What Your Digestive Health Says About Urinary Symptoms

Jason B. Carter, M.D.

Credit: Aeroflow Urology

When bladder symptoms like frequent urination, urgency, recurrent urinary tract infections (UTIs) or incontinence appear, most people assume the problem starts and ends with the bladder itself. But according to Jason B. Carter, M.D., a urologist and medical adviser with Aeroflow Urology, the story is often much bigger — and it may begin in the gut.

In an interview with The Educated Patient, Carter explains the surprisingly close relationship between gut health and bladder function, shedding light on why constipation, microbiome imbalances and digestive disorders can quietly drive urinary symptoms. From the role of diet and fiber to the hidden costs of incontinence that patients rarely talk about, he outlines why persistent bladder issues deserve a broader, more holistic look, and why patients don’t have to simply live with these symptoms.

Most people think gut health only affects digestion — how is the gut actually connected to bladder function?

Jason B. Carter, M.D.: Most of my patients are surprised to learn this, but the gut and bladder are closely connected both physically and neurologically. They sit right next to each other in the pelvis and share muscles, nerves and space. Because of that, they also share inflammatory, immune and neurologic signaling pathways. There’s a lot of cross-talk between the two systems.

When the bowel isn’t working well, especially with chronic constipation or fecal impaction, it can put direct pressure on the bladder. That pressure can interfere with bladder emptying and trigger symptoms like frequency, urgency and incontinence. Other bowel conditions that commonly affect bladder function include irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis, diverticulitis and even colon cancer.

In clinical practice, many of my patients’ “bladder problems” improve once the underlying gut issues are addressed.

How can an imbalanced gut microbiome contribute to bladder irritation, recurrent UTIs or urinary incontinence?

JC: For UTIs in particular, the gut is often the source. Many of the bacteria that cause urinary tract infections normally live in the intestines. When the gut microbiome is out of balance, bacteria such as E. coli, Enterococcus, Klebsiella, Proteus mirabilis, Enterobacter and Citrobacter can overgrow and repeatedly reseed the urinary tract. That’s why some of my patients feel stuck in a cycle of infections despite doing everything “right.”

This pattern is especially common in people with chronic constipation, recent or repeated antibiotic exposure, IBS, pelvic floor dysfunction, diabetes or IBD, or in older adults where bowel transit slows and microbial diversity naturally declines.

From a symptom standpoint, constipation is one of the most common, and most overlooked, contributors to bladder problems. Stool retention can prevent the bladder from emptying completely and increase pressure on it, which raises infection risk and worsens frequency, urgency and leakage.

Why do you think this gut-bladder connection is so rarely discussed in primary care or urology visits?

JC: Part of the reason this connection is rarely discussed in primary care or urology visits comes down to time. My office visits are short and usually focused on the immediate complaint. Symptoms like frequency, urgency, dysuria or leakage take center stage, and bowel habits don’t always come up unless I ask directly.

There’s also a comfort factor. Many patients feel awkward talking about constipation or bowel function, even though it’s incredibly relevant. And unless urinary symptoms are recurring or resistant to treatment, the gut often gets overlooked early on.

What role do diet and fiber play in supporting both gut health and bladder health?

JC: Diet matters more than people realize. Adequate fiber helps keep bowel movements regular and complete, which reduces pressure on the bladder and can noticeably improve urinary symptoms in some patients.

At the same time, certain foods and drinks can irritate the bladder, especially when symptoms are active. Common triggers include alcohol, caffeine, carbonated beverages, and spicy or acidic foods. I tell my patients that the goal isn’t extreme restriction. It’s balance, supporting the gut with fiber and hydration while being mindful of bladder irritants during symptom flares.

When standard treatments for UTIs or bladder issues aren’t working, what should clinicians be considering next?

JC: When symptoms keep coming back, it’s a signal to step back and reassess rather than just repeating the same treatment. Often, this means performing a thorough physical exam, ordering hormonal tests and urine culture and sensitivity, assessing post-void residual urine volume, ordering appropriate imaging tests such as renal and bladder ultrasound or CT scan of the abdomen and pelvis, and scheduling cystoscopy and/or urodynamics.

Common contributors include constipation, hormonal changes, incomplete bladder emptying, pelvic floor dysfunction, resistant bacteria originating from the gut or urinary stones. I try to drill down to the most important factors.

For frequency, urgency and incontinence, it means looking beyond the bladder alone. Anatomy, bowel habits, lifestyle triggers, medications and pelvic floor dysfunction all matter. Persistent symptoms deserve a broader conversation and, in some cases, a more detailed evaluation.

Beyond physical symptoms, what are the real-life and financial costs of incontinence that patients often don’t talk about?

JC: Incontinence affects far more than most people realize. Many of my patients quietly plan their lives around bathroom access. They may avoid leaving the house to shop for essentials, skip social events, cut back on exercise or withdraw from intimacy. Over time, that can slowly erode confidence and independence.

There’s also a real financial burden too. Pads, protective garments, skin care products and extra laundering of clothes and bedding add up quickly. Missed work can further limit income. Many people carry this burden silently for years before seeking help, even though effective treatments exist.

Is there anything else you’d like our audience to know?

JC: Bladder symptoms rarely exist in isolation. If problems keep recurring, it’s worth looking at the bigger picture, including bowel function, diet, hormones, pelvic floor health and overall lifestyle.

People don’t have to live this way. Whether it’s recurrent UTIs, urgency, frequency or incontinence, there are almost always options beyond “just deal with it.” With the right questions and a thoughtful plan, quality of life can improve significantly.