UTIs and Hydration

You’ve heard it time and time again – “drinking more water can prevent UTIs”. But is there actually a link between hydration and risk of UTIs? Anecdotal evidence suggests that people with recurring UTIs swear by hydration as a preventative measure and studies have shown that drinking more water was associated with decreased occurrence of UTI hospital visits.

Let’s take a look at the science.

Hydration is important for more than just your urinary tract. In fact, water is responsible for many bodily functions including regulating body temperature, delivering nutrients to our cells, assisting the kidney and liver with getting rid of toxins in our bodies, and even improved cognition (6, 9).

We asked Dr. Katherine Klos, Urologist and Uqora Medical Advisor, if hydration can be used as a preventative measure to avoid UTIs.

“The European Food Safety Authority (EFSA) and the Institute of Medicine (IOM) recommend a female total water intake should be between 2.0 and 2.3 liters for “adequate hydration” (1). Whereas the U.S. National Academies of Sciences, Engineering, and Medicine determined that the total daily water intake should be about 3.7 liters fluids a day for men (7) Separate studies in women with recurrent UTI’s have demonstrated that increasing water intake by 1.5L per day reduced UTI rate (& antibiotic usage) by 50%. (2, 3)

The why behind how hydration decreased UTI rate is attributed to two factors:

The first factor is the dilution of urine. Dilute urine reduces nutrient concentration needed for bacterial growth. Meaning, without access to “food” the bacteria will not grow.

The second factor is the flushing of bacteria. With more urine volume, you are forced to empty the bladder at shorter intervals, thus pushing opportunistic bacteria out of the bladder instead of allowing it to sit and multiply within the bladder (2).”

Additionally, a study published in 2019 showed a positive association between hydration and UTI prevention in care home residents. The efforts from this study included seven structured drink times throughout the day and tracking hydration on a designated sheet. The number of hospital visits for patients with UTIs from the care home decreased from 18 in 2015/2016 to just 4 in 2017/2018 (8).

So how much water should you actually be drinking to prevent UTIs? Dr. Klos generally tells her patients that hydration for UTI prevention means drinking about 2-3L of water daily because 20% of water intake comes from food – but this recommendation can vary based on different lifestyles.

Dr. Klos shares that there is real controversy about defining and measuring hydration status because there are numerous factors that can impact hydration. Water is lost in the body through the skin, lungs, gastrointestinal (GI) tract, and the kidneys. Here are her general recommendations for these 3 lifestyle factors that may affect water loss:

Exercise

Physical activity increases water loss through the skin as sweat and through the lungs via increased respiration. You may want to increase your water intake above the recommendations noted above.

Climate

An important player in water loss is your environment. If you live in a warm climate, your body temperature tends to be more elevated, inducing sweat production for regular cooling. Sweat reduces overall hydration status and thus sweat should be an automatic trigger for grabbing that extra bottle of water.

Age

Dehydration in adults has been estimated to be between 16–28% depending on age, inversely related to age. (5) Meaning the older you are, the more likely you are in need of water.

It’s important to note that even though increased fluid intake has been linked to improved cognition (6) to better renal function and lower UTI prevalence – an excess of water can be detrimental to overall health. It’s important to modify your water intake in conjunction with your physician for the best and healthiest outcomes.

Water is the best source of hydration. Here are some ways you can stay hydrated:

• Always pack a reusable water bottle. Whether you’re on vacation, at work, or relaxing at home – keeping a water bottle nearby is a great reminder to stay hydrated.
• Set an alarm. Every 2-3 hours (while you’re awake) set an alarm to remind you to drink a glass of water.
• Start your day off with a glass of water. After a night’s sleep, a glass of water can rehydrate the body to get ready for the day ahead.
• Order a water with any other beverages you may be having. Some beverages like coffee, tea, soda, and alcohol might affect hydration in a negative way. Pairing them with a glass of water can help keep you hydrated!
• If you really don’t like water (or just want to change it up throughout the day), try flavored water by adding in fresh (non-acidic) fruit like cucumber, coconut, or peaches.
• Dr. Klos recommends the “The Slow Sip” method – fill up your 2L bottle of water and place it in front of you. Every few minutes, take a small sip. By the end of your work day you should be finished. If you aren’t, don’t get discouraged but assess how much you were able to drink and work to slowly improve on it.

1. (EFSA Panel on Dietetic Products Nutrition and Allergies (NDA) (2010) Scientific opinion on dietary reference values for water. EFSA J 8:1459
2. Hooton TM, Vecchio M, Iroz A, et al. Effect of increased daily water intake in premenopausal women with recurrent urinary tract infections: a randomized clinical trial [published online October 1, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.4204
3. EBM Verdict on: Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections: A Randomized Clinical Trial. JAMA Intern Med. 2018; 178(11):1509-1515. doi: 10.1001/jamainternmed.2018.4204.
4. Barley et al. Journal of the International Society of Sports Nutrition (2020) 17:52
   https://doi.org/10.1186/s12970-020-00381-6 Reviewing the current methods of assessing hydration in athletes
5. Stookey JD (2005) High prevalence of plasma hypertonicity among community-dwelling older adults: results from NHANES III. J Am Diet Assoc 105(8):1231–1239.
6. Riebl SK, Davy BM. The Hydration Equation: Update on Water Balance and Cognitive Performance. ACSMs Health Fit J. 2013 Nov;17(6):21-28. Doi: 10.1249/FIT.0b013e3182a9570f. PMID: 25346594; PMCID: PMC4207053.
7. Dietary reference intakes for electrolytes and water. U.S. National Academies of Science, Engineering, and Medicinehttps://www.nationalacademies.org/our-work/dietary-reference-intakes-for-electrolytes-and-water.
8. Lean, Katie et al. “Reducing urinary tract infections in care homes by improving hydration.” BMJ open quality vol. 8,3 e000563. 10 Jul. 2019, doi:10.1136/bmjoq-2018-000563
9. “The Importance of Hydration.” The Importance of Hydration, Harvard School of Public Health, 22 June 2018, https://www.hsph.harvard.edu/news/hsph-in-the-news/the-importance-of-hydration/.