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The bladder microbiome (no, the bladder isn’t sterile)
In the 1800s the bladder was declared to be a sterile environment, and this dogma has persisted until quite recently. In the 1950s, Edward Kass demonstrated pathogenic bacteria were present in urine (at over 100,000 bacteria per ml of urine) in women experiencing kidney infections; healthy individuals tended to have levels under this threshold. Still little was understood about the environment as a whole and the role of these microbes.
More recently, newer testing methods have been able to show that urine harbours a complex microbial community in all individuals, regardless of whether the individual has bladder symptoms or not. Specifically, a 2014 study found live bacteria and bacteria DNA in human urine in the absence of clinical infection.
From recent types of tests (culture and qPCR based), we can gain insight into what microbes are present in the bladder at one time - both commensal and pathogenic, and their relative quantity to each other. It’s the latter factor which may predispose someone to having bladder symptoms, or not.
What do we find in the bladder microbiome?
The ‘microbiome’ is the collective term for the microbes in a certain environment; we also have a microbiome in our gut, mouths and vaginas. Each microbiome has special characteristics to keep its unique environment functioning optimally.
When we discuss microbes, we refer primarily to bacteria species, but protozoa, fungi and viruses can also make up a microbiome.
Although science has revealed much insight into the bladder microbiome, there is still lots to find out about its ideal composition and its interaction with us, its host.
What we do know is that certain microbial communities in the urinary tract have been implicated in the maintenance of health but alterations in their composition have also been associated with different urinary pathologies.
A disruption to the urinary microbiome can lead to acute urinary tract infections (UTI’s), recurrent chronic urinary tract disorders, chronic urinary tract infections (cUTIs) and interstitial cystitis symptoms.
How is the bladder microbiome unique?
In general, the microbiome in urine is less abundant and less diverse than in the gut. For example, the female urinary microbiome is estimated to contain 104-105 colony forming units in comparison with 1012 in faeces. There is some overlap of microbes with the gut and the vagina, and recent research indicates there is a clear connection between the urinary microbiome and the vaginal microbiome.
Factors such as PH, oxygen and nutrient availability have been associated with alterations in the urinary microbiome. And of course, cross contamination of microbes from the vagina and gut into the urinary tract can cause issues.
How can we test and what are the benefits of this?
Unlike urine cultures taken at the GP surgery (which may or may not pick up any pathogenic bacteria depending on the conditions and quantity in the urine at any one time), PCR testing can more accurately identify microbes in a subject’s urine.
Invivo Healthcare in the UK have recently launched a test which does just this for women. Their Urinary EcologiX test can detect the presence and volume of 15 commonly found microbes (beneficial and pathogenic). The results of this test can in turn be extremely useful for informing treatment plans to support a female back to better bladder health.
Diet and lifestyle changes can be made which encourage commensal bacteria to thrive, and minimise colonies of pathogenic bacteria, to ultimately reduce bladder symptoms for the client. And targeted supplementation options can often be very effective too.
I run bladder microbiome test for clients if I think it will benefit them, and do so alongside a health, symptoms and diet review - the insights we can gain from the test can be a game-changer for a client's journey back to health.
Book yourself in for a 20 minute discovery call if you want to chat further!
