Bladder urgency and imbalance of vaginal bacteria

Could your bladder urgency be influenced by the balance of bacteria in the vagina?

Bladder urgency can occur with or without leakage. If with leakage, it is known as urge incontinence. Urge incontinence may sound melodramatic, as though you are losing control of the entire contents of the bladder. But any leakage whatsoever is officially known as incontinence. Still, you don’t need to be leaking for it to be distressing. That stressed-out feeling of having to rush to the toilet, worried you might not make it, has a terrible effect on your quality of life.

What does this have to do with the vaginal microbiome?

I’ll get there! But a little more about urgency first. People get the impression that any bladder weakness is the domain of older women – elderly or at least post-menopause – or pregnant or post-partum women. But this is a myth. Urgency and urge leakage can occur at any age. Physiotherapy evaluation and treatment has a central role.

Physiotherapy treatment for bladder urgency, sometimes called overactive bladder or OAB, is very comprehensive. It may include bladder training, pelvic floor exercises, correcting drinking habits or toilet habits, resolving constipation, managing swelling in the legs, TENS (a type of electrical stimulation) and much more. However, in my 20-odd years of clinical practice, I have seen a lot of vaginal bacterial imbalance issues – everything from recurrent thrush to bacterial vaginosis to irritation without a precise diagnosis. And yes – this can and does occur with bladder urgency!

Vaginal imbalance isn’t present in everyone with urgency, but it you have symptoms of vaginal irritation or imbalance, it should be looked into.

Recent research suggests that in some situations, vaginal dysbiosis, or bacterial imbalance, and bladder urgency can be connected.

Vaginal itch, irritation, discharge or bad odour are all warning signs you could have an imbalance in vaginal bacteria. Something could be going on with your vaginal microbiome. And this could be connected to your urgency!

A recent study looked at two bacteria that can be present in the vagina, but are generally “unfriendly” to the area. One you definitely will have heard of: E coli (a common culprit in UTI – urinary tract infection). One is less famous, but plays a major role in bacterial vaginosis: Gardnerella vaginalis.

The presence of E coli or Gardnerella in the vagina does not mean you have an infection. However, if either of them starts to take over, this can cause aerobic vaginitis and bacterial vaginosis, respectively.

So what does the research tell us about E coli, Gardnerella and bladder urgency?

This study found that E coli and Gardnerella produce compounds that “excite” the bladder. By increasing calcium influx into the bladder cell, they can cause the bladder to contract. This could lead to a feeling of “gotta go” – that is, bladder urgency. This effect was NOT shown with healthy vaginal bacteria, including two common species of Lactobacillus. In fact, Lactobacillus crispatus was able to REDUCE calcium influx into the cell.

Reading this study makes me consider that if you have

-a sensitive bladder

-a bladder that feels fuller than it is

-a need to go to the toilet too frequently due to a strong urge, even when drinking normal amounts

-a feeling of urgency

-a struggle to get to the toilet on time

…it’s worth considering the possibility of vaginal bacterial imbalance – specifically, an overgrowth of Gardnerella or E coli. This is a microbiome picture that you definitely don’t want to have!

We can test for clues to vaginal flora imbalance via a vaginal pH test.

This is something I do routinely in practice.

Remember, there are many causes of bladder urgency, and your pelvic physiotherapist can help work out which are playing a role in your case. But don’t neglect the possibility of imbalance in vaginal bacteria!