Preventing and Treating UTIs

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Preventing and Treating UTIs

Pamela A. Popper, President., Wellness Forum Health

Over half of all women will have at least one bladder infection, referred to as uncomplicated cystitis, during their lifetime, and those who have one are highly likely to develop more of them. Symptoms include a strong, persistent urge to urinate, a burning sensation during urination, passing small amounts of urine, blood in the urine, and pelvic pain. In addition to the bladder, other parts of the urinary tract can be affected, such as the urethra and kidneys.

About 27% of women will have another recurrence of cystitis within 6 months,[1] and for women who have had a previous urinary tract infection (UTI), between 44% and 70% will have a recurrence within a year.[2] Risk factors for recurrence include recent sexual intercourse, use of a diaphragm with spermicide, and history of recurrent UTIs.[3]

UTIs are generally treated with antibiotics, and about 15% of all antibiotic prescriptions are written for this condition. As a result, antibiotic resistance is increasing and is as high as 45% for ampicillin for women who have been given antibiotics for UTI.[4]

There are numerous ways to prevent cystitis, including not delaying urination, urinating shortly after sexual intercourse, and better pelvic hygiene.[5]  Both oral and intravaginal suppositories of probiotics are effective for prevention, and cranberry products have been shown to decrease recurrence of UTIs by 30-40% in premenopausal women.[6]

One of the simplest and most effective prevention strategies is hydration, because drinking enough water flushes out the bacteria in the urinary tract.[7] A new study included women who had at least 3 symptomatic episodes of cystitis during the previous year and who reported drinking less than 1.5 liters of fluid daily. They were randomized to either add 1.5 liters of water to the daily intake or no additional fluids for a year. Women who drank no additional fluids had an almost two times greater risk of cystitis than women who drank additional water.[8]

Cranberries, cranberry capsules, and cranberry juice are also inexpensive and effective tools for prevention. Cranberries contain proanthocyanadins (PACs) which prevent bacteria from attaching to the lining of the urinary tract. A study that compared the use of antibiotics to cranberry capsules showed that antibiotics were initially more effective for preventing infections. But women eventually developed resistance to trimethoprim sulfa, amoxicillin, and ciprofloxacin. On the other hand, resistance did not develop to the cranberry capsules. In other words, while the antibiotics were more effective in the short-term, cranberry was more effective in the long term.[9] Another advantage is that cranberry does not destroy beneficial bacteria, while antibiotics do.

Low-tech and inexpensive prevention tools such as probiotics[10] and better hydration have been shown to be safe and effective for prevention of UTI.

Women who develop cystitis or UTIs should avoid antibiotic treatment if possible. In many instances, the drugs can be avoided by using several strategies:

  • Drink 8 ounces of cranberry juice (not from concentrate) sweetened with raw honey 3-4 times per day. Raw honey has been proven to have antibiotic properties.[11]
  • Drink at least 64 ounces of water daily
  • Discuss the use of plant antimicrobials with a competent healthcare provider. Many are as effective as antibiotics and do not have negative side effects.

[1] Foxman B. “Recurring urinary tract infection: incidence and risk factors.” Am J Public Health 1990 Mar;80(3):331-333

[2] Ikaheimo R, Siitoenen A, Heiskanen T et al. “Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year follow-up of 179 women.” Clin Infect Dis 1996 Jan;22(1):91-99

[3] Hooten TM, Scholes D, Hughes JP et al. “A prospective study of risk factors for symptomatic urinary tract infection in young women.” NEJM 1996 Aug;335(7):468-474

[4] Mazzulli T. “Resistance trends in urinary tract pathogens and impact on management.” J Urol 2002 Oct;168(4 Pt 2):1720-1722

[5] Nosseir SB, Lind LR, Winkler HA. “Recurrent uncomplicated urinary tract infections in women: a review.” J Women’s Health (Larchmt) 2012 Mar;21(3):347-354

[6] Beerepoot M, Geerlings S. “Non-Antibiotic Prophylaxis for Urinary Tract Infections” Pathogens 2016 Apr;5(2):pii:E36

[7] Beetz R. “Mild dehydration: a risk factor of urinary tract infection?” Eur J Clin Nutr 2003 Dec;57 Suppl2:S52-S58

[8] Hooten TM, Vecchio M, Iroz A et al. “Water intake in Premenopausal Women With Urinary Tract Infections. A Randomized Controlled Trial.” JAMA Intern Med 2018;178(11):1509-1515.

[9] Beerepoot MA, ter Riet G, Nys S, et al. “Cranberries vs antibiotics to prevent urinary tract infections: a randomized double-blind noninferiority trial in premenopausal women.” Arch Intern Med. 2011;171:1270-1278.

[10] Stapleton AE, An-Yeung M, Hooton TM et al. “Randomized, Placebo-Controlled Phase 2 Trial of a Lactobacillus crispatus Probiotic Given Intravaginally for Prevention of Recurrent Urinary Tract Infection.” Clin Infect Dis 2011 May;52(10):1212-1217

[11] Kwakman P, te Velde A, de Boer L, et al. “How honey kills bacteria.” FASEB J  2010 Jul;24(7):2576-82.