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Conditions

15 Natural Ways to Avoid a Urinary Tract Infection

February 19 2018

by Eric Madrid MD

Urinary Tract Infections, or UTIs as they are commonly called, are more common in women than men. In the United States, almost 500,000 people are admitted to the hospital each year due to complications of urinary tract infections. The most common complication is a bacterial infection of the blood. In the United States, almost 11 percent of women reported a urinary tract infection in the previous 12 months. In addition, it is estimated that one in two women will develop at least one urinary tract infection during her lifetime. Worldwide, tens of millions of women get a urinary tract infection each year.

Almost daily, I have at least one or two patients come see me for symptoms related to a urinary infection. Their symptoms include burning during urination, urinary frequency, urgency, back pain and sometimes even incontinence. In those over 65, a urinary infection can cause confusion and sometimes hallucinations, especially if the bacteria enter the bloodstream.

Who is at risk for infection?

There are many risk factors for developing a urine infection:

  • Women have greater risk than men
  • Women 50 years of age or more (post-menopause)
  • Prediabetes  
  • Diabetes – Bacteria eats sugar. The more sugar one consumes and excretes, the more food for bacteria to eat and grow
  • Immunosuppression – A strong immune system is needed to fight off infection
  • Kidney stones    
  • Sexual intercourse – For women with frequent infections, emptying the bladder after intercourse can help with prevention
  • Certain birth control – The diaphragm, in particular, can contribute to UTIs
  • Use of a urinary catheter
  • Urologic procedure or surgery

Do Calcium Supplements Increase risk of a Urine Infection?

There is evidence in Urological Research, which suggests that elevated calcium ingestion may increase the risk of a urinary tract infection. Dr. Alan Gaby, in Nutritional Medicine, 2nd edition, recommends anyone taking up to 1,500 mg of calcium per day should divide their doses into two to three doses. Dr. Gaby advises that taking magnesium along with the calcium may be helpful. Suggested dose: Calcium 500 mg once or twice per day

Bugs that cause urine infections

Escherichia coli is responsible for 80 to 90 percent of urinary tract infections. Most E. coli bacteria are completely harmless when they are in the gut.  However, if the bacteria find their way into the urethra, a person may develop a urinary tract infection.

Other bacteria which cause a urinary infection include the Klebsiella, Enterobacter, Enterococcus, Proteus, Pseudomonas, Staphylococcus, Streptococcus, Serratia and Candida–a yeast.

Common Medications used to treat acute infections

  • Cephalosporins – Cephalexin (Keflex) among others
  • Trimethoprim-sulfamethoxazole  (Septra, Bactrim)
  • Nitrofurantoin (Macrobid)
  • Quinolones (ciprofloxacin, levofloxacin)

Six Ways to Avoid Infections

  1. Wear cotton underwear
  2. Drink plenty of water each day
  3. Drinking cranberry juice daily may decrease recurring UTIs
  4. Do not hold urine for prolonged periods of time
  5. Wipe from front to back to help prevent bacteria from the anal area coming into contact with the urethra
  6. Women should urinate after intercourse to help reduce risk

Prescription Medications for Urinary Tract Infections

  • Methenamine hippurate – A 1996 study showed that methenamine could be helpful in the prevention of infection. A 2014 study showed similar findings.
  • Some women at risk for a UTI after intercourse take a one-time dose of an antibiotic, which appears equally effective as a daily dose of antibiotics in the prevention of an acute urinary tract infection.
  • Hormone replacement – Oral estrogen replacement or vaginal estrogen application can be helpful in women who are postmenopausal. Discuss the risks versus benefits with your healthcare provider.

Primary Supplements

The most commonly used supplements to help prevent a urine infection are cranberry,  D-mannose, and vitamin C.  If those are not sufficient, many add some of the secondary supplements discussed below.

Cranberry

Cranberry supplements may also be helpful in the prevention of urinary tract infections and are cost-effective, according to a 2014 study in Clinical Infectious Disease.  A 2013 study in Nutrition Research confirmed the effectiveness of cranberry supplements in preventing recurrent urinary tract infections in those at risk. A 2014 study in the Journal of the American Geriatric Society showed those seniors at high risk who resided in long-term care facilities, such as a nursing home, were 26 percent less likely to have a urine infection if a cranberry supplement was taken. Molecules inside of the cranberry fruit help prevent, specifically, the E. coli bacteria from sticking to the bladder wall. Suggested dose: As directed on the label.

D-mannose

A 2014 study, which used a combination of D-mannose, cranberry and the probiotic Lactobacillus, showed benefit in preventing urinary tract infections. A 2017 study in the journal In Vivo showed that when combined NAC, D-Mannose and Morinda (NDM) helped in preventing urine infections. Another 2014 study in The World Journal of Urology concluded that D-mannose significantly reduced the risk of recurrent urinary tract infections. Suggested dose: 1,500 mg one to three times per day.

Vitamin C

A 1997 study in Urology showed oral vitamin C could be helpful in killing bacteria in the urine. A 2007 study demonstrated that pregnant women who took at least 100 mg of vitamin C per day were 56 percent less likely to have a urine infection when compared to women who did not take the vitamin C.  Suggested dose: 500 -1,000 mg daily or twice per day.

Secondary Supplements

Melatonin

Secreted by the pineal gland after the sun goes down, melatonin is a hormone that makes you sleepy. Some experience its effects by taking melatonin supplements. And while it helps many get a good night sleep, it might also help in preventing a urinary tract infection according to a 2015 study.   Suggested dose: 3 to 10 mg each night.

Vitamin D

Studies have shown that vitamin D has antibacterial properties. When blood levels are adequate, the body makes a protein called AMP (antimicrobial peptide). AMP prevents bacterial infections and possibly is effective against urinary infections, according to a 2017 study in Frontiers in Microbiology.  Suggested dose: 2,000 IU to 5,000 IU daily.

L-arginine

L-arginine is an important amino acid that is the precursor to nitric oxide (NO).  NO has been shown to have antimicrobial properties and, therefore, may be helpful in the prevention of urinary tract infections.  Suggested dose: 500 to 1,000 mg once or twice per day.

Probiotics

Some studies show that those who take routine probiotics orally can reduce their risk for recurrent urinary tract infections. A 2011 study of women using vaginal probiotic supplements showed benefit in the prevention of urinary tract infections. A 2013 study suggested that Lactobacillus may prevent urinary tract infections. Other studies, however, have not supported these findings. A 2015 study stated that the evidence of probiotics effectiveness was not sufficient.  Suggested dose: 5 billion to 100 billion units up to twice per day.

However, I do recommend anyone who is taking a daily antibiotic for prevention, or who is taking a course of antibiotics for an acute infection, to consume a probiotic supplement. At a minimum, this will help prevent antibiotic-induced diarrhea and yeast infections while promoting a healthy gut.

Herbs

Herbs have been used for thousands of years for various medical ailments.  Scientists are discovering new benefits daily.

Morinda Citrifolia

This medicinal plant has been used for thousands of years by Traditional Chinese Medicine (TCM) specialists. It is estimated that there are over 100 active ingredients in the herb.  A 2017 study showed the combination of D-mannose, NAC, and Morinda was useful in the prevention and treatment of urinary tract infections in women.

Berberine

According to a 2016 study in Microbiological Research, Berberine has also shown beneficial in killing a common bacteria (Enterococcus), which causes urinary tract infections. Suggested dose: Take as directed on label.

Garlic

Garlic, a vegetable, is known to have antibacterial properties. In those with recurrent urinary tract infections, routine consumption of garlic is often considered. The active ingredient in garlic responsible for its antibacterial properties is allicin according to a 1988 study.  Suggested dose:  As directed on the label.

Uva-Ursi

Also known as bearberry, this herb has been approved by the German Federal Institute for Drugs and Medical Device for urinary tract inflammation and is available by prescription in Germany. Other studies also have shown benefit.  Suggested dose:  As directed on the label

Other herbs which have scientific evidence of helping prevent and treat urinary tract infections include goldenseal, blueberry, green tea, curcumin, Rhodiola and Andrographis

Decrease Risk of Urinary Tract Infections

Urinary Tract Infections (UTIs) are one of the most common infections a woman will experience in her lifetime. The majority are caused by the E. coli bacteria. There are several things that can be done to help prevent the infections, while antibiotics are frequently used to treat an acute infection. The strategies discussed are utilized by many so that an infection can be prevented from developing.  Drinking plenty of fluid, consuming a healthy diet and being optimistic are all important for a strong immune system.  Eat healthy, think healthy, be healthy.

References:

  1. Ann Epidemiol. 2000 Nov;10(8):509-15
  2. Urol Res. 1991;19(3):177-80.
  3. Tidsskr Nor Laegeforen. 1996 Mar 10;116(7):841-3.
  4. Tze Shien Lo, Kimberly DP Hammer, Milagros Zegarra & William CS Cho Expert Review of Anti-infective Therapy Vol. 12 , Iss. 5,2014 Methenamine: a forgotten drug for preventing recurrent urinary tract infection in a multidrug resistance era
  5. Cochrane Database Syst Rev. 2004;(3):CD001209.
  6. Eells S. J., Bharadwa K., McKinnell J. A., Miller L. G. Recurrent urinary tract infections among women: comparative effectiveness of 5 prevention and management strategies using a markov chain monte carlo model. Clinical Infectious Diseases. 2014;58(2):147–160. doi: 10.1093/cid/cit646
  7. Vasileiou I, Katsargyris A, Theocharis S, Giaginis C. Current clinical status on the preventive effects of cranberry consumption against urinary tract infections. Nutr Res 2013;33:595–607.
  8. Caljouw MA, van den Hout WB, Putter H, Achterberg WP, Cools HJ, Gussekloo J. Effectiveness of cranberry capsules to prevent urinary tract infections in vulnerable older persons: a double-blind randomized placebo-controlled trial in long-term care facilities. J Am Geriatr Soc 2014;62:103–10
  9. Tao Y, Pinzón-Arango PA, Howell AB, Camesano TA. Oral Consumption of Cranberry Juice Cocktail Inhibits Molecular-Scale Adhesion of Clinical Uropathogenic Escherichia coli. Journal of Medicinal Food. 2011;14(7-8):739- 745. doi:10.1089/jmf.2010.0154.
  10. J Clin Gastroenterol. 2014 Nov-Dec;48 Suppl 1:S96-101. doi: 10.1097/MCG.0000000000000224.
  11. MARCHIORI D, PAOLO ZANELLO P. Efficacy of N-acetylcysteine, D-mannose and Morinda citrifolia to Treat Recurrent Cystitis in Breast Cancer Survivals. In Vivo. 2017;31(5):931-936. doi:10.21873/invivo.11149.
  12. Kranjčec B, Papeš D, Altarac S. D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World J Urol 2014;32:79. 10.1007/s00345-013- 1091-6 Urology. 1997 Aug;50(2):189-91.
  13. OCHOA-BRUST, G. J., FERNÁNDEZ, A. R., VILLANUEVA-RUIZ, G. J., VELASCO, R., TRUJILLO-HERNÁNDEZ, B. and VÁSQUEZ, C. (2007), Daily intake of 100 mg ascorbic acid as urinary tract infection prophylactic agent during pregnancy. Acta Obstetricia et Gynecologica Scandinavica, 86: 783–787. doi:10.1080/00016340701273189
  14. Fathollahi A, Daneshgari F, Hanna-Mitchell AT. Melatonin and Its Role in Lower Urinary Tract Function: An Article Review. Current Urology. 2015;8(3):113-118. doi:10.1159/000365701.
  15. Terlizzi ME, Gribaudo G, Maffei ME. UroPathogenic Escherichia coli (UPEC) Infections: Virulence Factors, Bladder Responses, Antibiotic, and Non-antibiotic Antimicrobial Strategies. Frontiers in Microbiology. 2017;8:1566. doi:10.3389/fmicb.2017.01566.
  16. Foxman B, Buxton M. Alternative Approaches to Conventional Treatment of Acute Uncomplicated Urinary Tract Infection in Women. Current infectious disease reports. 2013;15(2):124-129. doi:10.1007/s11908-013- 0317-5.
  17. Evid Based Med. 2013 Aug;18(4):141-2. doi: 10.1136/eb-2012- 100961. Epub 2012 Nov 2.
  18. Cochrane Database Syst Rev. 2015 Dec 23;(12):CD008772. doi: 10.1002/14651858.CD008772.pub2.
  19. MARCHIORI D, PAOLO ZANELLO P. Efficacy of N-acetylcysteine, D-mannose and Morinda citrifolia to Treat Recurrent Cystitis in Breast Cancer Survivals. In Vivo. 2017;31(5):931-936. doi:10.21873/invivo.11149.
  20. Microbiol Res. 2016 May-Jun;186- 187:44-51. doi: 10.1016/j.micres.2016.03.003. Epub 2016 Mar 9.
  21. Feldberg RS, Chang SC, Kotik AN, et al. In vitro mechanism of inhibition of bacterial cell growth by allicin. Antimicrobial Agents and Chemotherapy. 1988;32(12):1763-1768.
  22. Altern Med Rev. 2008 Sep;13(3):227-44. (Discusses other studies which show the benefit of Uva-Ursi for urine infections)

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