Natural Health Advisory

A urinary tract infection (UTI) is a bacterial infection in the urethra, bladder, ureters, or kidneys and is the most common bacterial infection in women. The majority of UTIs occur in the bladder, a condition known as cystitis. Infection occurs when bacteria, most commonly Escherichia coli (which normally inhabit the vagina), ascend into the bladder and invade the inner mucosal lining.

Symptoms

UTI symptoms last for an average of six days1 and may include any of the following:

• More frequent urination
• Pain or burning during urination
• Urge to urinate
• Urine leakage
• Sensation of bladder fullness
• Lower abdominal discomfort
• Tenderness over the pubic bone
• Foul-smelling urine
• Blood in urine
• Back pain
• Fever (usually not present unless infection spreads to kidney)
• Nausea and vomiting (usually not present unless infection spreads to kidney)

Risk factors

Simply because of female anatomy, UTIs in women are very common, with one-half of all women experiencing at least one UTI in their lifetime.1 Risk increases with age, with postmenopausal women at highest risk. Other risk factors include:

• Having urinary incontinence
• Having prior history of symptomatic UTI
• Being sexually active
• Diaphragm use with spermicide
• Diabetes
• Catheterization
• Frequent/recent use of antibiotics

Conventional treatment

The most common conventional treatment for uncomplicated UTIs is a three-day course of an antibiotic, often trimethoprim sulphamethoxazole (TMP/SMX), nitrofurantoin, or fosfomycin.2
Unfortunately, the bacteria that usually cause UTIs are becoming resistant to all the most commonly used antibiotics, limiting the options for treatment.3 Furthermore, antibiotics have adverse effects on the healthy flora of the gut and the vagina.2 In fact, the antibiotics themselves deplete the vaginal and bladder lactobacillus species that serve to prevent UTIs in the first place, potentially leading to a vicious cycle and chronic UTIs.4

Indeed, the more UTIs one has had, the more likely another will occur. Women with chronically recurring UTIs are often prescribed long-term antibiotic treatment, further contributing to gut and vaginal dysbiosis and antibiotic resistance.

Top natural UTI treatments

Many evidence-based natural treatments can treat UTIs with fewer side effects. The three best-researched natural treatments showing the greatest effectiveness are discussed here.

Cranberry extract can be recommended as a first-line therapy for active UTIs and for prevention of UTIs despite the fact that there have been mixed reports of effectiveness in clinical trials.5 But it’s crucial to take the right product. It was recently shown that only a small percentage of cranberry products provide the recommended dose of active constituents (A-type proanthocyanidins); some products contain none at all.6,7 The specific A-type proanthocyanidins in American cranberry reduce the ability of bacteria like E. coli to adhere to the lining of the bladder and urethra, especially when taken at a daily dose of 36 to 72 mg.8-10

To prevent UTIs, you need to take a high enough dose of a standardized extract to deliver the recommended dose of at least 36 mg of proanthocyanidins per day. For example, Cran-Max® by Proprietary Nutritionals is standardized to provide a minimum of 7.2% (36 mg) proanthocyanidins per 500 mg.11 So, for prevention, you would take at least one 500 mg capsule per day.

To treat an active infection, increase the dosage to ensure that you get 72 mg of proanthocyanidins AND drink 16 ounces of unsweetened cranberry juice per day.12 To make it more palatable, you can mix it with water or seltzer, another fruit juice, or stevia-sweetened natural soda. (Drinking cranberry juice for prevention of UTIs is not recommended.)

D-Mannose. On the surface of the bladder and urethra, there are receptors containing a naturally occurring simple sugar known as d-mannose. E. coli attaches to the d-mannose in these receptors. But when you ingest d-mannose, E. coli predominately attaches to these free molecules instead of the receptors13 and is flushed out during urination.

When taken as a supplement, d-mannose prevents recurrent UTIs.13-15 In high doses, it can also treat acute UTIs, especially when it is combined with other natural therapies like cranberry and probiotics.16

Take 2 g once per day for prevention. To treat an infection, take 2 g four to six times per day for three days.

Probiotics. Healthy bacteria such as Lactobacillus species live in the bowel, vagina, and around the urethra, where they help the urinary tract resist invasion by pathogens such as E. coli.17,18 When levels of Lactobacilli in the vagina become depleted, UTI risk increases.18,19

Probiotics taken orally or inserted vaginally can help increase the numbers of Lactobacilli and other healthy bacteria in the vagina and around the urethra, preventing UTI recurrence.20-23 Even a fairly low oral dose of probiotics (1 billion organisms twice a day) is only slightly inferior to daily prophylactic antibiotics.21 The slightly lower effectiveness of the probiotic might be worth the benefit in terms of decreased antibiotic resistance.24

Naturopathic leaders in women’s health recommend the use of eight or more billion probiotic organisms daily for UTI prevention, using specific probiotic species and strains that are known to colonize the urinary and genital area, including the Lactobacillus strains, Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC.14.25

Tips for treatment & prevention

In addition to the three treatments discussed above, it is crucial to increase urinary flow by drinking at least 8 glasses of water and herbal tea daily. Medicinal herbal teas containing uva ursi, pipsissewa, and buchu are especially recommended.25 High doses of vitamin C every few hours are also helpful during acute infection.25

Preventive action

In the case of chronic UTIs, being consistent with these preventative actions is extremely helpful:

• Empty the bladder after intercourse.
• Avoid long intervals between urinating.
• Wipe front to back.
• Do not wear tight-fitting undergarments made of non-breathable materials.
• Drink more water.
• Take d-mannose, cranberry extract, and probiotics regularly.

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1. Am Fam Physician. 2011 Oct 1;84(7):771-6.
2. Medscape. Cystitis in Females. Accessed Oct 19, 2014.
3. J Antimicrob Chemother. 2014 Feb;69(2):303-8.
4. Clin Infect Dis. 2011 May;52(10):1212-7.
5. Cochrane Database Syst Rev. 2012 Oct 17;10:CD001321.
6. J Agric Food Chem. 2012;60(13):3396-408.
7. Phytother Res. 2014 May 21. doi: 10.1002/ptr.5172.
8. Int J Immunopathol Pharmacol. 2010 Apr-Jun;23(2):611-8.
9. J Agric Food Chem. 2012;60(38):9688–9696.
10. Nat Prod Insid. News. 2010 Nov 18. Accessed Oct 20, 2014.
11. Southwest Med 1968; 47:17.
12. BMC Infect Dis. 2010 Apr 14;10:94.
13. BJU Int. 2014 Jan;113(1):9-10.
14. World J Urol. 2014 Feb;32(1):79-84.
15. J Clin Gastroenterol. 2014 Nov-Dec;48 Suppl 1:S96-S101.
16. Akush Ginekol (Sofiia). 2012;51(7):49-55.
17. Curr Infect Dis Rep. 2013 Apr;15(2):124-9.
18. urr Microbiol. 2011 Nov;63(5):484-90.
19. Clin Infect Dis. 2011 May;52(10):1212-7.
20. Int J Antimicrob Agents. 2006 Aug;28 Suppl 1:S30-4.
21. Arch Intern Med. 2012 May 14;172(9):704-12.
22. Infect Dis Obstet Gynecol. 2007;2007:35387.
23. Int J Antimicrob Agents. 2006 Aug;28 Suppl 1:S30-4.
24. Arch Intern Med. 2012;172(9):712-714.
25. Hudson, T. Botanicals for Common Infections in Women. 2013.

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