Escherichia coli is a gram-negative facultative anaerobe that can cause of urinary tract and vulvovaginal infections,such as aerobic vaginitis. E. coli is a common cause of infections in the digestive tract resulting in diarrhoea, and gallbladder and blood infections, as E. coli lives naturally in the digestive tract. E. coli is easily passed from the anus to the vagina and urinary tract, and may cause food poisoning.

E. coli is adapted to live in the urinary tract, where the force of urine makes it cling on harder to your cells. This means you can’t wash E. coli away by drinking a lot of water. E. coli can also swim. E. coli in the vagina is less common than in the urethra, but vaginal infections can also occur, contributing to vaginal odour, inflammation and discharge. Usually a test will reveal E. coli in the vagina or urinary tract.

E. coli creates biofilms, which is the sticky matrix that protects E. coli and friends, and blocks other, friendly microbes from colonising. This is particularly problematic in the urinary tract and vagina, where a seemingly successful treatment leaves you susceptible to infections in future.

People who ‘get UTIs’ really get them. You can get one or two, but typically you either do or you don’t, and this is largely down to whether unhealthy biofilms make it easy for you to develop a UTI again. No unhealthy biofilms means each new infection is truly new. Recurrent infections are just being recycled, and the bacteria never really go away.

While there are many ways to have symptomatic infections due to E. coli, particularly food poisoning, here we focus on urinary tract infections and vaginal infections.

E. coli in urinary tract infections

Most urinary tract infections (80-90 per cent) are caused by E. coli, with high recurrence rates after initial infection. This is likely due to biofilm formation.

Symptoms of a urinary tract infection caused by E. coli

  • Urethritis (inflammation of the urethra)
  • Cystitis (inflammation of the bladder)
  • Burning while urinating
  • Frequent urination
  • Urinary urgency
  • Low-grade fever
  • Cloudy urine (due to white blood cells)
  • Lower back pain
  • A positive test

Diagnosis of E. coli UTI

A dipstick test will quickly establish if there is pus and/or bacteria in the urine. Cloudy urine can also be a sign of a urinary tract infection, which will be obvious both in the toilet and with a urine sample at the doctor’s office. The cloudiness is caused by pus in the urine. There are a few other causes of cloudy urine, so it doesn’t necessarily mean you have a UTI, but it can add to the diagnosis.

If the kidneys are suspected of being involved, a scan may be scheduled.

Treating an uncomplicated UTI caused by E. coli

Treatment options vary widely for UTIs, however the conventional treatment is antibiotics, in particular fluoroquinolone. Antibiotic resistance is an issue, with multi-drug resistant Enterobacteriaceae, mostly E. coli, being a matter of concern. E. coli strains are resistant to penicillins and cephalosporins, as well as fluoroquinolones and gentamicin.

Non-antibiotic treatments that can be applied at home include herbal medicines, reflexology, and others, but ongoing or severe infection, especially involving the kidneys, requires prompt medical attention.

Non-antibiotic treatments for E. coli UTI

Staying hydrated is very important, but plenty of fluids in your system can ease the pain of unfruitful urination and help keep the urinary tract clear as you are doing non-antibiotic treatments.

How to treat a UTI at home

Vaginal infections of E. coli

If you are diagnosed with an infection that includes E. coli, you have what’s known as aerobic vaginitis. This condition is caused by different types of bacteria compared with AV’s cousin, bacterial vaginosis. See the information page for aerobic vaginitis for details, however you can go through the Killing BV treatment protocol.

E. coli can be found residing in the vagina without causing infections, and a positive test without symptoms may not require any treatment. Testing may find that you have normal levels of lactobacilli, with other microbes also found.

Often the presence of E. coli in a vaginal culture is considered to be contamination of the sample, with bacteria from the anus caught on the swab. The frequency of this underlines the importance of getting clean swabs, especially if you are using an at-home test.

How your digestion can contribute to a UTI or aerobic vaginitis

The urinary tract has its own microbial ecosystem, which in women resembles vaginal flora. This means that a healthy vagina supports a healthy urinary tract. If you have digestive problems, the gut microbiome can become unhealthy, contributing to poor vaginal health due to proximity of the anus to the vagina.

Poor digestive health typically results in unbalanced gut flora, where pathogens are able to proliferate because of the absence or lack of healthy intestinal flora. E. coli naturally resides in the colon, and can overgrow, resulting in more frequent cross-contamination with the vagina and urinary tract. This highlights the importance of focusing on gut health when dealing with frequent vulvovaginal or urinary tract infections.

Constipation, for example, leaves stool in the colon for long periods of time, providing an ongoing food source for microbes. Having a healthy bowel movement every day at least once ensures that the microbial colonies in the digestive tract are kept in check, since the stool passing through acts like a broom. Fibre makes stools larger and firmer, creating a sort of boulder that moves through the intestines, picking up anything in its way and pushing it out.

Diarrhoea doesn’t have the same effect as constipation, but comes with its own issues – think of wet sand in a wet sock. Bits of faeces can remain on the intestine walls, being slow to move through. This too provides a lingering food source for microbes.

The causes of constipation and diarrhoea vary, so if you find yourself with irritable bowel-type symptoms frequently, see a healthcare practitioner to figure out what is causing your problems.

Jessica Lloyd - Naturopathic Practitioner, BHSc(N)

Jessica Lloyd - Naturopathic Practitioner, BHSc(N)

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)
Read more about Jessica and My Vagina's origin story.
Jessica Lloyd - Naturopathic Practitioner, BHSc(N)

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