If you’re a woman, it’s likely that you’ve experienced a urinary tract infection (UTI) at some point in your life. Some of us might even experience them more frequently than we’d like (if that’s you – keep reading!).
Between 50 and 60 percent of women will experience at least one UTI in their lifetime, and the prevalence of UTIs increases as we age. [1] In fact, it’s the most common outpatient infection in the U.S.
UTIs are primarily caused by E. coli, with about 75 to 90 percent of cases attributed to this bacteria, while 3 to 10 percent of cases may be caused by Klebsiella (another type of bacteria, which can also cause an infection in the gut, and which happens to be a trigger for autoimmunity). [2]
UTIs can manifest with a variety of symptoms such as a strong urge to urinate frequently, a painful or burning sensation when urinating, and cloudy or bloody urine. You may also experience pelvic pain, strong-smelling urine, and, in some cases, fever, chills, nausea, or vomiting.
Possible root causes of UTIs may include unhygienic personal care practices, anatomical differences, sexual encounters, low estrogen, and others that I explore more in depth below.
For some women, UTIs can be stubborn, persistent, or recurring. Typical UTI treatment includes the use of antibiotics, but E. coli is becoming increasingly resistant to antibiotic treatment, making UTIs more difficult to treat.
Over the years, I’ve come across a number of ways to naturally prevent and treat UTIs, and I’m sharing them in this article. We’ll cover:
- The connection between UTIs and Hashimoto’s
- The conventional approach to UTIs
- My foundational approach to treating and preventing UTIs
- Deeper root causes to address
The Connection Between UTIs and Hashimoto’s
While there are currently no studies focused on the frequency of UTIs in those with Hashimoto’s, many of my readers have reported experiencing a number of UTIs preceding their Hashimoto’s diagnosis, so I was curious about the possible connection.
First, we do know that frequent antibiotic use is associated with higher rates of both autoimmunity and irritable bowel syndrome (IBS). [3] Antibiotics can disrupt the flora in the gut (and we also have a vaginal microbiome, which can be affected by oral antibiotic use as well).
Higher levels of bad bacteria and lower levels of beneficial bacteria can contribute to the development of leaky gut, which we know is one of three things that must be present in order for autoimmune disease to develop (in addition to a genetic predisposition and an environmental trigger). [4]
My theory is that if someone is consistently using antibiotics to treat UTIs, over time their gut may become compromised, and this could be a contributing factor to the development of autoimmune disease, including Hashimoto’s.
Another factor I’ve considered is the bacteria Klebsiella. As mentioned earlier, 3 to 10 percent of UTIs may be caused by Klebsiella. Interestingly, an overgrowth of Klebsiella in the gut can also be a trigger for autoimmune disease. I’ve analyzed nearly 300 GI-MAP tests from people with Hashimoto’s (which you can read more about that here), and Klebsiella was present in 40 percent of samples (it was only labeled as “positive” in around nine percent of test results, due to the parameters of normal lab ranges – but I always note levels of pathogenic bacteria, even if it’s below the normal range). It has been associated with ulcerative colitis, Crohn’s disease, ankylosing spondylitis, and arthritis. [5]
Several studies suggest that certain probiotics, especially strains of Lactobacillus, may help prevent recurrent UTIs, particularly in women. [6] These beneficial bacteria can restore and maintain a healthy balance of vaginal and urinary tract microbiota, which can help inhibit the growth of harmful pathogens like E. coli.
One notable randomized controlled trial found that Lactobacillus crispatus vaginal suppositories significantly reduced the rate of recurrent UTIs compared to a placebo. [7]
Additionally, phage therapy is showing promising results for the treatment of UTIs. Phages are benevolent viruses that disrupt bacterial biofilms, like the E. coli bacteria that cause UTIs. Recent studies have shown favorable results using phage therapy for UTIs, including cases of asymptomatic bacteriuria and uncomplicated cystitis. [8] These findings suggest that phage therapy could be an effective treatment option, either alone or in combination with antibiotics, for managing UTIs.
While we need more rigorous, large-scale clinical trials, probiotics (especially certain Lactobacillus strains) and bacterial phages show potential as a low-risk, supportive strategy for UTI prevention, and can be used alongside antibiotic treatment.
Probiotics are also commonly used as support for those with Hashimoto’s, and the gut microbiome does seem to be a common factor in both UTIs and Hashimoto’s.
Testing and the Conventional Approach to UTIs
To get tested for a UTI, you can visit your doctor to take a urine sample, and many pharmacy clinics and urgent care clinics also offer testing for UTIs. The urine sample will be monitored for the growth of bacterial cultures, and the strains will be identified.
If an infection is present, conventional doctors will usually prescribe antibiotics such as Macrobid, Bactrim, Cipro, or a broad-spectrum antibiotic.
Foundational Approach to Treating and Preventing UTIs
While antibiotics can certainly be helpful in treating a UTI, overuse of antibiotics is not great for your microbiome, plus it can lead to antibiotic resistance, making future infections more difficult to treat.
This is my foundational approach to treating and preventing UTIs:
- Wipe from front to back – Yes, we are going back to the basics here! But it’s always a good reminder that after going to the bathroom, you always want to wipe from front to back – never the other way around! This helps keep coli that is often found in our feces away from the vaginal area and urethra.
- Hydration – Dehydration is actually a major contributing factor to the development of UTIs. When we drink enough water, this encourages frequent urination, which helps clear out bacteria and reduce bacterial overgrowth.
- Cranberry juice – Yes, that’s right – good old cranberry juice! Cranberry juice may help prevent UTIs by preventing E. coli bacteria from adhering to the walls of the urinary tract, thanks to compounds called proanthocyanidins. [9] While not a substitute for treatment, cranberry juice may help prevent infection when you feel a UTI coming on. I recommend using a pure cranberry juice with no added sugar.
- D-Mannose – I also recommend taking ½ tsp of D-mannose powder if you feel a UTI coming on. D-Mannose is a naturally occurring sugar found in fruits like cranberries, apples, and peaches. It can bind to E. coli bacteria in the urinary tract, preventing them from attaching to the bladder wall, and allowing them to be flushed out with urine. [10] D-Mannose can be used as a preventative measure against oncoming UTIs or at the first signs of infection. Pure Encapsulations makes a D-Mannose powder that I like.
- Avoid bladder irritants – Avoid common bladder irritants like caffeine, alcohol, artificial sweeteners, and spicy foods. Doing so can help reduce UTI symptoms and lower the risk of irritation that makes the urinary tract more vulnerable to infection.
- Probiotics – As mentioned above, probiotics may be helpful in preventing recurrent UTI infections. For a broad-spectrum probiotic that contains the beneficial Lactobacillus, you may consider Rootcology’s ProB50 or Pure Encapsulations Probiotic 50B. Seed makes a vaginal probiotic suppository, which can help support a healthy vaginal microbiome and has been shown to increase L. crispatus levels (the vagina’s most protective bacteria).
- Phages – I’ve also developed a probiotic supplement that contains phages, which are benevolent viruses that selectively target bacteria, including E. coli. Rootcology Microphage combines four types of phages along with seven strains of probiotics. Please also see this article for more information about the most beneficial probiotics that I recommend for Hashimoto’s.
Deeper Root Causes
If you have recurrent UTI infections, you may need to dig deeper into underlying root causes. Here are some that I’ve learned about over the years:
- Estrogen deficiency – While we typically think of estrogen dominance as the trouble-maker, when it comes to UTIs, not having enough estrogen can actually contribute to UTIs. This is because low levels of estrogen can lead to thinning of the urinary tract lining, especially after menopause, but levels can start declining in perimenopause. [11] This thinning reduces the natural protective barrier against bacteria, making the urinary tract more susceptible to irritation and infection, including recurrent UTIs. In postmenopausal women, topical estriol may restore mucosal resilience and reduce UTI frequency.
- Incomplete bladder emptying – This can occur as a result of hypotonia, pelvic floor dysfunction, or neurological issues. Incomplete bladder emptying can feel like a lingering sensation of fullness or pressure in the lower abdomen, even right after urinating. You might also experience a weak urine stream, dribbling after finishing, frequent urination due to retained urine, or the feeling that you need to “go again” shortly after finishing. If you experience this, I would suggest screening for pelvic floor dysfunction, interstitial cystitis, or anatomical issues (especially if infections are frequent or severe). Carnitine may be helpful due to its positive effects on muscle tone. It’s also a nutrient I’ve found helpful for those with Hashimoto’s (read more about that here).
- Pelvic floor therapy – If pelvic floor dysfunction is at the root of recurrent UTIs, you may benefit from pelvic floor physical therapy or gentle bladder retraining. You will need to seek out a physical therapist who specializes in these areas.
- Blood sugar imbalances or insulin resistance – Elevated glucose levels in the urine create a favorable environment for bacterial growth. Additionally, high blood sugar can impair immune function, making it harder for the body to fight off infections. Keeping blood sugar levels balanced can be helpful, and supplements such as berberine can help support healthy blood sugar levels.
- Oxalate overload – An excess of oxalates, which are found in foods such as dark leafy vegetables and legumes, as well as some nuts and seeds, can irritate the urinary tract lining, potentially worsening UTI symptoms. Oxalate buildup can also lead to kidney stone formation, which can increase the risk of infection. Lastly, oxalate buildup is linked to the development of interstitial cystitis, a chronic bladder condition with symptoms similar to UTIs. See my article on oxalates for more information.
Some recurrent infections may involve biofilms, which are protective bacterial coatings that evade antibiotics. If you feel like you’ve tried everything, but continue to get UTIs, you may consider the following interventions that target biofilms:
- Interfase Plus or Biofilm Defense – These are enzyme blends that can disrupt biofilms. Ther-Biotic Interfase Plus and Kirkman Biofilm Defense are both available via Fullscript. If you don’t have a Fullscript account, you can sign up with my credentials here.
- Berberine, uva ursi, or garlic extract – These are antimicrobial botanicals that offer a natural alternative to antibiotics. Uva ursi works primarily for E. coli (available via Fullscript), while berberine and garlic extract work for both E. coli and Klebsiella.
As far as pharmaceuticals, Macrobid (nitrofurantoin) is an antibiotic that is used to treat and prevent UTIs. Macrobid concentrates in the urine, making it especially effective for bladder infections. It generally has fewer side effects compared to broad-spectrum antibiotics, and resistance may develop more slowly than other antibiotics. However, it still can lead to antibiotic resistance if used in the long-term, and it may cause nausea, headache, or in rare cases, lung or liver toxicity.
If you do need to take antibiotics, remember to take a probiotic alongside it, to minimize damage to the gut. I like to use the beneficial yeast S. Boulardii to replenish the microbiome and support the gut during antibiotic use.
Takeaway
Supporting a healthy gut microbiome may help reduce UTIs and also promote better thyroid function and immune balance in autoimmune conditions! Whether you experience recurrent UTIs or just want to help prevent them, taking probiotics to rebalance the good bacteria in your digestive tract is one effective strategy, as well as following the preventive measures I mentioned in this article.
I hope that this information helps you on your journey!
Do you experience frequent UTIs? Have you tried any of the interventions I discussed?
P.S. I love interacting with my readers on social media, and I encourage you to join my Facebook, Instagram, TikTok, and Pinterest community pages to stay on top of thyroid health updates and meet others who are following similar health journeys. For recipes, a FREE Thyroid Diet start guide, notifications about upcoming events, and the Nutrient Depletions and Digestion chapter from my first book for free, be sure to sign up for my email list!
References
[1] Medina M, Castillo-Pino E. An introduction to the epidemiology and burden of urinary tract infections. Ther Adv Urol. 2019;11:1756287219832172. Published 2019 May 2. doi:10.1177/1756287219832172
[2] Orenstein R, Wong ES. Urinary tract infections in adults. American Family Physician. March 1, 1999. Accessed May 7, 2025. https://www.aafp.org/pubs/afp/issues/1999/0301/p1225.html.; Ding Y, Wang H, Pu S, Huang S, Niu S. Resistance Trends of Klebsiella pneumoniae Causing Urinary Tract Infections in Chongqing, 2011-2019. Infect Drug Resist. 2021;14:475-481. Published 2021 Feb 9. doi:10.2147/IDR.S295870
[3] Räisänen LK, Kääriäinen SE, Sund R, Engberg E, Viljakainen HT, Kolho KL. Antibiotic exposures and the development of pediatric autoimmune diseases: a register-based case-control study. Pediatr Res. 2023;93(4):1096-1104. doi:10.1038/s41390-022-02188-4; 1. Livanos AE, Greiner TU, Vangay P, et al. Antibiotic-mediated gut microbiome perturbation accelerates development of type 1 diabetes in mice. Nature News. August 22, 2016. Accessed May 8, 2025. https://www.nature.com/articles/nmicrobiol2016140.; Staller K, Olén O, Söderling J, et al. Antibiotic use as a risk factor for irritable bowel syndrome: Results from a nationwide, case-control study. Aliment Pharmacol Ther. 2023;58(11-12):1175-1184. doi:10.1111/apt.17736
[4] Fasano A. Leaky gut and autoimmune diseases. Clin Rev Allergy Immunol. 2012;42(1):71-78. doi:10.1007/s12016-011-8291-x
[5] Rashid T, Wilson C, Ebringer A. The link between ankylosing spondylitis, Crohn’s disease, Klebsiella, and starch consumption. Clin Dev Immunol. 2013;2013:872632. doi:10.1155/2013/872632
[6] Sadahira T, Wada K, Araki M, et al. Efficacy of Lactobacillus vaginal suppositories for the prevention of recurrent cystitis: A phase II clinical trial. Int J Urol. 2021;28(10):1026-1031. doi:10.1111/iju.14636
[7] Stapleton AE, Au-Yeung M, Hooton TM, et al. Randomized, placebo-controlled phase 2 trial of a Lactobacillus crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection. Clin Infect Dis. 2011;52(10):1212-1217. doi:10.1093/cid/cir183
[8] Zulk JJ, Patras KA, Maresso AW. The rise, fall, and resurgence of phage therapy for urinary tract infection. EcoSal Plus. 2024;12(1):eesp00292023. doi:10.1128/ecosalplus.esp-0029-2023
[9] Jangid H, Shidiki A, Kumar G. Cranberry-derived bioactives for the prevention and treatment of urinary tract infections: antimicrobial mechanisms and global research trends in nutraceutical applications. Front Nutr. 2025;12:1502720. Published 2025 Feb 26. doi:10.3389/fnut.2025.1502720
[10] Kyriakides R, Jones P, Somani BK. Role of D-Mannose in the Prevention of Recurrent Urinary Tract Infections: Evidence from a Systematic Review of the Literature. Eur Urol Focus. 2021;7(5):1166-1169. doi:10.1016/j.euf.2020.09.004
[11] Robinson D, Toozs-Hobson P, Cardozo L. The effect of hormones on the lower urinary tract. Menopause Int. 2013;19(4):155-162. doi:10.1177/1754045313511398
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