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UTI Information Center

From understanding your symptoms to preparing for a doctor's visit, we are here to guide you towards proper treatment, healing and prevention. 

UTIs Are Common...Far Too Common!

It is estimated that 50% of women will have at least one UTI during their lifetime with many having repeat infections.  UTIs can occur at any age with an increase in risk after intimacy, exercise, travel, etc. 

UTIs are often caused by bacteria, with E. coli being the most common source. Other common UTI-causing bacteria are: enterococcus faecalis, staphylococcus, klebsiella, pseudomonas and several others.  Without going into the full microbiology studies, these bacteria can be grouped as Gram Negative or Gram Positive bacteria - with different antibiotic susceptibility.

Since UTIs are common they are sometimes treated without the proper attention and testing. For example, busy medical offices and urgent cares do not always send a urine sample for a culture and will prescribe a generic antibiotic, typically targeting the E. Coli bacteria. 

It is very important to determine the source of your UTI and treat it with the appropriate antibiotic. Re-occurrence of infection and antibiotic resistance can occur with improper treatment. Not treating an ongoing infection can lead to kidney infections and possibly sepsis.

With proper treatment, diet, and appropriate supplements you can heal and reduce the risk of repeat infections. You want to break the cycle before it becomes harder to recover.

UTI Symptoms

UTI symptoms can be one or a combination of the following: 

  • Strong urge to urinate frequently, even immediately after the bladder is emptied

  • Painful burning sensation when urinating

  • Discomfort, pressure, or bloating in the lower abdomen

  • Pain in the pelvic area or back

  • Cloudy or bloody urine, which may have a strong smell

  • Fever

Source: University of Maryland Medical Center

If you experience any of these symptoms, drink plenty of water and have your urine cultured as soon as possible. If your regular doctor can't see you right away we suggest going to an urgent care or ED/ER.

UTI Test Types and Reading Results

Once at a medical facility, it is vital to know the different types of tests available to you.  Often patients are ill or do not have the knowledge to ensure they are getting the best treatment possible.

We want to share our experience and knowledge to provide an overview of the tests that are available; including the benefits and limitations of each.  This is not an exhaustive list of all possible tests, but we strive to represent the common tests that are typically used to determine the cause of the UTI.  For in-depth understanding of each test and listing of additional tests, please consult a medical reference source, for example we found the University of Maryland Medical Center (link) site very informative.

Please note that for most tests, it is recommended for best results to use your first or second morning urine. The longer the urine is in the bladder, the better the sample is for test purposes. 

You may come across a term labelled "clean catch urine specimen."

This is a process that simply means collecting urine sample mid-stream to avoid contamination by contact with skin or other parts of your body.

Make sure the sample collection jar is sterile, where the lid is attached to the jar and has not been previously opened. This may seem redundant, but there have been cases where open contaminated cups were used for collection samples.

Steps for Clean Catch Urine Sample​

  • Wash yourself prior to providing the sample or if at the doctors office use the sanitary wipe provided.

  • Open sterile jar making sure you do not touch the inside of the lid or jar. 

  • Place lid face down on clean paper towel so that the inside of the lid is not exposed while you provide the sample.

Test strip is dipped into urine sample, typically during medical appointment.

Simple and quick preliminary test that can possibly show Leukocytes (white blood cells) and Nitrite in urine that are indicative of infection.

Limitations:

The nitrite (NIT) portion of the test may not detect all types of bacteria because it relies on a chemical reaction for the bacteria. There are bacteria types that are unable to reduce nitrate to nitrite, such as enterococci and staphylococci, rendering the results inconclusive or false negative. 

White blood cells may not show up if the urine is diluted due to higher water intake and urinary frequency. Additionally, a fairly large infection is needed to trigger a positive result. 

In general, diet, supplement use, medicine, and other factors may impact test results.

UTI Test Strips / Dip Stick

Urine sample is collected and sent for further analysis either onsite or separate lab.  This analysis involves multiple tests that combine into a single report.  The analysis is used to characterize a potential UTI based on multiple factors.

Urinalysis examines the physical, chemical, and microscopic aspects of the urine.

  • Color of the urine sample, appearance, specific gravity

  • PH level: optimal PH is 7.2 (too acidic or too alkaline is not optimal)

  • Red blood cells (RBC): check for visible and microscopic blood

  • Glucose: amount of sugar in the urine

  • Protein: can indicate UTI, dehydration, kidney problems, and other possible systemic issues.

  • Ketones: presence of ketones typically means the body is not getting enough sugar or carbohydrates. In some cases it can indicate sepsis.

  • Specific gravity: evaluates your body's water balance and urine concentration.
    This can be low if drinking lots of fluids.

Specific details of the tests are available at reference sites such US National Library of Medicine (link)

This test may have to be requested directly by the doctor in order to be performed.  It may not be provided by default otherwise.

Please note that this test may be influenced by amount of water intake and is a snapshot of the sample provided.  Microscope analysis of the sample is used to detect bacteria.  This test does not include a culture of the sample to better identify bacteria presence. 

We highly recommend to ask your doctor to add the Urine Culture test (discussed next) even if Urine Analysis is negative.  Sometimes there are separate boxes on the requisition form that the doctor needs to check.

Unfortunately, sometimes the lab is left to decide whether to perform the Urine Culture test if the Urine Analysis shows as negative.  It is possible to request for a "culture regardless" by the doctor, if applicable, to overcome any discrepancies.

Urine Analysis (UA)

Urine sample is collected and sent to lab for culture over 2-3 days.  The growth of bacteria is analyzed for "normal" vs. abnormal (ex. positive) test results.  The normal result is a low bacteria count that is denoted as no infection.  Normal value is not necessarily a set value across all labs.

Positive test results indicates bacteria or yeast growth in sample, and is likely pointing to an infection.  There may be a single or multiple bacteria detected in the test. 

 

Additional details are available at reference sites such US National Library of Medicine (link

 

If test is positive, the sample is tested against various antibiotics to determine the best treatment.  Part of the Urine Culture report includes Susceptibility of different antibiotics against the found bacteria.

The Susceptibility report includes listing of antibiotics and their ranking on effectiveness against the bacteria.  The score used to rank the antibiotics is termed the Minimum Inhibitory Concentration (MIC).  Not all reports will show the MIC, but all reports should include an indication for each antibiotic tested with the following designations:

  • S - Susceptible

  • I - Intermediate - May be effective at a higher dosage, or more frequent dosage

  • R - Resistant

Additional details are available at reference sites such Lab Tests Online (link

Please note that use of MIC is preferred as this provides a sensitivity score that can be used to understand the most susceptible antibiotic to use.  MIC scores are a bit confusing, with lower score being better since it indicates a more effective antibiotic option.  MIC measures the lowest amount (concentration) of the antibiotic that will stop the growth of the bacteria.

Additional details are available at reference Lab sites such ArupLab (link

Urine Culture

Same as sample that is collected and sent to lab for culture over 2-3 days but

lab report will show all levels of possible bacteria, even low Colony Forming Units (CFUs).

Best to do a first or second morning urine sample so that urine is more concentrated.

LabCorp has this option. Code is: 8086 Urine Culture, Comprehensive 

 

We recommend to request this enhanced reporting of the same test to show all levels of found bacteria.  Without this add-on request, the report will likely only show bacteria with high concentration, as measured by colony forming units (CFUs).  That is, only bacteria with above a certain threshold will be deemed infection level.  Ideally you would want the full report so you can work with your doctor if symptoms persist and low level of bacteria CFUs are found.

Most labs use a standard of a measure of bacteria greater than 100,000 colony forming units (CFU)/mL to indicate an infection.  It is possible that lower CFUs may indicate an infection, especially if symptoms persist. We recommend discussing the findings with your doctor.

Comprehensive Urine Culture

MicroGenDx

Use of DNA sequencing to detect pathogens such as bacteria, fungi, candida, and others at the molecular level that standard urine cultures may have missed. 

This test is becoming more readily available and can be ordered by your doctor.

MicroGenDX is a leading lab test option that you can speak to your doctor about.

Watch out for our upcoming blog about this test! In the meantime, here's a link for more information about MicroGenDX (link)

Aperiomics

This test uses sequencing and genomic analysis approaches, which can identify any known pathogen. They compare the complete genetic fingerprint of a sample to a database of more than 32k+ microbes/pathogens, the largest database of its kind in the world. Click here for more info about Aperiomics (link)

Next Generation DNA Sequencing

Additional testing to identify possible imbalances include (but are not limited to):

Pelvic Ultrasound
This non-invasive test can be helpful to see if there are any other possible causes for your symptoms, such as ovarian cysts or fibroids.

Post-Void Residual Urine Test
This test checks to see if you are retaining any urine. Can be done at the same time as pelvic ultrasound.

Pelvic Floor Dysfunction (PFD): a trained Physical Therapist can help tremendously if symptoms are caused by PFD.

 

Full Blood Work including: CBC, Kidney Function, ANA, and HNK1 CD57.

Thyroid: there is a direct connection between the thyroid and bladder.

Hormones: for example, low estrogen is known to cause bladder issues. Dutch Dry Urine test is a good option to determine any imbalance (link).

Vitamin deficiencies: Vitamin D3 being a common factor with bladder health and immunity.

Lyme Disease and Co-Infections: These pathogens commonly cause bladder issues.

Gene mutations such as MTHFR (methylenetetrahydrofolate reductase -- don't worry we can't pronounce it either). It's important to test for MTHFR a1298c and c677t gene mutations since many people with bladder issues have this gene mutation, so it's good to know if this needs to be addressed. Watch out for a blog on the MTHFR / bladder connection!

Systemic issues such as Candida: Natural cleanses and practitioner-led protocols can help the body recover.

Small Intestinal Bacterial Overgrowth (SIBO): Genova has a popular test that can be discussed with your doctor (link).

Interference Fields / Previous Surgeries or Injuries: Scar tissue or injury can affect the meridians and blood flow to certain areas of the body so it's helpful to get these checked. Mud packing can help clear these interference fields to promote healing and strengthen the area. A C-Section is a good example of a surgery that affects circulation and can be addressed. Also, any injury to the spine can directly affect the bladder. 

Comprehensive Stool Analysis:  Tests such as Doctor's Data (link) or Genova Diagnostics (link) can be ordered by your doctor to detect imbalances, possible pathogens and parasites . For example, low elastase levels (enzyme produced by special tissue in the pancreas) can contribute to painful symptoms as well as Yeast and/or bacterial imbalances. Make sure analysis report includes a list of herbs/supplements and medicine that any found pathogens are susceptible to. Blog on this coming soon!

Additional Testing 

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