What Runners Need to Know About UTIs

This article originally appeared on Womens Running

First, you feel an urgent need to pee. When you try, all you get is a burning sensation and barely a dribble. Soon, the whole cycle starts all over again.

Anyone who's had a urinary tract infection, or UTI, knows how painful and debilitating the symptoms can be.

While there's no evidence running causes UTIs or makes the infection worse--in fact, regular exercise might protect you--the symptoms can make it uncomfortable to train. "You may not get very far, or you may just run to the bathroom," says Dr. Rachel Rubin, a urologist and sexual medicine expert in Washington, D.C., who recently moderated a special session on urinary health at the American Urological Association's 2022 Annual Meeting.

Fortunately, a few habits that are good for your running (for instance, staying well hydrated) can also reduce your risk of developing UTIs and speed your recovery once you have one.

Running and UTIs: 5 Things to Know

Here's what else runners should know about these pesky and sometimes-recurrent infections.

Health experts don't always know why some people develop UTIs and others don't--but running may ward them off.

UTIs occur when infection-causing bacteria, typically those that normally live in your bowel, invade your bladder, kidneys, or the tubes that connect them (your urethra and ureters). And they're more than just annoying: Left untreated, UTIs can spread to your kidneys, causing fever, back pain, and the potential for more serious health problems.

Women are more likely to develop UTIs than men because their urethras are shorter (about 4 centimeters, if you're measuring), says Rubin, who's also a clinical professor at Georgetown University.

That makes it easier for bacteria to enter the urinary tract. Almost half of women will get one in their lifetime, and once you do, you're likely to soon get another one--about one-fourth of women who have a UTI will get a second within six months.

The reasons why some women are more prone to them aren't always well understood, says Dr. Kimberly Cooper, a urologist at ColumbiaDoctors and associate professor of urology at Columbia University Medical Center.

RELATED: A Pelvic Floor Physical Therapist's Guide To Urinary Incontinence

A family history of UTIs can increase your susceptibility, as can diabetes, pregnancy, and constipation. And you may get them more frequently after menopause, when levels of the hormone estrogen decline, making your vagina less acidic and more welcoming to bad-for-you bugs, Rubin says.

Some habits common among runners, including not drinking enough water holding your pee during long workouts, may increase your risk, says Dr. Meredith Metcalf, a urologist at NYU Langone Ambulatory Care Bay Ridge. So does having sex and using diaphragms or spermicide for birth control.

But overall, running can give you a leg up: People who exercise regularly appear to have a lower risk of developing UTIs, according to a 2016 study in Medicine & Science in Sports & Exercise, perhaps by bolstering your immune system.

Note: You might have heard hanging out in damp, sweaty running clothes can contribute to infections, but there's not much evidence to back this claim, Cooper says. Still, showering--or at least changing--post-run is a pretty good idea; doing so might ward off yeast infections, Metcalf says.

If you think you have a UTI, getting a urine culture is key.

The burning, urgent feeling of a UTI can seem unmistakable--but in fact, other conditions can irritate the bladder and vulva, resulting in similar symptoms, Rubin says.

In fact, dehydration can sometimes produce a stinging sensation when you pee, because more concentrated urine irritates the lining of the bladder, Cooper says. If you cross-train on the bike, cycling can cause pelvic discomfort that also mimics UTI symptoms.

See your doctor if you suspect you have a UTI, and go in person if you can, rather than booking a tele-health visit, Rubin says. Testing your urine for bacteria is the only way to know for sure if you have an infection, and if so, which type of bugs are causing it.

That's critical, because antibiotics, especially when used improperly, can actually contribute to future infections. "The normal flora that live in our body get wiped out by antibiotics, and then you’re getting rid of your own natural defense mechanisms," Cooper says. They can also contribute to antibiotic resistance, or infection with bacteria that no longer respond to medication.

If your infections are recurrent--defined as three infections confirmed by a culture in one year, or two in six months--you should see a specialist, such as a urologist. That way, you can get specific guidance on how to reduce your risk.

For peri- or post-menopausal women, this can involve vaginal estrogen products, Cooper says. These creams, rings, or tablets restore hormonal balance to the area without some of the risks or side effects associated with taking hormone replacement therapy as pills or patches.

Hydration is key for both prevention and treatment.

Urine flushes harmful bacteria from your system, so the more you go, the lower your risk of an infection taking hold. And of course, the more water you drink, the more urine you produce. In one study, women prone to UTIs cut their occurrence by half by gulping down an extra six cups of water per day.

Once you're diagnosed, you might want to up your intake yet again, especially on the run. "Make sure you’re really flooding yourself with water when you’re symptomatic," Cooper says. "It really helps to flush things out frequently."

Cranberry juice is another fluid purported to help prevent UTIs in women who develop them regularly. You'll likely have better luck with cranberry pills, Cooper says--they boast a higher concentration of compounds called proanthocyanidins, which prevent bacteria from sticking to your bladder and urinary tract.

Another supplement extracted from fruits, D-mannose, has shown promise in preventing UTIs. While the evidence for its effectiveness is still thin, it's worth a try if it may help prevent you from developing an infection and having to take antibiotics, Cooper says.

Study up on any antibiotics you're prescribed.

About those antibiotics: They're the primary treatment option for UTIs. Common options include Bactrim (co-trimoxazole), Macrobid (nitrofurantoin), or a class of antibiotics called cephalosporins.

Whichever one you receive, make sure to take it exactly as your doctor and the drug label indicate, Cooper says. Take the whole course, even after you feel better, to prevent antibiotic resistance. And pay close attention to whether you should swallow the pills with food or need to avoid certain foods and beverages, such as alcohol or grapefruit juice.

Note: If you're prescribed a type of antibiotic called a fluoroquinolone (examples include Cipro (ciprofloxacin), Levaquin (levofloxacin), or any others whose full name ends in -oxacin) ask your doctor about other options. The FDA actually recommends against prescribing these drugs for uncomplicated UTIs, because they have serious side effects, including a risk of tendinitis and tendon rupture that lasts for months after you take them.

"Sudden tendon ruptures would obviously be devastating to a runner," Cooper says. "All athletes should be aware of this and should refuse quinolones when they are prescribed them, if there’s something else available."

You can still run when you have a UTI, if you feel up to it.

For most runners, this is the million-dollar question. Fortunately, there's no reason you can't run while you recover from a UTI, Metcalf says. Cross-training--including cycling--is also fine, although it might feel uncomfortable to sit in the saddle.

"If they’re really debilitated from the symptoms, they may not feel like running, but they’re not going to cause themselves any harm," Cooper says. Just up your water intake even more to compensate for the fluid you're sweating out.

In addition, you might just want to alter your route so you're never too far from a bathroom, choose looser-fitting clothing, and use a medication like AZO (phenazopyridine), some formulations of which are available over-the-counter. This numbs your urinary tract so you feel better until the infection clears, Metcalf says.

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