If you suffer from recurrent urinary tract infections (UTIs) or interstitial cystitis you need to know about biofilm infections.

More and more studies have demonstrated that pathogenic bacteria can persist within the bladder tissue and serve as a ‘reservoir’ for recurrent urinary tract infections.

Bacteria and fungi can make so-called biofilms and hide under them. This protects the bacteria from being discovered by our immune system or from being killed by antibiotics. It also makes it harder to discover them in a urine culture.

Biofilms are estimated to be the cause of up to 80% of all microbial infections [1].

There’s a strong connection between biofilm infections, urinary tract infections and interstitial cystitis.

How can bacteria persist within the bladder tissue?

First of all, bacteria can develop new characteristics when allowed to proliferate inside the bladder.

Through a process called ‘quorum-sensing’ (aka bacterial communication) the bacteria can sense a high density of fellow bacteria and then start to attach to the bladder lining.

When enough bacterial density occurs, bacteria start to pass underneath the protective layer that is surrounding bladder cells (called uroplakin) and invade these cells.

They then multiply within the cell and form a colony of rod-shaped microbes.

As the colony grows, a pod forms and bulges into the bladder. This pod is covered by protective uroplakin.

What are biofilms?

Once in the pod, bacteria change shape and start to produce a mesh-like fibre structure out of a kind of starch (polysaccharide).

This structure is called a ‘biofilm’.

The biofilm links the bacteria to each other and to the outside matrix of uroplaktin.

The bacteria can now rest in the biofilm structure like ‘eggs in an eggshell’ [2].

This structure can protect the bacterial community from changes in the environment, antimicrobial agents and the host’s immune defences.

Living in a bacterial community has even more advantages: the bacteria can now share metabolic by-products (food) and transfer genes between them. This makes the bacteria more resilient.

Moreover, the bacteria get the chance to reproduce and proliferate – without being disturbed.

Biofilms and recurrent UTIs

E. Coli and Klebsiella are believed to be the main urinary tract infection causing bacteria.

Unfortunately, they are also both avid biofilm formers [3].

A recent study showed that 74% of E.Coli bacteria responsible for relapses of UTIs were biofilm formers [1].

Once the bacteria have reproduced, they can detach from their biofilm matrix and cause another bladder infection in another part of the urinary tract.

Through the quorum-sensing process they may also be able to become an antibiotic-resistant bacterial community.

Antibiotics may or may not be able to get rid of the recurring bladder infection but as the rest of the bacteria are protected in the shelter of their biofilm, infections may recur again and again.

Therefore, chronic UTIs could really be a biofilm infection.

Biofilms and interstitial cystitis

The symptoms of interstitial cystitis and chronic UTIs are often hard to distinguish. The main difference is that interstitial cystitis is present all the time whereas UTIs come and go.

UTIs are usually diagnosed when bacteria are detected in the urine. In interstitial cystitis, urine samples usually come back clear.

When we look at biofilms, we know that the bacteria are present. But because they are sheltered, they are not easily detectable or destroyed.

Let’s look at one researcher’s description of a biofilm infection:

‘A typical biofilm infection is usually a chronic infection with intermittent exacerbations’ [4]

Sounds familiar? To me, this very much describes interstitial cystitis.

Therefore, if you suffer from interstitial cystitis you may indeed be suffering from biofilm infections.

It is unlikely that this would always be the cause as interstitial cystitis is such a multi-factorial condition.

But it may be one piece of the puzzle.

Stay tuned as I will discuss testing and treatment options for biofilm infections in Part 2!

Now I’d like to hear from you. Do you think your bladder problems could be caused by a biofilm infection? Have you found relief with biofilm treatment? Let me know in the comments!

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Sources

1. Soto, Sara M. Importance of Biofilms in Urinary Tract Infections: New Therapeutic Approaches Advances in Biology 2014 [vol. 2014, Article ID 543974, 13 pages] available at: https://www.hindawi.com/journals/ab/2014/543974/cta/
2. Ward, Darrell Biofilms may be responsible for recurrent bladder infections theSource August 2003 https://source.wustl.edu/2003/08/biofilms-may-be-responsible-for-recurring-bladder-infections/
3. Hancock, Victoria et al Abolition of Biofilm Formation in Urinary Tract Escherichia coliand Klebsiella Isolates by Metal Interference through Competition for Fur Environ. Microbiol. June 2010 [vol. 76 no. 12 3836-3841] available at: http://aem.asm.org/content/76/12/3836.full
4. Wu, Hong et al Strategies for combating bacterial biofilm infections International Journal of Oral Science(2015) [7, 1–7] available at: http://www.nature.com/ijos/journal/v7/n1/full/ijos201465a.html

Mulvery, MA et al Bad Bugs and beleaguered bladders: interplay between uropathogenic Escherichia coli and innate host defenses. Proc Natl Acad Sci USA 2000 [97 (16): 8829-35] available at: https://www.ncbi.nlm.nih.gov/pubmed/10922042

Anderson, Gregory et al Intracellular Bacterial Biofilm-Like Pods in Urinary Tract Infections Science  04 Jul 2003 [Vol. 301, Issue 5629, pp. 105-107] available at: http://science.sciencemag.org/content/301/5629/105