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So Your UTIs Keep Coming Back...
So Your UTIs Keep Coming Back...
If you have had a urinary tract infection, or UTI, in the past, you are familiar with the discomfort associated with UTIs. The unfortunate part is that having a UTI once increases the chance of you getting another one in the future. So how can you prevent them from coming back? Throughout this article, I will discuss how to navigate UTIs and help you find an alternative treatment to prevent future infections.
What are urinary tract infections?
What are urinary tract infections?
Urinary tract infections (UTI) are bacterial infections that occur in the lining of the urinary tract including the kidneys, ureter, bladder, and urethra (Sihra et al., 2018). UTIs cause irritation and pain during urination and in the pelvic area (Sihra et al., 2018). A common cause of UTIs is contamination of the urinary tract or vaginal tract from natural gut bacteria such as E. coli (Genovese et al., 2017). The bacteria is more likely to access the urinary tract due to sexual intercourse, use of vaginal contraceptives, and hygiene practices such as wiping back to front or douching (Genovese et al., 2017). Once in the urinary tract, the bacteria replicate rapidly, migrating upwards as shown in “Stage 1” in the diagram. The large amount of bacteria soon becomes difficult for our immune system to clear out, and a UTI occurs (Sihra et al., 2018). If left untreated, it could advance to “Stage 2” in the diagram infecting the bladder, ureter, or kidneys (Sihra et al., 2018).
Although UTIs can affect both men and women, this type of infection is more common in women because women have a shorter duct, or urethra, that moves urine from the bladder to the exterior of the body (Sihra et al., 2018). It is estimated that 50% of all women will experience a UTI in their life, and 50% of those women will have a recurrent UTI (Sihra et al., 2018). A recurrent urinary tract infection is defined by having two UTIs within a 6 month period of each other (Porru et al., 2014). Some risk factors for recurrent UTIs include diabetes, kidney stones, having a catheter, previous UTIs, sexual activity, and using birth control methods that are inserted into the vaginal tract (Sihra et al., 2018).
Common symptoms of UTIs include pain with urination, urgency to urinate, increased frequency of urination, and presence of blood in the urine (Sihra et al., 2018). UTIs are confirmed from the presence of symptoms and a positive bacterial culture, which can be done at the doctor’s office or at a medical lab (Sihra et al., 2018). If you are experiencing any of these symptoms, it is best to see a healthcare professional.
How are urinary tract infections normally treated?
How are urinary tract infections normally treated?
The standard treatment for UTIs is a course of antibiotics such as Macrobid, Bactrim, and Keflex. Although antibiotics are effective treatments, there is a growing need to find alternative non-antibiotic treatments, especially for recurrent and uncomplicated UTIs. While taking antibiotics, many women report negative side effects such as stomach cramps, nausea, vomiting, loss of appetite, and diarrhea. These negative side effects occur because antibiotics decrease the amount of all bacteria in the urinary and vaginal tracts, including the “good” bacteria (Barbut & Meynard, 2002). Without “good” bacteria, harmful bacteria can grow rapidly causing these negative side effects and increasing the chance of other infections in the urinary and vaginal tracts (Barbut & Meynard, 2002).
In addition, antibiotics become less effective with repeated use (Ballini et al, 2018). This is due to antibiotic resistant bacteria. Antibiotic resistant bacteria arise when patients use antibiotics improperly or when physicians give patients the incorrect antibiotic prescription (Mihankhah et al., 2017). These mistakes allow bacteria to develop mutations to survive antibiotic treatment (Mihankhah et al., 2017). This is a major area of concern because of the limited stock of antibiotics that can treat UTIs and with no other approved alternatives (Ballini et al., 2018). To battle antibiotic resistance, researchers are developing alternative preventatives and treatment options to manage urinary tract infections.
Alternatives to antibiotics
Alternatives to antibiotics
There are many alternative preventative treatments that are currently being researched. Below I overview some common treatments that are being researched as alternative non-antibiotic treatments for UTIs. If you ever find that antibiotic treatment is not working well for you, you may want to try one of these options. Remember that most of these therapies can be used preventatively as well as to treat a mild infection. It is always important to discuss with your doctor which treatment option is the best fit for you.
D-mannose
D-mannose
D-mannose is a simple sugar that has a similar chemical structure to glucose (Sihra et al. 2018). It works by attaching to bacteria such as E. coli, by mimicking the structure of the binding sites within our urinary tract lining (Kranjec et al., 2017). Once taken, the body absorbs it within 30 minutes and it leaves through the urinary tract (Sihra et al, 2018). Research has shown that taking D-mannose is effective as both a preventative and treatment for active UTIs because it is just as effective as antibiotics (Domenici et al., 2016; Kranjec et al., 2017). Although there are no defined dosages for D-mannose, research suggests that using 2 grams once per day is effective for prevention (Kranjec et al., 2017). To treat an active infection, 1.5 grams should be taken twice a day and then once a day for 10 days after (Domenici et al., 2016)
D-mannose is a good alternative to antibiotics because it can be used for both prevention and active UTIs (Domenici et al., 2016; Kranjec et al., 2017). It has minimal side effects and can be easily found both online and in grocery stores in both the capsule and powder forms. Those with diabetes should consult with a doctor because D-mannose can alter blood sugar levels. However, research has shown that D-mannose is a safe supplement for those with diabetes (Shi & Yin, 2017).
Pros:
Pros:
Studies have shown that it is effective as a preventative and is comparable to antibiotics (Kranjec et al., 2017)
Well tolerated (Kranjec et al., 2017)
Available online and in grocery stores
Comes in powder and capsule form
Cons:
Cons:
Undefined dosage ranging from 1-3 grams (Domenici et al., 2016)
Could raise blood sugar to dangerous levels for those with diabetes (Wong, 2021)
Zazzee Naturals D-mannose capsules
Zazzee Naturals D-mannose capsules
Seller: Amazon
Price: $20 per bottle with 90 servings
Recommended dosage: 1000 mg per serving daily (prevention: 4 capsules per day; active UTI: 3 capsules twice per day for 3 days, 2 capsules for 10 days)
Zazzee Naturals D-mannose Plus
Zazzee Naturals D-mannose Plus
Seller: Amazon
Price: $30 per bottle with 67 servings
Recommended dosage: 2000 mg per serving (prevention: 1 scoop per day; active UTI: 1.5 scoops twice per day, ½ scoop once per day)
Solaray D-mannose capsules
Solaray D-mannose capsules
Seller: Grocery Stores - Whole Foods & Sprouts Market
Price: $34 per bottle with 30 servings
Recommended dosage: 1000 mg per serving (prevention: 4 capsules per day; active UTI: 3 capsules twice per day for 3 days, 2 capsules for 10 days)
Probiotics
Probiotics
Probiotics are live bacteria and yeast that are beneficial and keep us healthy (Sihra et al., 2018). Our bodies naturally have bacteria, so taking probiotics can increase the amount of “good” bacteria and keep the “bad” bacteria out (Sihra et al., 2018).
Probiotic foods such as yogurt, kombucha, and kimchi have been long labeled as healthy superfoods. But can probiotics be used to prevent UTIs? It is clear the probiotics do not treat active UTIs; however research on the effectiveness of prevention is unclear (Ballini et al., 2018). Some studies suggest taking probiotics with Lactobacilli can prevent future UTI episodes, while other studies suggest that probiotics do not prevent UTIs at all (Ballini et al., 2018; Beerepoot et al., 2012). Dosages for probiotics are also unclear. Some studies suggest that taking a tablet containing 5 billion colony forming units per day increased the amount of “good” bacteria in the vaginal tract (Ballini et al., 2018).
Even if probiotics aren’t completely effective at treating UTIs, it doesn’t hurt to try since there are few side effects and are other health benefits such as improved gut health.
Pros:
Pros:
No or little side effects (Ballini et al., 2018)
Has other health benefits such as increasing good gut and vaginal bacteria (Uehara et al., 2006)
Can be found naturally in foods or as supplements
Cons:
Cons:
No definitive dosages (Ballini et al., 2018).
Some research show ineffectiveness for treating UTIs (Beerepoot et al., 2012).
Garden of Life Dr. Formulated - Urinary Tract+
Garden of Life Dr. Formulated - Urinary Tract+
Seller: The Vitamin Shoppe
Price: $33 per bottle with 30 servings
Recommended dosage: 2 capsules with 16 bacterial strains
Yakult - Probiotic Drink
Yakult - Probiotic Drink
Seller: Grocery stores - Walmart, 99 Ranch
Price: $3 per pack with 5 servings
Recommended dosage: 1 bottle (20 billion L. casei)
Gives - Wholesome Probiotics
Gives - Wholesome Probiotics
Seller: Gives Health
Price: $34 per bottle with 30 servings
Recommended dosage: 1 capsule with 18 bacterial strains
Cranberry
Cranberry
Has your mother or aunt ever told you to drink cranberry juice to prevent or treat a UTI? This treatment option has been long recommended by women who have had UTIs, but there has been mixed conclusion in research about its effectiveness as a preventative. Cranberry products and extracts contain proanthocyanidins, which have an anti-adhesion properties to prevent the adhesion of bacteria on the urinary tract lining (Ballini et al., 2018).
In a recent study, Bruyere et al. found that the average number of participants taking cranberry and bee pollen as a preventative had less UTI recurrence than the control group, yet their data was not significant enough to conclude that cranberry products are effective to prevent UTIs. There is also no research to confirm how much cranberry extract is needed to prevent UTIs. This shows that cranberries may not be the best alternative to help prevent UTIs.
Pros:
Pros:
Easy to find (grocery stores and online)
Many women testify that this works
Cons:
Cons:
Data is not strong enough to prove that cranberry works to prevent UTIs (Bruyere et al., 2019)
No definitive dosages (Bruyere et al., 2018)
Combination therapies
Combination therapies
A new idea that researchers have been testing is a combination of various alternative treatments. By combining the treatments together, a more powerful treatment can be created, taking the best effects from each of the individual treatments.
Research has found that combining D-mannose with plant extracts from berberine, arbutin, uva-ursi, and forskolin are effective at preventing UTIs just as well as the antibiotic nitrofurantoin (Genovese et al., 2018). This treatment works because it combines D-mannose’s anti-adhesion properties with the plant extracts’ antimicrobial and anti-adhesion properties (Genovese et al., 2018). These results highlight that combining various treatments that don’t work to prevent or treat UTIs alone can be combined to make an effective treatment option. Although the results have been positive, more research needs to be done to confirm that these therapies will be effective to prevent and treat UTIs.
Pros:
Pros:
Synergistically work together to increase effectiveness of treatments (Genovesse et al., 2018).
Works just as well as antibiotics (Genovesse et al., 2018).
Cons:
Cons:
Newer area of research, and more trials need to be run before it can be implemented as a alternative treatment
Questions? Contact us at womensurinaryhealth@gmail.com
Questions? Contact us at womensurinaryhealth@gmail.com
References
Ballini, A., Santacroce, L., Cantore, S., Bottalico, L., Dipalma, G., De Vito, D., ... & Inchingolo, F. (2018). Probiotics improve urogenital health in women. Open Access Macedonian Journal of Medical Sciences, 6(10), 1845.
Barbut, F., & Meynard, J. L. (2002). Managing antibiotic associated diarrhoea: Probiotics may help in prevention. Bmj, 324(7350), 1345-1346.
Beerepoot, M., ter Riet, G., Nys, S., van der Wal, W. M., de Borgie, C. A., de Reijke, T. M., Prins, J. M., ... & Geerlings, S. E. (2012). Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Archives of Internal Medicine, 172(9), 704-712.
Bruyère, F., Azzouzi, A. R., Lavigne, J. P., Droupy, S., Coloby, P., Game, X., ... & Allaert, F. A. (2019). A multicenter, randomized, placebo-controlled study evaluating the efficacy of a combination of Propolis and cranberry (Vaccinium macrocarpon)(DUAB®) in preventing low urinary tract infection recurrence in women complaining of recurrent cystitis. Urologia internationalis, 103(1), 41-48.
Genovese, C., Davinelli, S., Mangano, K., Tempera, G., Nicolosi, D., Corsello, S., ... & Di Marco, R. (2018). Effects of a new combination of plant extracts plus d-mannose for the management of uncomplicated recurrent urinary tract infections. Journal of Chemotherapy, 30(2), 107-114.
Kranjčec, B., Papeš, D., & Altarac, S. (2014). D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World journal of urology, 32(1), 79-84.
Mihankhah, A., Khoshbakht, R., Raeisi, M., & Raeisi, V. (2017). Prevalence and antibiotic resistance pattern of bacteria isolated from urinary tract infections in Northern Iran. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences, 22.
Porru, D., Parmigiani, A., Tinelli, C., Barletta, D., Choussos, D., Di Franco, C., ... & Rovereto,
B. (2014). Oral D-mannose in recurrent urinary tract infections in women: A pilot study. Journal of Clinical Urology, 7(3), 208-213.
Shi, Y. B., & Yin, D. (2017). A good sugar, d-mannose, suppresses autoimmune diabetes. Cell & Bioscience, 7(1), 1-2.
Sihra, N., Goodman, A., Zakri, R., Sahai, A., & Malde, S. (2018). Nonantibiotic prevention and management of recurrent urinary tract infection. Nature Reviews Urology, 15(12), 750-776.
Uehara, S., Monden, K., Nomoto, K., Seno, Y., Kariyama, R., & Kumon, H. (2006). A pilot study evaluating the safety and effectiveness of Lactobacillus vaginal suppositories in patients with recurrent urinary tract infection. International journal of antimicrobial agents, 28, 30-34.
Wong, C. (2021, November 17). The health benefits of D-mannose. Verywell Health. Retrieved June 5, 2022, from https://www.verywellhealth.com/d-mannose-for-bladder-health-89443#:~:text=D%2Dmannose%20supplements%20may%20cause,risks%20such%20as%20kidney%20damage.
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