**By Una Lee, MD**
If you have ever had a urinary tract infection (UTI), you know how debilitating and miserable it is. You also know that the usual treatment is a course of antibiotics. Some frequent sufferers may have tried antibiotics as a preventive measure, such as taking a low-dose antibiotic daily, or after sexual activity, when women are more vulnerable to UTIs. While studies have shown preventive antibiotics are safe and effective, there are some promising non-antibiotic options to consider for keeping UTIs at bay.
- Review your personal risk factors. UTIs occur for a variety of reasons that can’t always be prevented, but it can’t hurt to think about what you could change to reduce your risk. Do you always wipe front to back after using the toilet? Are you using a spermicide, some of which are known to kill the “good” bacteria and let an infection take over? Are you drinking enough non-caffeinated fluid? Whatever the case don’t get too stressed: scientific evidence supports that different biological factors simply make some women more vulnerable to UTIs. There are also different times in a woman’s life when she may be more susceptible, which makes healthy habits even more important.
- Vaginal estrogen. For women who are approaching menopause, in the middle of it or beyond, their innate defenses can be altered by declining hormone levels in the vaginal area. Treatment with a low dose topical (not oral or patch-based) estrogen can help strengthen vaginal and urinary tract tissues, making them more resilient to infection.
- Probiotics/lactobacillus/acidophilus. There is some clinical data that restoring vaginal lactobacillus is beneficial. Probiotics have theoretical benefits in that they support healthy microorganisms that may help prevent UTIs. More research is needed, but it seems to be positive so far.
- Cranberry had been used for hundreds of years for urinary relief and treatment. The active ingredient in cranberry is the proanthocyanidins (PACs). The PACs prevent the bacteria from sticking to the walls of the bladder. Not all cranberry products and formulations are the same, and they aren’t regulated by the FDA. There is good scientific evidence that supports the use of cranberry, but if it doesn’t seem to be helping then check the amount of PACs: 36 milligrams of PACs has been shown as effective in reducing the frequency of UTIs.
- Vitamin C. Vitamin C is thought to have an effect on UTIs by acidifying the urine, which may be deadly to infection-causing bacteria.
- Methanamine is a prescription medication that works by making the urine inhospitable to bacteria. Because it is an antiseptic, not an antibiotic, it can help prevent a UTI, but not treat one.
- D-mannose. More research is needed on this nutritional supplement, but the biologic mechanism, which is thought to prevent bacteria from sticking to the walls of the urinary tract, looks promising.
- Chinese herbal medicine. While Chinese herbal medications have been used for thousands of years, the data using Western medicine standards is not conclusive in support of them preventing UTIs.
- Natural supplements. There are many natural and botanical supplements that have ingredients that may ease urinary discomfort, and these supplements generally do no harm. The efficacy of various supplements in the prevention of UTIs has not been rigorously scientifically studied. The most commonly used natural supplements are Vaccinium macrocarpon (a species of cranberry), cranberry-lingonberry, Berberine sulfate (a plant alkaloid), and the herb uva ursi (bearberry leaf).
- Vaccine therapy. Vaccines to prevent UTIs are in development in clinical trials, but not yet ready for prime time.
Frequent UTIs cause tremendous distress in one’s life and have a huge impact on health care costs. So for people who are interested in reducing their exposure to antibiotics, it’s good to know there are natural and non-antibiotic options that may help prevent UTIs and improve your health.
Una Lee, MD, is board certified in Urology and subspecialty certified in Female Pelvic Medicine and Reconstructive Surgery at Virginia Mason.