diaphragmatic breathing exercises stimulate the vagus nerve, which dials down cortisol, while also promoting nitric oxide, which opens up your blood vessels and turns down the pressure that cortisol ramps up.
#2. Cold showers – trendy but effective!
Take a cold shower! While it doesn’t sound much fun, there are many, many pretty amazing benefits. Regular cold showers boost the immune system, reduce inflammation and improve mood. You might be saying, no way!
But you shouldn’t cause a gasp anxiety response – start slowly with lukewarm water, one arm or leg at a time, and practise the cold without the awful shock.
#3. Movement is your friend
Exercise is one of our best cortisol-reducing activities, the more vigorous, the better, but work to your abilities. Sweat and puff, and use your muscles however you see fit. Turn your favourite music up and dance, work out, go for a walk or weed the garden. Stress can cause UTIs if your body doesn’t have everything it needs to defend itself.
The internet is full of free and hilarious ways to move your body in the privacy and comfort of your own home, so make use of it.
#4. Make time for you
Make time each day to do something you really enjoy, and wish you did more “but can’t find the time”. Prioritise this activity as necessary medicine for your body and mind – and urinary tract. Read a real book, sing, write a letter, walk barefoot in the grass, spend time with people who make you belly laugh.
In doing so, it is likely to mean saying no to something else, another obligation you’re not that into, but remember, when you say yes to someone else when you don’t want to, you’re saying no to yourself.
4 tips for preventing UTIs and bladder symptoms
#1. Stay hydrated
Fluids don’t have to be plain water and the whole 8 glasses a day is not a real thing. Tea, diluted fruit juice, juicy fruits, soups and water all count. To make water more hydrating, add a generous pinch of sugar and salt – your body will recognise the sugar and salt as worth absorbing, and take up more fluid as a result.
More is not always better. You want to be urinating 5-8 times per day, and after your first morning void, urine should be pale yellow with an inoffensive, barely discernible odour. If you always have copious clear urine, it may be time to add some electrolytes into your beverages and moderate your intake. If you don’t feel thirsty, you may need more salt and electrolytes.
Salt and water attract, so if you’re low in electrolytes (like salt), the water will simply pass right through largely unabsorbed.
#2. Lower inflammation and cortisol levels
Work towards lowering inflammation and cortisol through positive diet and lifestyle choices. Aim for healthy, nutritious and delicious meals, eat regularly to maintain blood sugar levels, and find ways to stay active and connect with others – some of the tenets of a happy, healthy person.
Work towards deliberately calming your nervous system, and make a big deal out of it – say it out loud, tell your friends and family, and they’ll help you. If you feel a bit lost, there are plenty of incredible holistic nutritionists, herbalists and naturopaths and other practitioners who will be more than happy to help you.
#3. D-mannose and high-dose cranberry supplements
Consider taking D-mannose or high-dose cranberry tablets. The main bacterial cause of UTIs, E. coli, attaches to the D-mannose in bladder cells. Our body naturally produces D-mannose, which is present in these types of cells – that’s how E. coli attaches to the bladder wall.
Supplements or cranberry (high in D-mannose) ‘tricks’ the bacteria into attaching to the supplement sugars, and not the D-mannose in your cells, thus the bacteria are urinated out of the body and can’t cause symptoms.
D-mannose comes in a powdered form most often. Take 1 tablespoon in a small amount of water per day before bed for prevention, and during an acute UTI, take 1 tablespoon every 1-2 hours during symptoms and for a day after.
High dose cranberry is also used in this way, but is more expensive to maintain. Specialised herbal medicine is very effective from a qualified, experienced herbalist or naturopath to both treat and prevent UTI, and address underlying issues.
#4. Practice good sexual hygiene
Sex can be a huge source of urinary tract flare ups, so taking extra care to be hygienic during intimacy is important.
Use condoms or a barrier with plenty of lubricant (but never with spermicide); avoid anal to vaginal penetration without thorough washing with soap and hot water between; and for those with vaginas, insert a vaginal probiotic afterwards as a UTI preventative.
When to seek professional help for urinary tract symptoms
When you have UTI or bladder symptoms, it’s important to seek medical assessment and get a diagnosis and appropriate treatment. Symptoms are your body’s way of telling you something is wrong, so if you can’t alleviate the problem with simple interventions, please see a healthcare professional for advice and treatment.
If your symptoms are worsening, not getting better, you are in severe pain, have bloody urine (red, pink or brown urine), pain around the kidney, have a fever or are feeling unwell, see a doctor immediately.
FAQ
Why do I get a UTI when I’m stressed?
Elevated cortisol interrupts sleep, digestion and the immune system, resulting in lowered protections against disruptive bacteria that cause UTIs.
Additionally, during stressful periods, we don’t eat as well, are more tense, and our breathing may become shallower, affecting the motion of the pelvic diaphragm, and impacting the relaxing function of the vagus nerve.
Can stress cause UTIs and bladder discomfort?
Chronic stress can result in bladder symptoms via several mechanisms, both physical and chemical, that impact the bladder’s ability to function normally. Consistently elevated cortisol promotes dysfunction in many organ systems, including the urinary tract.
Can stress cause UTI-like symptoms?
Some people may be more susceptible to the impacts of stress on their urinary tract and bladder, and this may feel like a UTI, but actually be due to another mechanism that results in similar sensations.
For example, inflammation caused by poor sleep and an unhealthy diet might result in a sensation of bladder pressure and increased urinary frequency.
References
- 1.Gao Y, Rodríguez LV. The Effect of Chronic Psychological Stress on Lower Urinary Tract Function: An Animal Model Perspective. Front Physiol. Published online March 21, 2022. doi:10.3389/fphys.2022.818993
- 2.Jones BM, Tykocki NR. New direct evidence that histamine augments bladder sensory outflow during filling is nothing to sneeze at. American Journal of Physiology-Renal Physiology. Published online February 1, 2020:F455-F456. doi:10.1152/ajprenal.00581.2019
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Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.
Jessica is the owner and lead naturopath of My Vagina, and is a member of the:
- International Society for the Study of Vulvovaginal Disease (ISSVD)
- International Society for the Study of Women's Sexual Health (ISSWSH)
- National Vulvodynia Association (NVA) Australia
- New Zealand Vulvovaginal Society (ANZVS)
- Australian Traditional Medicine Society (ATMS)