Overview: Urinary Tract Infection

• Urinary tract infections (UTIs) are common, with an estimated lifetime incidence of approximately 53% in women and 14% in men.

• The higher prevalence in women is thought to be related to urethral length.

• For those who have had a prior infection, the risk of another increases dramatically.

• One study found a recurrence rate of 44% within 1 year for those women with a history of UTI.

• The most common pathogens include gram-negative organisms, in particular Escherichia coli (E. coli), which accounts for 80% of infections.

• Many recurrent infections may actually represent reinfection with the same organism.

• Despite clearing the bacteria from the urine, the colon may act as a reservoir for pathogenic bacteria.

• A urine culture test is the first diagnostic tool. Your urine must be sent out for culture to determine the pathogen and what antibiotics it is sensitive to.

Risk Factors for Urinary Tract Infection

Important Points to Consider

• D-Mannose supplementation is thought to inhibit urinary tract infection by encouraging binding of bacteria to this sugar instead of the bladder wall and thus enhancing evacuation through the urine.

• Many cranberry beverage products on the market contain only a small amount of cranberry juice and a significant amount of sweeteners. This may have a minimal impact on the urinary tract and potentially a negative impact on overall health. But a trusted source of cranberry juice and hydration should help.

• Tip 💡 : If you are taking Apple Cider Vinegar, please cut back on them. Reason: If you put too much acid in your body, it overreacts and starts producing more bases which would throw off the pH balance and allow for more infections.

• For females: a urogynecologist evaluation is an important step.

  
  

Prevention Prescription: Urinary Tract Infection

• Encourage a plant-based diet high in garlic and onions.

• A trusted source of probiotics.

• Urge removal of possible bladder irritants such as caffeine, alcohol, and simple sugars.

• Encourage adequate fluid intake. Monitor stress, and focus on foundations of health such as optimal diet, physical activity, sleep.

• Mental and spiritual health.

• Encourage frequent voiding and avoidance of holding urine.

• Consider changing method of birth control if frequent UTIs occur after use of spermicides, condoms, or diaphragms.

• Recommend urination after intercourse.

• Avoid using a toilet paper and try switching to a bidet.

Therapeutic Review

This is a summary of therapeutic options for UTI both for acute treatment and for prevention. If a patient presents with severe symptoms or has a history suggestive of a complicated UTI, an initial course of antibiotics would be beneficial. For the patient who has mild to moderate symptoms, a ladder approach may be appropriate. Patients should be counseled to seek further care if their symptoms worsen or do not resolve.

Acute Infection

Nutrition

• Encourage garlic consumption.

Supplements

• D-Mannose: ¼ to 1 teaspoon three times daily

Botanicals

• Cranberry 16 oz of unsweetened juice daily or extract 500 mg bid

• Uva ursi: hydroquinone derivative 400-840 mg up to 4 times daily or 3 grams of dried root daily

Pharmaceuticals

• Trimethoprim-sulfamethoxazole: one double-strength tablet twice daily for 3 days

• Nitrofurantoin extended release: 100 mg twice daily for 7 days

• Ciprofloxacin: 250 mg twice daily for 3 days

• Phenazopyridine: 200 mg twice daily for 2 days

Recurrent Infections

Removal of Exacerbating Factors

• Eliminate use of spermicides, and try a change of birth control method.

• Recommend urinating after intercourse.

Nutrition

• Encourage garlic consumption.

• Encourage adequate fluid intake.

Supplements

• Probiotics: 1 billion CFUs daily of Lactobacillus rhamnosus or L. fermentum

• Vitamin C: 100 mg daily

Botanicals

• Cranberry: 16 oz of unsweetened juice daily or extract, 500 mg twice daily

• Uva ursi

• Other herbal products that have potential benefit, including berberine-containing plants and echinacea

Pharmaceuticals

• Trimethoprim-sulfamethoxazole: one double-strength tablet daily

• Nitrofurantoin: 100 mg daily

• Ciprofloxacin: 250 mg daily

Other Therapies

• Biofeedback for those with dysfunctional voiding

• Acupuncture

Key Web Sources

• National Center for Complementary and Alternative Medicine (NCCAM) Dietary and Herbal Supplements page. http://nccam. nih.gov/health/supplements

• National Kidney and Urologic Diseases Information Clearinghouse. http://kidney.niddk.nih.gov/index.htm