Urinary Tract Infections

Urinary Tract Infections

What is a Urinary Tract Infection?

A urinary tract infection (UTI) occurs when bacteria (usually from the gastrointestinal tract) migrate into the urinary tract. This can occur more commonly when dehydrated, after sex, with declining oestrogen levels, with intervention such as catheterisation and when there are changes in bladder emptying such as incontinence.

 

What are the Symptoms of Urinary Tract Infections?

Symptoms of a mild urinary tract infection include:

  • Burning on urination
  • Pressure/pain to the pelvic area
  • Frequently needing to pass urine
  • Blood in urine
  • Fever
  • Change in colour or smell to urine

If the infection persists and tracks up to the kidneys, you might experience more severe symptoms such as:

  • Lower back pain and flank pain
  • High fever
  • Rigors (shaking body)
  • Nausea/vomiting
  • Feeling faint

 

How to Test for Urinary Tract Infections?

The usual test is a urinary dipstick, which could show leucocytes +/- nitrates and occasionally blood.

The urine is usually then sent for microscopy and culture.

If you experience chronic of recurrent symptoms, it may be worth testing for Ureaplasma, Mycoplasma and performing screening for sexually transmitted infections. If these tests are negative. Further testing may be required with an Ultrasound of the kidneys, ureters and bladder (USS KUB) or a CT KUB.

Vaginal microbiome testing is now available for those that want to investigate things more comprehensively.

 

How to Treat Urinary Tract Infections?

Conventional Approaches

The conventional approach to treatment is antibiotics. For a simple UTI these can be given for 3-5 days. These are often prescribed before the urine culture is back and may be changed if there is bacterial resistance or symptoms persist. The usual antibiotics prescribed are.

  • Cephalexin
  • Trimethoprim
  • Nitrofurantoin

Antibiotics may be needed to avoid the infection migrating up to the kidneys. However, unfortunately, they will affect levels of good vaginal flora as well as the gut microbiome. Almost one quarter of women taking antibiotics for a UTI will develop Candida.

 

Alternative Treatments

Most alternative treatments focus on prevention, rather than treatment.

 

Lifestyle measures include:

  • Urinate when you feel the urge and ensure complete emptying.
  • Drink plenty of water (aim for 6+ glasses a day) to flush out bacteria
  • Avoid using condoms with spermicide
  • Wear loose fitting cotton underwear
  • Avoid eating lots of processed sugars
  • Aim for foods high in essential fatty acids such as oily fish and seeds

 

Supplements may include:

 

Cranberry:

  • Cranberries contain A-type proanthocyanidins (PACS), which can prevent Escherichia coli (a primary pathogen involved in UTIs) from adhering to the cells lining the urinary tract.
  • Cranberry products work best for people who experience recurrent UTI or are susceptible to UTI. (Recurrent UTIs are defined as two or more UTIs within six months or three or more UTIs within a year.)
  • Cranberry products reduce the risk of repeat symptomatic, culture-verified UTIs in women by about 26%; children by about 54%; and people susceptible to UTI following medical interventions by about 53%. These findings don’t relate to people who don’t get UTIs very often but want to avoid them.
  • It is still unclear which formulation or dose of cranberry product works best.RACGP – Cranberry juice can prevent some recurrent UTIs: Cochrane Review

 

Probiotics:

Probiotics can be used in prevention and treatment of UTIs in women. Lactobacillus is the most well studies strain and has been found to inhibit the growth of pathogens in the urinary tract. The following strains have evidence supporting their use and can be used orally or vaginally.

  1. Lactobacillus rhamnosus GR-1
    • Helps maintain a healthy vaginal flora and inhibits E. coli adherence to uroepithelial cells and reduce UTI recurrence in women
  1. Lactobacillus reuteri RC-14
    • Restores vaginal microbiota and prevents pathogen colonization and can reduced UTI recurrence in women.
  1. Lactobacillus crispatus CTV-05
    • Particularly beneficial for women with recurrent UTIs.
    • This strain is native to healthy vaginal microbiota and has shown good colonization ability. It can reduce UTI recurrence when delivered intravaginally
  1. Lactobacillus acidophilus
    • General support for vaginal and gut microbiome health, though less targeted than the others
  1. Bifidobacterium species (e.g., B. longum, B. bifidum)
    • Helpful in gut health and immunity, which may indirectly support UTI resistance.

 

D Mannose

  • D-mannose is a type of sugar that can be taken orally to prevent and treat UTIs. It is most effective when treating UTIs caused by Escherichia coli (E. coli).
  • It works by binding to E. coli bacteria in the urinary tract, preventing them from attaching to the bladder wall.
  • The bacteria bound to D-mannose are then flushed out in urine, reducing infection risk.
  • Several small clinical studies suggest D-mannose may be as effective as low-dose antibiotics for preventing recurrent UTIs
  • Some research shows it may help reduce symptoms of acute UTIs, but it’s not a substitute for antibiotics in moderate to severe infections.
  • Dose: Prevention: 1.5–2 grams once or twice daily. Treatment: 1.5–2 grams 2–3 times daily for several days.

 

Vitamin C

  • Acidifies urine, which may inhibit the growth of some UTI-causing bacteria like coli.
  • Supports immune function, which could help the body fight off infections.

 

Herbs

Please consult a naturopath for advice on herbs. One consideration could be Uva Ursi (Bearberry).

 

How Does Oestrogen Impact Urinary Tract Infection Frequency & Severity?
  • Oestrogen plays a significant role in preventing UTIs, particularly in postmenopausal women.
  • After menopause, declining oestrogen levels lead to changes in the vaginal and urinary tract environment that can increase UTI risk
  • Oestrogen restores healthy vaginal flora. It increases lactobacilli in the vagina, which produce lactic acid and help maintain a low pH. This inhibits the growth of coli and other harmful bacteria
  • Thinning of the urogenital tissues occurs after menopause and makes it easier for bacteria to colonise. Oestrogen thickens and strengthens these tissues

 

 

 

 

 

Reference links:

RACGP – Cranberry juice can prevent some recurrent UTIs: Cochrane Review

MET2474-Probiotics-GR-1_RC-14-for-Women-Science-Review-IPAD.pdf

 

 

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