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A Holistic Approach to Urinary Tract Infections

Adrienne Carmack, MD

Adrienne Carmack, MD

As a urologist, one of the most frequent problems I see is recurring urinary tract infections (UTIs). Urologists treat both men and women, and specialize in treating disorders of the urinary tract (kidneys, ureters, and bladder) and the male genital system. I personally see about 50% men and 50% women in my general urology practice. (Gynecologists specialize in the female genital system. Since there is some overlap between the female genital system and the urinary system, there is some overlap in the roles urologists and gynecologists have in treating women.)

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

{ 14 comments… add one }
  • Susan Jones April 29, 2016, 8:25 am

    Lesley, D-mannose did not work for me. It only works for E-coli based UTIs.

    What helps me is a combination of avoiding sugar, grains, coffee, etc, eating alkaline forming foods, drinking plenty of water and the following supplements:

    Alkalising salts (I initially took sodium bicarbonate which is much cheaper but this disrupts the potassium so not good to take long term)

    Olive leaf extract 20% oleuropein, 750mg – take one per day initially and build up because it is very powerful and can provoke a Herxheimer reaction. I can now take 8 capsules per day but it took a few weeks to get there. This is an antibacterial and anti fungal substance

    Interfase Plus – to destroy the biofilms surrounding the bacteria that the olive leaf extract cannot reach

    Lauricidin – to restore gut bacteria and fungal balance – I take 6-8 capsules per day

    Lactoferrin – to rebuild immunity – I take one scoop per day

    Probiotics – at least 50 billion viable cultures, enteric coated – I take up to 10 capsules per day

    Fem Dophilus – this is a probiotic that targets the urinary tract and vagina – I take about 3 capsules per day

    These are powerful supplements and I don’t recommend you start with the doses I do, but build up gradually. I have eaten a very clean diet for years with lots of salad and raw food. I believe that my UTI has been caused by a combination of dietary factors ( I did not take probiotics or fermented food ) plus non dietary factors ( I have been under great stress and working excessively long hours 7 days a week with no exercise for 5 years ).

    I hope this helps others.

  • So Sick of UTIs March 25, 2016, 7:09 am

    Have had recurrent Uris for 6 years. So sick of antibiotics. Just stopped my 2nd round of Macrobid for a stubborn uti. Am Cipro resistent, which makes these extra difficult to cure. Everyone is different, but the protocol below is working for me so far to keep this from coming back a third time (so far). Check with your dr. before trying this yourself.

    Never knew about the benefits of alkalizing urine (keeping urine at 6.5 or above). Am using 1/2 tsp baking soda mixed in 8 oz water 1-2 times a day. Am now tracking urine acidity daily with urine ph strips. Acid urine is food for bacteria. Best to keep an alkaline state. Trying to keep at 6.5 or higher. There are many books out there on how to alter your diet to help with this.

    When I feel a twinge of this uti coming back, I take Alka Seltzer Gold as needed (doesn’t have any aspirin in it). Takes pain away within an hour and puts me back in alkaline mode (baking soda and Alka Seltzer have sodium, (among other things)), so check with your doc if u have high blood pressure or are pregnant or are taking any other meds. Uribel doesn’t help me with pain. Azo is ok but not as effective for me. Alka Seltzer Gold is the only thing that gets me comfortable again. I stop coffee, tea, sugar, alcohol when I feel it coming on or my urine gets too acid. I normally limit this anyway, but especially when feeling one coming on.

    When I feel a uti coming on, I also take 3 Uva Ursi pills with a glass of water (morning and night with food). Will only work if urine is alkaline. It’s what they used to cure UTIs before sulpha antibiotics were invented. Can damage liver so don’t take more than 5 days in a row and don’t use more than 5 times/year. Check with your doc before using this as may interfere with other drugs/herbs. Do your own research on this one. I hear 1 uva ursi pill a day with water can keep you uti free (once infection is gone). Again, Uva Ursi can mess with your liver and has drug interactions so check with your dr. before doing this. I haven’t tried this yet but might.

    I also regularly take a probiotic pill (50 billion) day. I regularly eat 1 cup of low sugar yogurt in morning with teaspoon of Manuka honey (expensive but has healing organisms in it). Take 1 organic oregano tab after sex (plus peeing and showering right after) works great for me to prevent sex induced UTIs.

    Tried Braggs Apple cider vinegar (ACV) to also alkalize my urine (2 tbsp in 8 oz water)…it worked to alkalize my urine but seemed to irritate my bladder etc… so dropped this from my routine. May work for others? Cranberry tabs or pure cran juice doesn’t help me to prevent or cure UTIs since it makes urine acid, so dropped this from my protocol. I do hear it can work for prevention but not to cure UTIs. Just hasn’t worked for me. Also, D-mannose tabs don’t seem to work for me to prevent or rid a uti. I’ve tried the pills, maybe powder works better?

    If uti is coming on strong, I’ll also take Airborne morning and night to amp up my immune system until symptoms subside. Trying to not use anything that will kill off good bacteria in my gut/lady parts since need for a healthy immune system and to keep all balanced. Hope this helps others.

    So far, I’m able to keep uti away. Have macrobid on hand if things get bad. If all else fails, always go to dr. to culture urine to ensure using right prevention/cure treatments. Need to find a doc who is aware of homeopathic treatments for UTIs. Many don’t mention any of these options since many of these treatments aren’t FDA approved. Doesn’t mean they aren’t worth trying if not harmful to you.

  • Karl December 14, 2015, 9:41 pm

    My mother is 92 years old and has severe dementia. I am usually able to prevent her from having bowel movements in bed, but occaisional they get by me. She has had three UTIs over the past five years. This time around I decided to try a natural product instead of using antibiotics. My co-op carries a product called UT Answer by a company called Nature’s Answer; this product is a liquid. This is an organic product that contains D-manose, cranberry concentrate, and a small amount of vitamin c. They seem to have very high standards. I followed their three day regimen and it seems to have worked. They also have a low alchohol uva ursi liquid.

  • Beverly Mandell December 1, 2015, 5:19 am

    Excellent article and just the information that I have been searching for for a long time!

  • lindy roy September 24, 2015, 2:57 am

    My mother has chronic urinary tract infections which have been repeatedly treated with antibiotics, which are becoming increasingly ineffective. This is a really helpful article which I’ll forward to her.

    I’ll also recommend Christine’s online course related to incontinence.

  • jaime August 9, 2014, 8:00 pm

    There are 2 main reasons that I have reoccurring UTI’s, holding my urine and not emptying completely. It seems like I ALWAYS have to urinate so I hold it because I get tired of going to the bathroom! Why is my bladder so overactive? #frustrated

  • Cheree November 21, 2013, 7:46 pm

    I have been told that D-Mannose works better where E-coli is present, but cranberry is more effective if staph is present.

  • Kara August 20, 2013, 9:58 am

    D-mannose did not work for me. Went through 2 jars, 2 reputable brands. I don’t understand how people say it works so well?

  • Julie March 29, 2013, 5:47 pm

    Thank you Dr. Carmack for such a straight-forward explanation of recurrent uti’s and most importantly, natural prevention! I’ve gone round for round with multiple doctors who are quick to prescribe antibiotics without even knowing what sort of bacteria is causing the uti – hence 6 whole weeks of trying now my 4th antibiotic to cure what should have been a simple, uncomplicated infection. The uti or series of uti’s I’ve experiences are finally gone but what’s worth more than the initial cure, is having a great regimen to follow for long term prevention. What a relief it was to see this article (I’ve been doing constant research)! Thank you again for providing a glimmer of hope and simple remedies that no other doctor I’ve met with has been willing to share. You’re a lifesaver!

  • Jen November 17, 2012, 2:25 am

    Have grade 2 cyctocele hence constant urinary infections. I do Kegal exercises, the obvious, drink lots of water and take 5000 mgs cranberry three times a day. Have ordered D-mannose from Nature Supplies, a bit worried as don´t like to take tablets bought on the web, who knows what the tablets might contain, also in my case is there any chance that this strange sugar will work, an expensive buy too, Any help out there. Thanks in advance.. J

  • Jan April 4, 2011, 2:07 pm

    You don’t have to get d-mannose from england. I think there are a number of US companies that make it (not sure where you are). I buy the d-mannose made by NOW supplements which is the brand my local health food store carries. It worked great for my chronic UTI problem (which has been gone for more than 6 years now). I don’t even take the d-mannose regularly anymore.

    hope this helps you find a local/cheaper source.

  • Rosemary March 21, 2011, 3:32 pm

    I have to tell Lesley how much I appreciate her sharing the news about waterfall-d-mannose. For those of us who have had to deal with too many recurring UTI’S and realize the futility of constant antibiotics, this a godsend natural product. I feel I, too, have my life back and can “deal” with what prolapse has dealt me!! The only drawback is that it is only available from York,England which makes the cost a consideration. But, I will sacrifice on something else in oder to have this product.

  • Amy January 26, 2011, 1:21 am

    Urinary tract infections can respond miraculously (as can many other woes) to the right homeopathic remedy. Which remedy is the right one? Get a book on homeopathy and read about the matches between symtoms and remedies, or find a medical practitioner who is very educated about treating with homeopathy.

    Homeopathy and holistic / natural medicine are NOT synonymous; homeopathy is a particular type of medicine, and the majority of natural medicine practitioners are not that well educated about homeopathy, if they are educated about it at all. There IS such a thing as a doctor of homeopathy, but educated practioners may also include MDs, DOs and NDs, as well as non-degreed practitioners.

    Two remedies I have used myself and for my dog are Cantharis and Causticum. Cantharis worked for me but not for my dog. I then tried Causticum for her and it worked beautifully. No more waiting two days while the vet-prescribed sulpha drugs kicked in… I also used Cran-Actin tabs for both of us.

    Homeopathic remedies must be taken when you haven’t had anything else in your mouth for an hour, and you never touch the pellets. (Pour a few from the bottle cap into your mouth, under your tongue, and let them melt there. The amount of pellets in each dose is not as important as frequent dosing, which will get you better results.) You may have caffeine during the course of treatment but no coffee – not even decaf. Also homeopathics need to be kept away from EMFs, light and strong-smelling things like essential oils, perfume, aftershave, etc.

    A naturopathic doctor cured me of five years of chronic urinary tract infections in 1977, and he didn’t even use homeopathics. Since then I have rarely had any symptoms but when I did I was able to vanquish them almost immediately with the homepathic and Cran-Actin. Of course lots of plain water is essential.

    Traditional Chinese Medicine (TCM) teaches that we store fear in our kidneys and bladder, which points to fear as a root cause of urinary tract infections. I have not needed to try TCM for urinary tract infections, but it would strive to balance the meridians so that no more infections would occur. Holding the index finger helps strengthen the kidney and bladder meridians. A TCM doc or practitioner of Jin Shin Jyutsu energy healing would be able to help release the fear and balance the meridians.

  • lesley January 23, 2011, 6:39 am

    The article is very comprehensive but there is an easier way, both to treat and prevent UTIs without the use of antibiotics or herbs that may cause liver damage.
    After the menopause and also having a prolapse, I contracted a UTI which kept coming back and ended up resistant to all the antibiotics. I also had some very bad side effects from the drugs. I decided to search for alternative treatments and tried various herbs and cranberry which helped but did not completely clear the problem. after about a year of suffering repeated infections I discovered D-Mannose which has completely solved the problem. It is completely non-toxic and may be used by anyone – pregnant, babies and children without any adverse effects at all. It is almost tasteless (very slight sweet taste) powder and dissolves easily in water, tea or juice (not coffee) and will clear symptoms in a few hours. You then carry on taking it for a few days to be sure. You can then take a maintenance dose of half a teaspoon per day. It also helps if you take before and after sex- it is easy to take a glass of water with a teaspoon in it up to bed to drink if required! Not too much of a passion killer!
    You can also get capsules which are handy when traveling – more information on dosage/how it works etc can be found on http://www.waterfall-d-mannose.com sorry I don’t know how to insert a link to their website you will have to type it in yourself.
    One more tip I have found is to avoid coffee and teas that contain high levels of caffeine, also alcohol – these seem to irritate the bladder especially when it is trying heal following an infection. Make sure you keep well hydrated preferably with plenty of water – this may sound obvious but it really helps.
    Using a small maintenance dose of D-Mannose I have kept myself clear of any symptoms for about six years now, I got my life back! I tried to tell my doctor about this but he was not interested, however his practice nurse made a note of it so hopefully she will spread the word if she’s allowed to!
    Hope this post is of help to other Whole Woman members.
    From Lesley

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