Many women experience repeated urinary tract infections. Not only does this take a toll on their health, but it can also be emotionally draining to finish treatment of a UTI only to have it come back again within a short time. Fortunately, there are many more options available than the standard course of antibiotics, which often relieves symptoms by treating the current infection, but does not address the underlying cause of the problem, allowing re-infections to occur.
Urinary tract infection is a general term for infections anywhere within the urinary tract, usually in the bladder or kidney. A bladder infection is also called cystitis, and a kidney infection is also called pyelonephritis. Usually, when someone talks about UTIs, they are referring to cystitis.
UTIs typically cause burning with urination, a need to urinate very frequently and urgently but in small amounts, and pelvic pain. Some people also have low back pain and foul-smelling urine with a UTI. Many of my patients have described a tingling sensation in their fingers when they are developing an infection, and just overall feeling poorly. Symptoms of fever and pain in one side of the back, just under the rib cage, suggest that the infection has spread to one of the kidneys. Some patients do not have any of these symptoms. Involuntary leakage of urine (incontinence), even without other symptoms, is often caused by UTIs, so checking a urine culture is one of the first things I do when evaluating a patient for incontinence.
UTIs occur when bacteria make their way into the bladder and are able to stay there and grow. Usually, these are bacteria that normally live in another part of the body (E. coli is the most common), but occasionally infections occur when foreign bacteria are introduced, such as when a catheter is placed. In most cases, the bacteria cause a UTI because of factors within the body, such as a bladder that has not yet healed from another infection. Certain blood types have been found to be associated with a higher chance of UTIs. Some people also have certain proteins in the bladder that make it easier for bacteria to stay in the bladder and grow.
On occasion, a patient will have an underlying anatomic problem that causes the infections to occur. These may include kidney stones, the presence of a foreign body (such as a catheter), and poor emptying of the bladder. Poor emptying can occur from anatomic problems such as a cystocele (prolapsed bladder), from behavioral tendencies like holding the urine and not emptying completely, or from functional problems such as nerve damage. A standard urologic evaluation checks for signs of these problems.
Recurring infections tend to happen because of a vicious cycle of bladder inflammation and disruption of the normal bacteria in the body. Because urinary infections most often come from bacteria that are normally present in the body, having unhealthy bacteria in the body is a set-up for infections. When the bladder is already inflamed from a recent infection, it becomes much easier to get another infection, and the cycle begins. Taking antibiotics kills the infection but also tends to kill the good bacteria in the body as well (the bacteria that do not cause infections), and these bacteria are then replaced by those that are more likely to cause infections. In other words, if there is less Lactobacillus (which does not cause UTIs) and more E. coli in the body, one will be more likely to get an infection.
A UTI is suspected based on symptoms. A urinalysis can be performed immediately in the office, and certain findings on this test suggest that an infection is present. However, the only way to know for sure if an infection is present is to perform a urine culture, in which the urine is sent to the lab and monitored to see if bacteria grow from it. In most cases, the urine can be cultured from that obtained from a “clean catch, mid-stream” specimen. For this, a woman spreads the labia, begins urinating, and catches urine in the middle of the stream for culture. This avoids contamination from the opening of the vagina. In rare cases, if it is not possible to get a mid-stream culture, catheterization can be performed to collect urine for culture.
When an infection is found in the urine, tests are run on the bacteria to determine which antibiotics can kill it. Other conditions can cause symptoms that mimic a urinary tract infection, so cultures are very important for confirming the diagnosis. Examples of this are problems with the uterus (which can cause fullness, pressure, and urgency of urination) and vaginal problems (which can cause irritation externally that burns with urination).
UTIs are typically treated with antibiotics. Studies show that for most women, who do not have underlying problems, a 3-day course of antibiotics is as effective as a longer course. In complicated cases and in men, a longer treatment is needed. Mild infections can sometimes be cured with natural therapies, including the use of uva ursi and marshmallow root, two herbs that help to heal the urinary tract. A tea can be prepared by brewing 1 tablespoon of each of the herbs in 1 cup of water for several minutes. These herbs can be tried at the first sign of an infection, but if symptoms are severe, fever is present, or symptoms are not improving within 1 or 2 days, I recommend that a culture be obtained and antibiotics started to prevent more serious illness. An integrative approach does not shun conventional medicine and pharmaceuticals in their entirety, but also does not make the mistake of solely relying on drugs to treat problems that can only be cured with a holistic approach.
The blended tea should be drunk 4 times a day for 5 days to completely clear the infection. Most sources recommend that uva ursi not be used for more than 5 days in a row or more than 5 times a year because chronic use can cause liver dysfunction. Uva ursi is also not considered safe during pregnancy or breastfeeding, in children, or in those with underlying liver or kidney problems.
Drinking large amounts of water, especially with lemon added, helps to flush the urinary tract, and is also recommended during a UTI. Other herbal and natural remedies may help to clear a UTI, but I have not seen as convincing evidence of these as those mentioned here.
Once active infections are treated and cleared, a holistic approach to prevention can yield excellent results in resolving recurring infections. I have had great success in my practice using a combination of cranberry, probiotics, and vitamins that boost the immune system, coupled with lifestyle changes to ensure the physical environment does not remain a set-up for infections.
Both cranberry juice and tablets have been proven in multiple scientific studies to be as effective as daily low dose antibiotics (the standard treatment offered by most urologists) for preventing recurrent UTIs. Most cranberry juice, however, contains large amounts of acid and sugar and is not well-tolerated. Cranberry tablets are effective and do not have these side effects. Cranberry products have been well-studied in children, young women, and elders and found to be effective in all groups. The most important time of day to take tablets is bedtime, so that the cranberry product will remain in the urine during the time that it sits in the bladder the longest, when bacteria are most able to grow and establish an infection. However, taking cranberry 3 times a day is more likely to afford the best prevention. Because cranberry tablets are not regulated by the FDA, no standard dosing exists. Studies have all been done using different dosages and no data exists in the scientific literature to support any particular brand over another. I recommend that patients buy a brand they feel comfortable with, such as from their local health food store, and that they use the dosing recommended by the manufacturer.
The standard treatment for recurrent UTIs over the past several years has been the use of low dose antibiotics taken daily or after sexual intercourse, if infections are associated with sex. Studies have shown that cranberry tablets are at least as effective and have fewer side effects. However, antibiotics can still be used. If the choice is made to go this route, it is best to take an antibiotic that has a minimal effect on the remainder of the body, so that the healthy bacteria in the body are not killed. Nitrofurantoin typically only reaches treatment levels in the urine, so is a preferred drug for this. It is also uncommon to develop resistance to nitrofurantoin because of the way it works, unlike other antibiotics. However, long-term use of this medication can cause serious lung problems in a small percentage of those who take it.
Probiotics are pills or liquids that contain the healthy bacteria that normally are in the colon and vagina. When these places contain healthy bacteria, it is much less likely that an infection will occur. When antibiotics are taken to kill an infection, these good bacteria are also killed. The bacteria that come back in their place are often bacteria that are more likely to cause infections. Taking probiotics helps to restore the healthy bacteria in the body. I recommend that patients purchase a brand they trust, and use probiotics daily for several months to rebuild their system and then for at least a month every time antibiotics are taken for any reason.
A healthy immune system helps the body resist infections. Several vitamins help with immune system function. I recommend a regular daily dose of vitamins A, C, and zinc, and a higher dose when an infection is present. These doses are based on treatment regimens that have been studied for the common cold and found to be effective in preventing other types of recurring infections. Vitamin C should be taken 1000 mg a day on a regular basis, and four times a day when an infection is present. Vitamin A should be taken 10,000 units a day when not infected, and 25,000 to 50,000 units are recommended when an infection is present. Zinc should be taken 30 mg a day regularly and 60 mg a day when infected. Other vitamins also help with infection prevention and healing, but I’ve had good success using this regimen.
Emotions and stress affect the body by causing the release of chemicals that affect physical processes. Many people believe that chronic illnesses such as recurrent UTIs are the body’s way of trying to get its owner’s attention. Unreleased anger is one emotion thought to be commonly associated with UTIs. A great book that goes into this further is Women’s Bodies, Women’s Wisdom by Christiane Northrup, MD. Louise Hay also explains these ideas fully in her book You Can Heal Your Life.
Many other factors contribute to UTIs. These include constipation and diarrhea, vaginal health, and sex. Problems with the digestive tract tend to alter bladder function and increase the amount of bacteria present in the pelvic area. Anything that irritates the vagina makes it easier for infections to take hold–the use of douches or scented tampons, or having a dry and irritated vagina are all potential factors. Many women find that infections tend to occur after sex. Often, it is helpful to urinate before and after sex, to take a low dose antibiotic or cranberry tablet after sex, and to drink extra water afterwards to help flush the system.
If behavioral factors exist, these need to be addressed as well. Holding the urine is a set-up for infections. Rushing to void doesn’t allow the bladder to empty completely. Assuming a squatting position can help with emptying. Taking the time to notice and care for the body’s basic needs is critical to recovering health.
Having repeated urinary tract infections is very frustrating for many women. The good news is that patients respond very well to a preventive program, and the infections will become less common and then very infrequent altogether. By following the guidelines here and working with health care providers, the bladder can be given a chance to heal. As the body is restored to its normal balance, health can be enjoyed again.
For more information see Dr. Carmak’s Resource Page in the Whole Woman Library