Urinary tract infections
A Natural Approach to Urinary Tract Infections
Becka, a 24-year-old woman, came to my office feeling discouraged because of recurrent urinary tract infections (UTI’s) over the past few months. After being treated with multiple rounds of antibiotics which helped with the UTI but often left her with a yeast infection, she stated, “not only are the symptoms uncomfortable, but it makes me feel ashamed and humiliated, especially when I have to confess to my new partner that I’m symptomatic … again.” Becka is not alone. In fact, over 50% of women will experience at least one urinary tract infection during their lifetime and 27% will have a recurrent episode within six months.
Let’s talk about how we can prevent UTI’s for good, naturally.
SYMPTOMS OF A URINARY TRACT INFECTION
A urinary tract infection can include any part of your urinary system including the urethra, bladder, ureters, and/or kidneys. Most commonly, it is the lower urinary tract (urethra and bladder) but in severe cases the bacteria can travel up the ureter(s) and infect the kidney(s).
Symptoms of a Bladder Infection
Frequent need to urinate
Urinary urgency
Burning or painful urination
Strong smelling urine
Bloody, dark coloured or cloudy urine
Small amounts of urine being passed
Pelvic discomfort (aching, cramping, pressure)
Fatigue, or feeling unwell
Symptoms of a Kidney Infection
A kidney infection generally displays the same symptoms as a bladder infection, with the addition of a fever, chills, nausea, vomiting and/or low back pain. These symptoms should be taken very seriously as they usually indicate the infection is spreading and antibiotics are required.
WHAT’S THE CAUSE?
Urinary tract infections occur when bacteria, most commonly E.coli, invade and grow in the urinary tract.
Risk Factors of Bacterial Invasion
Consumption of excess sugar and/or alcohol (feeds the bacteria, dampens immune response)
Excess stress (dampens immune response)
Frequent sex, especially with a new partner (disrupted microbiome, new bacterial exposure)
Antibiotic use (disrupts the microbiome)
Low estrogen levels, such as in menopause (changes in the bladder cells and coating)
Diabetes (higher blood sugar can feed the bacteria)
Oral contraceptive pill (disrupts hormone balance)
Birth control methods with spermicide such as diaphragms, cervical caps, spermicide gels or creams, and spermicide-coated condoms (can destroy good bacteria and alter the microbiome)
Chemical sensitivities or exposure (disrupts microbiome)
Pelvic disorders such as endometriosis or pelvic floor tension (hormone imbalance, structural causes)
WHAT ELSE MIGHT IT BE?
Interstitial cystitis (IC) - Non-infectious bladder inflammation that causes pain, urinary frequency and urgency with incontinence. Possible causes may include bladder epithelial permeability (i.e., “leaky bladder'“), autoimmune, mast cell activation, etc.
Vaginitis - Inflammation of the vagina that can result in discharge, itching and pain. The cause is usually a change in the normal balance of vaginal bacteria or an infection. Examples of vaginitis include bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis, gonorrhoea and herpes simplex virus.
Pelvic inflammatory disease - Infection of the upper female genital tract, involving any combination of the endometrium, fallopian tubes, peritoneum and/or any other contiguous structures.
HOW CAN WE CONFIRM THE DIAGNOSIS?
Urinalysis - assesses if there is blood, inflammatory and infectious markers, altered pH, and more
Urine culture - determines if there is a specific bacteria involved (e.g., E. coli)
PCR testing (e.g., by MicrogenDx) - superior to urine cultures in detecting slow-growing, fastidious, non-aerobic organisms as well as polymicrobial infections; usually reserved for chronic lower urinary tract infections (not acute)
Additional testing to consider for chronic or recurrent cases: hematology panel, vitamin B12, vitamin D3, ferritin, thyroid panel, celiac antibodies, inflammatory markers, hormone testing, food sensitivity testing, GI Map, SIBO, mold profile.
NATURAL TREATMENT OPTIONS
Overarching Goals
Support the body’s immune system to naturally defend against infection.
Restore a healthy vaginal and gut microbiome.
Promote an acidic bladder pH that resists harmful bacteria.
Prevent bacterial adherence to the bladder lining.
Lifestyle
Wipe front to back after a bowel movement or urination
Always urinate immediately after sex
Avoid intercourse during symptomatic phases
Opt for cotton underwear; avoid nylon, pantyhose, thongs, and tight clothing
Reduce stress in your life as much as possible (e.g., allow yourself rest, self-care)
Get adequate rest
Determine possible allergens (e.g., foods, detergent)
Void at first urge (don’t hold your pee!)
Hydrate!
Avoid excess use of antibiotics, if possible
Consider condoms, an IUD or the natural method instead of the birth control pill or spermicides
Choose tampons over pads
Avoid bubble baths and strong soaps; rinsing with water is best
Avoid douches
Avoid smoking and tobacco use
Nutrition
Increase:
Healthy fats - e.g., avocado, chia seeds, fresh ground flaxseeds, hemp seeds, olives, olive oil, walnuts, wild salmon
Fiber - e.g., vegetables such as leafy greens
Fermented milk products (3x/week) - e.g., plain greek yogurt, kefir
Garlic and onion consumption
Water intake - 6 to 8 oz. per day
Cranberry juice, unsweetened - 16 oz. per day
Reduce:
Sugar intake (cut out completely for 5 days)
Bladder irritating foods - e.g., alcohol, carbonated beverages, spicy foods, chocolate, coffee, black tea, tomatoes, vinegar, high-potassium foods, apples, citrus
Supplements
I generally recommend following a supplement regimen for 1 to 2 weeks in acute cases or 3 to 6 months in recurring cases. Symptoms are expected to improve within 24 hours, otherwise antibiotics are likely indicated. Note: The below recommendations are NOT intended for pregnant women.
Probiotics: Lactobacillus rhamnosus or reuteri
20 billion daily oral plus a vaginal suppository nightly
Prevent E.coli from proliferating, maintain acidity
E.g., HMF Vaginal Health suppositories, HMF Women’s Daily 17.6 B, Natural Factors Women’s Multi Probiotic 12B
Cranberry Extract
400 mg three times daily
Antimicrobial effect, prevent’s adherence of E. coli, acidifies urine
E.g., Natural Factors CranRich Cranberry Concentrate Super Strength 500 mg per cap, Theralogix TheraCran 350 mg per cap
D-Mannose
1.5 g twice daily for three days then 1.5 g daily for 10 days; 2 g for a six months if recurrent or chronic
Prevents E.coli from binding to bladder wall, increases acidity
Note: Usually a combination product with cranberry extract
Vitamin C
1000 mg three times daily
Supports immune health, acidifies urine
E.g., Natural Factors Vitamin C 100mg, Innate Response Formula C Complete Powder, Designs for Health Buffered Vitamin C Powder, LivOn Laboratories Lypo-Spheric Vitamin C, AOR Vitamin C, CanPrev Vitamin C
Vitamin D
Dose is dependant on lab work, climate, sun exposure, etc.
Supports immune health, pelvic floor function
E.g., AOR Vitamin D, Pure Encapsulations Vitamin D, Natural Factors Vitamin D
*Combination products e.g., Vitazan D-Mannose Plus (600 mg cranberry, 4800 mg d-mannose, 500 M probiotic per 2 scoops) 2 scoops once or twice daily, Vita Aid UTI-XP (600 mg cranberry + 1500 mg d-mannose per scoop) 1 scoop twice daily, AOR UTI Cleanse Powder (100 mg cranberry + 1000 mg d-mannose per scoop) 1-2 scoops 4-5 times daily, AOR Cran-Mannose UTI (100 mg cranberry + 1000 mg d-mannose per cap) 1 to 2 caps 4 to 5 times daily.
Herbs
I generally recommend a herbal tea adapted from Aviva Romm, containing equal parts of:
Bearberry (Arctostaphylos uva-ursi) leaf - One of the best herbs to treat urinary tract infections due to it’s antimicrobial, anti-inflammatory, soothing, and astringent effects.
Marshmallow (Althea officinalis) root - A wonderful addition for its soothing and anti-inflammatory effects.
Yarrow (Achillea millefolium) blossoms - An anti-spasmodic herb wonderful for any pelvic discomfort, also contributing antimicrobial, anti-inflammatory, and astringent (pulls water into the urinary tract) effects.
Lavender (Lavandula officinalis) flowers - A calming, relaxing herb that also contributes antimicrobial and anti-inflammatory effects.
Directions: Place 2 tablespoons in 4 cups of water. Steep for 1 hour. Drink 1/2 to 1 cup 2-3 times per day, taken hot or cold. Refrigerate for up to 48 hours.
Contraindications: Pregnancy.
WHEN TO SEE YOUR DOCTOR
I generally recommend consulting a practitioner at the onset of symptoms. At this point they can complete a thorough physical assessment, urinalysis, and guide you through a treatment plan. It is especially detrimental to consult your practitioner if you are:
Having any symptoms of a kidney infection (e.g., fever, chills, low back pain)
Pregnant
Under the age of 10
Elderly
Having symptoms of bladder infection lasting longer than 24 hours
Immune compromised (e.g., diabetes)
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