Short Wave - Recurring UTIs: The Infection We Keep Secretly Getting

Episode Date: September 6, 2023

Have frequent, burning pee? Cramping or the urge to pee even though you just went? If you haven't yet, you probably will eventually—along with an estimated 60% of women and 10% of men. That's the large slice of the population that experiences a urinary tract infections (UTI) at least once. Many people avoid talking about these infections, but about one in four women experience recurring UTIs. No matter what they do, the infections come back, again and again. So today on the show, Regina G. Barber takes producer Rachel Carlson on a tour of the urinary tract. We zoom into what recurring UTIs may have to do with changes on the DNA of our bladder cells and the hidden bacterial houses in our bladder walls. Read more about the latest research into recurring UTIs in this article from our colleagues at NPR's global health blog, Goats and Soda.Got questions about the big and small of our universe? Email us at [e-mail] pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Hey there, shortwavers, producer Rachel Carlson here, and today I'm playing host so our scientist in residence, Regina Barber, can bring me a story. Hey, Gina. Hey, Rachel. What you got for me today? So we're talking all about urinary tract infections or UTIs. They're very common. They happen to about 60% of women and 10% of men in the U.S.

That's a huge amount of people, but you're definitely right. I don't feel like I really hear people talk about them, and I don't know much about them, other than that they're not fun at all. Yeah, I didn't really know too much about them either before I started working on this story. So UTIs are when bacteria get into part of your urinated tract and create an infection. We'll get into more details later, details that Kelly Holden is very familiar with. So Kelly gets chronic or recurring UTIs. That's when somebody has at least two UTIs every six months or three in a year. And it's pretty common about one in four women experience this.

She's been getting UTI since she was a six-month-old baby. And over the years... Years. Yeah, years. She's gotten very familiar with a particular sensation. It was wanting to pee all the time. And I guess for lack of a better term, burning when you peed. Yeah, it really hurts.

And I think a lot of us have felt that before. Yeah, I definitely have. And I've never gotten any treatment for it. But Kelly has a lot because at certain points Kelly's UTIs were so bad that in addition to frequent painful pee, that pee became bloody. And since she had so many of them over the years, she'd gotten into a kind of routine for getting them treated. Basically, every single time I would get a UTI, I would go into a walk-in clinic and I'd say I have chronic UTIs. Can I please have antibiotics? And so essentially I was taking antibiotics every time I got one, which isn't really great for your system.

Some people also report needing to pee even when their bladders feel empty, cramps in their groin or lower abdomen. And if the UTI is in the kidneys, they can also have fever, chills, and vomiting. Oh, that sounds really awful. Yeah, awful. And so many doctors turn to antibiotics for their patients that suffer from these chronic UTIs. But the problem... Wait, stop. So there's a problem on top of the pain.

UTI problem. Right, yeah. The other problem is that for some people, these antibiotics eventually stopped working. That was the case for Megan Pratt, another person I talked to who experiences chronic UTIs. And I have in the past had daily antibiotics prescribed, so I had some, and I took them, you know, as prescribed for treating a UTI, and it didn't really go away. So her medical team eventually had to switch her to a new set of antibiotics that she hadn't built a resistance to.

daily ones she is still taking. But we might be one step closer to understanding why these UTIs keep coming back. And put a stop to the seemingly endless cycle all these people are facing. Thanks to new research out this year about what's happening to people's DNA. Today on the show, demystifying the UTI. We give you the lowdown on what's happening to your body when you get one and why some people get them over and over. I'm Rachel Carlson and you're listening to Shortwave from NPR. So Gina, let's get into the science.

What happens in the body when someone gets a UTI? Okay, Rachel, let's first start with a little anatomy lesson. The urinary tract is basically the body's drainage system. It removes urine, which is filled with all sorts of waste and extra fluid your body doesn't need, like toxins, extra water, salt, stuff like that. And it includes two kidneys that hang out below your rib cage. each about the size of your fist, two urators, which are those thin tubes made up of muscle that connect your kidneys to your bladder. So then there's your bladder, which doctors also compared to a balloon.

It's hollow, also muscular, it changes shape as it fills or expels your pee, and it lives in your pelvis between your hip bones. Right, love it. I feel like I'm back in school. Yeah, I love school. And then this last piece of your urinary tract is the urethra. And you can think of that as this little tube at the base of your bladder. That's where your pee comes out. Okay, so what's going on in this part of your body when you get a UTI? Well, I talked to microbiologist Dr. Indira Mizorker.

She's at Baylor College of Medicine, and she's been studying the bladder and UTIs for most of her career. And she told me that basically a UTI happens with some part of this tract, usually the bladder, which is why we're going to focus on UTIs in the bladder this episode. Okay, so that's in the pelvis area. Right, yeah. It gets infected with one of a few. specific kinds of bacteria, mostly one called uropathogenic E. coli. And Eurro means bladder, and Europathogenic means something that's bad for the bladder.

And these bacteria can get inside our bladders through multiple sources. Once they enter into our bladder ecosystem, these bugs have specific hairs that have a very high affinity for binding to proteins on our bladder cells. And then what happens when the bacteria binds to the bacteria binds to the proteins. Once they bind to the cells, that's when things get bad. When the infection is severe, the bacteria damages our bladder cells and tissue. When that tissue begins to heal, proteins go back into the bladder cells. But after the infection, some of those proteins have the bacteria bound to them. So the bacteria gets inside our cells too. And then we've shown that once they're

inside our cells, now they're protected from our immune system, our immune cells, which are outside in the bladder or in our bloodstream. Then over the next several hours, the bacteria multiplies super rapidly. And generate millions of bacteria that are living inside our cells. Eventually, the damaged cells can't function anymore, and the body starts to expel them into the urine. And then that's when all the bacteria are shed out, and that's what we sense as an acute infection with a lot of immune cells coming in.

Hmm. So if we shed the cells, why are people like Megan, and Kelly still getting these chronic infections. So that's the big question, like what's causing recurring infections? Indira says that there are certain circumstances that make it more likely for someone to get chronic or recurring UTIs. We do know that UTIs can increase in people under certain conditions, like if one is pregnant or if one has diabetes, if one has had transplant surgery, or if one has spinal cord damage. and most importantly, as people get older, there's a higher risk, higher incidence and frequency of getting urinary tract infections.

But the exact mechanisms that are underlying that, causing them to come back again and again, it isn't totally clear. Endera says that bacteria can start to just hang out in your bladder. They also can establish little houses inside our bladder wall, which can come out and cause recurrent infection. And some people can have recurrent UTIs for months on end in years on end. That's so frustrating. I agree. But researchers might be one step closer to solving this puzzle. Researchers at Washington University in St. Louis published a paper this year that looks at the bladder cells of mice, particularly the mice that, when exposed to UTI-causing bacteria and then given antibiotics, were later more susceptible to future UTIs.

Right. And you mentioned changing deities. DNA earlier? Yeah, so they found that these cells and mice that were susceptible to UTIs were different from the cells from mice that weren't. There were epigenetic changes in the DNA of the mice bladder cells. Epigenetic like changes on top of your DNA, right? Right, so it affects how the genes are interpreted.

And in this case, it's markers that are put on DNA in the urinary tract cells or the bladder cells that change how the DNA sequence is red. And they're usually due to environmental changes. like an infection or behavioral changes. And this is making the genes be read in a way that's worse and somehow makes people more likely to get UTIs again? Yeah, so not all epigenetic changes are bad. Like sometimes an epigenetic response can help your immune system

prepare for an infection it's seen before. But in the case of recurring UTIs, it's actually making things worse. Okay, how? So when your body fights an infection, like a UTI for the first time, once it's done, your immune system basically goes, okay, let's post some signs so that we know next time this is how we defeated this bacteria. Nice.

And there's different signposts depending on whether you... Tom Hannon was one of the authors of this paper on recurring UTIs, and he says that when people get mild UTIs, these signposts are useful. But for people with severe UTIs, these signposts can stop being helpful. Yikes. Those signposts don't pose. Make the subsequent fix. Worse because on their DNA,

they end up with basically the memory of this UTI infection and how it was very aggressively fought. It's epigenetic. And the way that your body fights this kind of severe infection and heals itself is to expel the bacteria, which is the right end goal. But Tom says that to do that, the body can end up hurting another part of itself. And so the signposts get changed in a way to where the inflammation is not regulated well, and so it's unchecked. And there are mechanisms that are activated that cause wounding of the law. lining of the bladder. And that actually can work to the bacteria's advantage. Because extra damage gives the bacteria a foothold in the bladder and helps them thrive, which can make you more

susceptible to getting a UTI in the future. It's unclear if this is exactly the same thing Indira was talking about before. But researchers are clearly consenting around bacteria sticking around in the bladder one way or another. So, Gina, I'm thinking about all of the people we talked about before who have these recurring UTIs and might have felt like it was their fault or they didn't do enough to prevent them. And we know that UTIs can carry a bunch of stigma. So what does this research mean for them? Yeah, I thought about that a lot too when I was reporting on this, the stigma of getting one and how that prevents them from talking about it or even seeking treatment. When I talked to Indira, she was really clear that this was about the interaction between your

body's DNA and the bacteria. It's not about someone failing to follow their doctor's treatment plan. And it is not anyone's fault. It is how it is. And so how to treat them better, how to improve quality of life, it should be our goal, not stigmatizing and having any kind of shame associated with infection. That's so powerful. So for the women you talked to before, did you tell them about this new research? Yeah, I did.

And for Megan, it was a relief. she had been exhausting herself trying to prevent them most of her life. And if it's just not possible to prevent them, that will be a relief to me because it's not anything I'm doing, right? And so if the response to that is that no, you're not doing something wrong, that's a relief because I haven't created this problem for myself. I have only responded to it in the way that I can. Yeah, I'm imagining that's also kind of frustrating, though, to feel like there's nothing you can do to prevent them. Yeah, she did talk about that. She said that she felt a little discouraged. But there is hope. Unlike genetic changes, epigenetic changes are theoretically reversible. They don't alter your literal DNA sequence, right? So when I talk to Tom about this and about the outlook for research and the patients, he was clear that, yes, there needs to be more research, but just maybe. If given absence of infections for a period of time, they may revert to a state where they're better able to defend against bacterial infection.

So we'll keep our fingers crossed that these epigenetic changes are short-lived. We definitely will. Thank you so much for bringing the story to us, Gina. Thank you for listening, Rachel. Our colleagues here at NPR did a great write-up of the Washington University in St. Louis' team's recent study looking at recurrent UTIs for the Goats and Soda blog. We'll link to it in our show notes. This episode was produced by Burley McCoy and fact-checked by Anil Oza. It was edited by managing producer Rebecca Ramirez, and the audio engineer was Robert Rodriguez.

Special thanks to reporter Max Barnhart for sharing his reporting with us. Betzanovin is our senior director, and Anya Grendman is our senior vice president of programming. I'm Rachel Carlson, and I'm Regina Barber. Thank you for listening to Shortwave from NPR. So how does it feel to be on this side of the story? It feels good.