Deep insights into urinary tract infections and effective natural remedies | African Journal of Urology

This review was based on data extracted from published papers with the search terms of urinary tract infection, herbal medicine, vitamin, probiotics, supplements, and antibacterial resistance which are available in all relevant databases, especially PubMed, Web of Science, Scopus, MEDLINE, and EMBASE, without limitation up to August 1, 2020.

Herbal medicine

In recent years, the use of medicinal herbs in the prevention and treatment of various diseases has been increased [13, 21]. Complimentary therapy with medicinal herbs is a research area that may be deserving of special attention. The complementary therapy of antibiotics with medicinal herbs showed mainly synergistic effects [11]. In many studies, herbal medicines could reduce bacterial resistance to antibiotics, remarkably [15, 16]. So, in many cases, patients may benefit from this type of therapy. It was shown that herbal medicines could play an important role in the treatment of a type of UTI [22]. Since several plant antimicrobial compounds contain various functional groups in their structure, the antimicrobial activities are attributed to multiple mechanisms [13]. The chemical compounds presented in herbal medicines evolved to protect the plant from pathogenic microorganisms and therefore could prevent or treat infections in animals. Many of these compounds are renally excreted so that they are specifically useful as urinary antiseptic agents. Two major mechanisms are involved in the antimicrobial properties of these compounds. Some of them directly kill microbes and some of them interfere with microbial adhesion to epithelial cells [23]. These herbs play an important role in assisting to resolve UTI. Here, we briefly review the role of medicinal herbs and their variant in the treatment of infections. Some of these herbal medicines with more details are illustrated in Fig. 1.

Fig. 1

Used herbal medicines in the treatment of UTI. The active constituents with the related mechanism of action(s) are also described

Arctostaphylos uva-ursi

Arctostaphylos uva-ursi (bearberry) is a plant species of the genus Arctostaphylos. The leaves of this plant have been traditionally used because of their diuretic properties [23]. The plant has been used for the treatment of infectious diseases, especially for UTIs. The herb is approved in Germany for the treatment of bladder infections and effective against E. coli in the bladder [24].

The leaves of the plant are responsible for the therapeutic actions which contain the glycoside arbutoside. This compound is hydrolyzed in the bowel to glucose and the aglycone hydroquinone which is absorbed and glucuronidated in the liver. Hydroquinone glucuronide is then carried to the kidneys and excreted in the urine. In the alkaline condition of urine, the hydroquinone glucuronide will decompose automatically and hydroquinone which is worked as a direct antimicrobial agent will be released [23].

It should be noted that based on information from laboratory researches exposure to synthetic hydroquinone for the long-term may be carcinogenic, so that it is recommended the consecutive consumption of this herbal medicine should not be extended more than two weeks.

Tannins presented in this plant could potentiate the in vitro antibacterial activities of β-lactam antibiotics against methicillin-resistant S. aureus (MRSA). Consequently, due to that whole plant extracts contain other constituents that increase antibacterial activities, it is recommended to use whole plant extracts instead of isolated arbutoside.

Juniperus communis

Juniperus communis (juniper), which belongs to the Cupressaceae family, and other closely related species including Juniperus monosperma (Engelm) Sarg and Juniperus osteosperma (Utah juniper) show remarkable antimicrobial activities [25]. It was reported that terpenoids in the leaf of the herbs are responsible for the antibacterial and diuretic activities of the herbs [23]. Schilcer reported that Juniper oil was effective against urinary tract infections [26]. Leaf and berries of the plant show antimicrobial activities against urinary tract infections. The main antibacterial constituent of this plant is terpinen-4-ol, a volatile oil, which plays an important role in the treatment of UTIs [27]. This plant also contains other active agents such as oxygenated sesquiterpene, β-pinene, sabinene, monoterpene hydrocarbons, limonene, and myrcene [22]. It should be noted that the volatile oil of juniper contains nephrotoxic compounds, especially hydrocarbon terpenoids. However, these adverse effects might only be seen after receiving high doses which far exceeded the therapeutic dose [23].

It was indeed previously demonstrated that the extracts presented diuretic activity [27]. The juniper leaf infusions show more diuretic activity than the volatile oil, which suggests that other constituents contribute to the diuretic activity of the herb.

Vaccinium macrocarpon (cranberry)

Many researchers have suggested that cranberry is active against UTIs. The plant belongs to Ericaceae family and can be potentially active against E. coli, the leading causes of bacteria-mediated UTIs, by reduction of bacterial attaching to the walls of the bladder, and then, the bacteria are more likely to be washed out during urination. Cranberry juice intake leads to measurable protection against both sensitive and resistant strains of E. coli [28]. It could also inhibit the binding of bacteria to gastrointestinal mucosa [29]. It was shown that cranberry juice consumption reduced the biofilm formation of both Gram-negative and Gram-positive uropathogens [30, 31].

Cranberry contains proanthocyanidins, which are stable phenolic compounds and contribute to the anti-adhesion activity against E. coli. Also, the in vitro antibacterial activities of cranberry extracts and juice against other pathogens such as S. aureus, P. aeruginosa, K. pneumoniae, and P. mirabilis have been previously demonstrated [32]. Cranberry proanthocyanidins mainly contain A-type and B-type linkages, while in comparison with B-type linkage, A-type linkage is more effective in preventing adhesion of P-fimbriated uropathogenic E. coli to uroepithelial cells of the bladder and responsible for anti-adhesion activities of the extract, therefore inhibiting the ability of E. coli to infect the urinary mucosa [33, 34].

Cranberry also contains other biologically active constituents such as anthocyanidin, catechin, flavanols, myricetin, quercetin, and phenolics which are supposed to be responsible for its activities [35].

The other possible mechanism of action of cranberry might be related to acidification of the urine; however, it only causes temporary effects, and the changes last about 15 min in most people. Therefore, this mechanism could not be of relevance.

Due to these health benefits of cranberry extract, different commercial formulations of the extract exist in the market. In acute situations, the usual dose of the juice is 250–500 ml two to three times daily and for prevention consumption of 250–500 ml per day is enough. The solid dosage forms such as capsules that contain concentrated cranberry extract are also available. In acute situations, taking 2–3 capsules two to four times per day and taking 1 two to three times daily for prevention are recommended [36].

In summary, the existing data indicate the beneficial effects of cranberry preparations against UTIs; however, these effects are mainly related to prophylactic activities by preventing the development of infections or in combination with conventional antibiotics and solely intake of the herb is not recommended for UTI treatment.

Vaccinium myrtillus (Blueberry)

Blueberry has extensively been used traditionally to treat and prevent UTI. Blueberry extracts contain similar constituents as cranberry extracts, and the extracts possess similar anti-adhesive activities against uropathogenic bacteria and the bacteria are significantly less able to adhere to the walls of the bladder [24, 37]. Tannins are the most active constituents of blueberry extracts against UTI.

Cinnamomum verum (Cinnamon)

Cinnamon belongs to the Lauraceae family and shows antioxidant and antibacterial activities. It contains bioactive phytochemical compounds such as trans-cinnamaldehyde, eugenol, trans-cinnamyl acetate, and proanthocyanidins which have been used in the treatment of UTI.

Amalaradjou et al. showed that trans-cinnamaldehyde as an essential oil was able to inhibit biofilm formation of E. coli on urinary catheters by downregulating major virulence genes in the bacteria.

Various mechanisms are involved in antibacterial activities of essential oils: (I) due to their hydrophobicity, these molecules could target the lipid-containing bacterial cell membrane and mitochondria and alter the permeability which finally leads to leakage of ions and other cell contents, (II) inhibiting energy generation and glucose uptake, and (III) inhibiting activities of important enzymes such as amino acid decarboxylases [38].

Agathosma betulina (buchu)

A. betulina is one of the oldest known herbs for the treatment of uncomplicated UTI [39]. The leaves of the herb contain various phenolic compounds and have been used as an herbal remedy for urinary tracts, because of the diuretic and antiseptic properties. In a study, it was demonstrated that the ethanolic leaf extract of A. betulina showed antibacterial activities against E. coli, K. pneumoniae, P. mirabilis, P. aeruginosa, S. aureus, Staphylococcus saprophyticus, and E. faecalis [40]. For a preparation containing the leaves extract of A. betulina, the anti-adhesive properties were investigated, and the results showed the anti-adhesive effects of the preparation by interacting with T24 cells [41].

Hybanthus enneaspermus

H. enneaspermus was studied to evaluate the in vitro antibacterial activity of various types of extracts against the major UTI including E. coli, P. aeruginosa, K. pneumoniae, P. mirabilis, E. faecalis, and S. aureus. Among the extracts, ethanol extract showed the most antibacterial activities against the pathogens. The extract has various bioactive compounds such as flavonoids, terpenes, phenolic, and alkaloids that the therapeutic values are attributed to the presence of them.

Armoracia rusticana (horseradish)

A. rusticana (synonyms: Cochlearia armoracia, Radicula armoracia), which belongs to the family Brassicaceae, traditionally has been used to treat UTI. It shows favorable results for the prevention of recurrent UTI in pediatric patients [42]. It was demonstrated that the isothiocyanates of horseradish are responsible for their antibacterial activities of the herb. It was shown that these bioactive compounds could block the pathogenic process of human cell penetration by uropathogenic E. coli [43].

Hydrastis canadensis (Goldenseal)

H. canadensis (Goldenseal) has been used traditionally to treat various diseases such as digestive disorders, UTI, and skin diseases and also to check internal hemorrhage [44]. The rhizome, rootlets, and root hairs of the herb produce bioactive alkaloids and isoquinoline alkaloids [45]. These bioactive compounds may act similarly to proanthocyanidins, which are found in cranberry, in inhibiting bacteria from sticking to the bladder walls [24].

Berberine is a bioactive herbal alkaloid which presents in various medicinal plants such as H. Canadensis, Berberis aquifolium, B. vulgaris, and B. aristata [13]. This compound has been used in the treatment of UTI [46]. Notably, berberine exerts its antibacterial activities against UTI with interfering adhesion of E. coli to bladder epithelium.

Equisetum arvense (Horsetail)

E. arvense (Horsetail) is one of the oldest and most famous herbal medicine. The plant has a vast variety of therapeutic properties such as antibacterial activities [47, 48]. It was shown that the ethanol extract of the herb showed antibacterial activities against urinary tract pathogens including E. coli, K. pneumonia, P. mirabilis, P. aeruginosa, S. aureus, S. saprophyticus, and E. faecalis. The commonly known phytochemical compounds from Horsetail are alkaloids, phytosterols, tannin, triterpenoids, and phenolics [49]. Among them, phenolic compounds, especially flavonoids, present in the plant extracts are responsible for the antibacterial activities [50]. The essential oil of the herb was shown to possess broad-spectrum antimicrobial activities against tested strains.

Urtica dioica (nettle)

U. dioica (nettle) is a perennial plant of the Urticaceae family and has been traditionally used for the treatment of various diseases such as arthritis, rheumatism, UTI, kidney stones, and gingivitis [51].

It was shown that the plant extracts exhibit antimicrobial activities against various Gram-positive and Gram-negative bacteria such as Bacillus subtilis, Lactobacillus plantarum, P. aeruginosa, E. coli, K. pneumoniae, S. aureus, and S. epidermidis [52]. The leaf of the herb is a valuable source of biologically active compounds that show antimicrobial activities and could be used to treat infectious diseases [53].

It should be noted that the role of nettle in the treatment of UTI might be due to the diuretic activities of the herb [54].

Plantago major L.

P. major L. belongs to the Plantagináceae family and is used traditionally for the treatment of several diseases such as infectious diseases, pain relief, and reducing fever. The major chemical compositions of the herb include mucilage, organic acids, polysaccharides, and flavonoids. The herb traditionally has been used in Iran for pulmonary infections, stomach ulcers, and infections [55].

Other herbs

The essential oil of Salvia officinalis showed inhibitory activities against clinically isolated uropathogens [56]. Barosma betulina has been used traditionally for the treatment of various diseases such as UTI, catarrhal cystitis, and urethritis. The in vitro studies showed its antimicrobial effects against uropathogens. Other herbs that have been used for the treatment of UTIs but are not yet adequately studied include Mentha piperita, Allium sativum, Terminalia chebula, Taraxacum officinalis, and Zingiber officinale [22].

Nutrition therapy

Using nutrients is an integral part of the management, prevention, and treatment of UTIs. In most cases, micronutrients have been used to this end and they are included vitamins and minerals in general. The role of each agent in the prevention or treatment of UTIs is illustrated in Fig. 2.

Fig. 2

The role of nutrition therapy in the prevention and treatment of UTIs. The ingredients with the related mechanism of action(s) are also described

Vitamins

Vitamin C possesses antimicrobial activities and is frequently used as an important supplement to antibiotic therapy for UTI [57]. Vitamin C is considered as a non-enzymatic antioxidant that slows down the production of free radicals and oxidation, which leads to strengthening the immune system and the deficiencies of vitamin C could place the persons at risk for infections due to the negative impacts on immune function [58]. Various studies have been conducted to show the efficacy of vitamin C in the management of UTIs. Yousefichaijan et al. studied the efficacy of vitamin C supplementation on UTI in children for 14 days. The results showed that vitamin C supplementation was able to control the symptoms of UTI, including dysuria, fever, urinary urgency, and also dribbling urine [59]. Ochoa et al. investigated the role of a daily intake of vitamin C for its effect on UTIs during pregnancy. They showed that daily usage of vitamin C has significant effects on the reduction of UTIs and also improving the health level of the women [60]. The formation of struvite stones is associated with UTIs by urease-producing bacteria. It was shown that the vitamin can modulate the struvite crystal formation in the presence of uropathogenic bacteria [61]. In another study, the combination of cranberries, a probiotic (Lactobacillus rhamnosus), and vitamin C has been used to evaluate the clinical benefits due to their additive or synergistic effects. The results showed that the approach might represent a safe and effective option in UTI management [62]. It was shown that nitrite may be generated by bacteria in urine during UTI. Acidification of nitrite leads to the formation of nitric oxide (NO) and other reactive nitrogen oxides that are toxic for a wide range of microorganisms. In a study, NO formation and bacterial growth in mildly acidified urine containing nitrite and vitamin C as a reducing agent were investigated. The growth of bacteria was markedly reduced by the addition of nitrite to acidified urine. Additionally, the inhibition was enhanced by vitamin C. These results help to explain the bacteriostatic effects of acidified nitrite because of the release of NO and other toxic reactive nitrogen intermediates and also the role of vitamin C in the treatment and prevention of UTI [63].

The positive role of vitamin A supplementation in the prevention and treatment of UTI has been mentioned previously [64]. Vitamin A has been used in the management of UTIs in children. The results of the study indicated that in the group of the children who received 200,000 IU of the vitamin in combination with antibiotics, the incidence of UTIs was lower than the control group [65]. In another study, vitamin A supplementation in addition to antimicrobial therapy was used to improve UTI symptoms and preventing renal scarring in girls who suffer from acute pyelonephritis. The results showed that vitamin A supplementation is an effective approach for improving the clinical symptoms of UTI and also reducing the renal injury and scarring following acute pyelonephritis [66]. Sobouti et al. studied the effects of vitamin A or E supplementation in addition to antimicrobial therapy for the prevention of renal scarring in acute pyelonephritis. According to the results, vitamins A or E supplements were effective in reducing renal scarring secondary to acute pyelonephritis [67]. The other study was conducted to determine the effect of vitamin A supplementation on the rate of permanent renal damage in children with acute pyelonephritis. It was demonstrated that the administration of vitamin A leads to a significant reduction in permanent renal damage [68].

Different mechanisms have been mentioned for the implication of vitamin D on the management of UTI. It was shown that tight junction proteins play important roles in preventing the bacterial invasion of the epithelial barrier and supplementation with vitamin D could strengthen the urinary bladder lining and restore the bladder epithelial integrity [69]. Additionally, on the one hand, vitamin D could act as a local immune response mediator in UTI and on the other hand, enhancing vitamin D levels leads to modulate the innate immune system and provides a protective response to infection [70, 71]. The relation between the status serum level of vitamin D and the risk of UTI has been studied extensively, and the results showed a significant association between increased risk of UTI and vitamin D insufficiency, as an independent risk factor, especially in children [72,73,74]. Women with vitamin D deficiencies show a higher risk level of UTI during pregnancy [75]. Vitamin D deficiency is common and the proven risk factor for UTIs especially in girls and supplementation with vitamin D could prevent first-time UTI [76]. In a randomized clinical trial, the subjects who received vitamin D3 (20,000 IU per week) for five years showed better prevention against UTI [77]. Together, these results demonstrate that vitamin D supplementation provides a potent weapon in the prevention of UTI.

Minerals

The role of zinc in the management of the infectious disease has been described extensively [17, 78]. It was shown that the element increases the response to treatment in many infections and active against different pathogens such as E. coli, Mycobacterium tuberculosis, Salmonella typhi, and Streptococcus pyogenes [79,80,81]. The incidence of zinc deficiency in infectious disease clinics has been reported extensively [82, 83]. The results of the Mohsenpour et al. study showed that serum zinc levels in people with recurrent UTI were lower than those in the control group. So, the zinc level could be assumed as a risk factor for recurrent UTI [84]. In another study, the relation between serum zinc levels in children inflicted with UTI and the control group was assessed. According to the data, lower zinc levels were associated with susceptibility to UTI, and therefore, zinc administration has been suggested [85].

Microbial infections are often associated with selenium deficiencies. The main physiological properties of this micronutrient are directly attributed to its presence within selenoproteins [11]. Selenium at a certain concentration was effective in preventing uropathogenic E. coli biofilm formation on urinary catheters. Further, the inhibitory effects were associated with a reduction in EPS production and gene expression of the bacteria. Additionally, at higher concentrations, selenium was effective in inactivating preformed bacterial biofilms on catheters within 3 days of incubation. These observations suggested that selenium could be potentially used in the control of bacterial biofilms on the catheters [86]. Also, it was shown that selenium-containing analogs of L-proline and L-cystine are effective in the treatment of UTI [87]. A study was conducted to compare the blood level of retinol and selenium in a person who suffered from minor lower urinary lesions. The results showed that there was a significant difference in the mean blood level of selenium between cases and control groups [88].

Copper, Cu, is an essential micronutrient for optimal innate immune function, and the nutritional deficiency of this element leads to increased susceptibility to bacterial infections [11]. During clinical UTI, uropathogenic E. coli upregulated the expression of copper efflux genes in patients. And, this element as a host effector could be involved in protection against pathogen colonization of the urinary tract [89]. Moreover, Cu export transport in bacteria has been addressed as an important virulence and fitness determinants during UTI [90]. Copper supplementation in drinking water has been suggested as an effective approach to reducing E. coli colonization in the urinary bladder of the animal model [91].

Other agents

Citrate salts could be used in the management of UTI due to their ability to alkalinize the urine, and alkaline urine is helpful for UTI symptoms such as dysuria. It was shown that by the administration of sodium citrate in women with UTI problems for 48 h, the symptoms were significantly improved in 80 percent of the subjects [92]. Additionally, alkalinity in the urine provides an effective environment for some of the antimicrobial agents such as uva-ursi and berberine to perform their function [37]. The role of these salts in the treatment of urinary candidiasis has been mentioned in an earlier study [93].

Simple sugars such as D-mannose could prevent the adherence of pathogens to uroepithelial cells. Various evidences show that the implementation of mannose exerts beneficial results in the treatment of UTI. It was shown that a mannose-specific lectin exists on the surface of adherent strains of E. coli and the sugar acts as the primary bladder cell receptor site for UPEC to bind [94]. Likewise, it was reported that in the adhesion of UPEC to the uroepithelial cells, the first step is the binding of FimH adhesin to the bladder epithelium through the interaction of mannose moieties with the host cell surface [95]. So, the use of the sugar or its analogs can help to block the adhesion of E. coli to the bladder epithelium. The efficacy of these sugars in controlling UTI has been studied previously [96,97,98].

An in vivo study indicated that demonstrated D-mannose in mice not only blocked adhesion of E. coli to the epithelium of the urinary tract but also prevent bacterial invasion and biofilm formation [99]. Also, in the presence of D-mannose, the adherence of clinical isolates of E. coli was inhibited remarkably [100]. Oral supplementation of D-mannose decreases the perception of lower urinary tract symptoms in postmenopausal women [101]. The results of another study indicated that D-mannose efficiently blocked the adhesive properties of all type 1 fimbriae-positive isolates of E. coli in low concentration, but did not show any bacteriostatic effects [102]. The results of another study demonstrated that antibiotic therapy in combination with long-term enrichment of the diet with D-mannose leads to prolongation of the inter-relapse period of uncomplicated UTI [97].

The effects of different derivatives of the sugar in the control of UTIs were studied. Klein et al. synthesized and evaluated the efficacy of these sugars in blocking bacterial-host interaction. Among them, para-substituted biphenyl derivative was the most effective agent in controlling UTIs. Following oral administration of this compound, bacterial numbers were reduced by twofold and fourfold in the urine and bladder, respectively [103].

Probiotics

Probiotics are living microorganisms which when administered in certain numbers exert a health benefit on the host [104]. The clinical efficacy of probiotics for adjunct treatment in the treatment of different gastrointestinal and urinary tract infections has been addressed previously [105]. They have demonstrated positive effects in the treatment and prevention of rotavirus diarrhea and alleviation of the antibiotic-associated intestinal adverse effects by recognizing the commensal microbiota and also restoration of the microbial ecosystem after an imbalance or infection [106]. Probiotics are clinically proven to be effective in the management of UTI including accelerating recovery after UTI and also decreasing recurrent UTI in children [107]. It must be emphasized that, for better effectiveness of probiotics, they must be able to colonize in the intestinal and/or urogenital region [108]. These positive effects of probiotics might be attributed to the intrinsic properties of microorganisms. For example, lactobacilli are able to grow in an environment with pH ≤ 4.5, where they could multiply and produce additional antibacterial molecules, such as bacteriocin and hydrogen peroxide [109, 110]. Besides these advantages, probiotics could produce biosurfactants that inhibit the growth of uropathogens by reducing the adhesion of the pathogens to the uroepithelium. Moreover, lactobacilli could co-aggregate with uropathogens and block their adhesion to the urinary tract and also displace previously adherent uropathogens from uroepithelium. This process can create a microenvironment in which the inhibitory products of lactobacilli can concentrate on the pathogens and therefore inhibit the pathogens [111]. It is worth noting that the most effective lactobacilli for controlling UTI are L. rhamnosus GR-1 and L. reuteri B-54 and RC-14 which have been proven [108].

The common vaginal Lactobacillus species were used to investigate the inhibition of E. coli growth. The results showed that when L. crispatus was incubated with clinical E. coli strains, the growth of E. coli was inhibited in the acidic environment [112]. Wolff et al. studied the changes in the ratio between uropathogens and Lactobacillus (U/L) within the lower UTI in response to oral probiotic supplementation. Based on the results, there were no changes between groups in terms of microbiota diversity and the use of oral probiotic did not alter the U/L ratio [113]. The physicochemical cell surface, adhesion properties, and the antagonistic activity of recombinant Lactococcus lactis containing the Ama r 2 gene against the E. coli causing UTI in humans were studied. The results indicated that this recombinant probiotic showed desirable properties and the Ama r 2 gene expression did not affect the positive probiotic properties [114].

The ability of a clinically isolated probiotic, L. fermentum strain 4–17, to adhere to human intestinal was studied. L. fermentum strain 4–17 showed appropriate anti-adhesive properties against human pathogenic bacteria [115].

Osset et al. [116] studied the antimicrobial activities of 15 Lactobacillus species against pathogens. Among them, L. crispatus could block pathogen adhesion efficiently.

The results of another study revealed that a pyelonephritic E. coli was sensitive to L. rhamnosus, Bifidobacterium lactis, and Bifidobacterium longus and these probiotics were able to suppress the growth of enteric and urinary pathogens [117].

Oral administration of multispecies probiotic formulations showed antimicrobial activities against the pathogens that are responsible for vaginal dysbiosis and infections [118].

The effects of vaginal suppositories of probiotics for the prevention and treatment of UTI have been studied previously. The concept for instilling probiotic into the vagina might be related to the belief that by the presence of probiotic as the dominant bacterium the ascension of uropathogens into the bladder was restricted by various mechanisms, such as interfering with pathogen adhesion, biofilm formation reduction, reducing the expression of virulence factors, and also modulation of the host’s defense systems to better combat infection [108]. The Lactobacillus strains inhibited the growth of E. coli via the production of organic acids. Additionally, the adhesion and internalization of E. coli into HeLa cells were reduced by probiotics [119]. Reid et al. investigated the effect of probiotic lactobacilli in controlling acute UTI in women. Based on the results, recurrence reduced remarkably in the Lactobacillus group compared to the placebo group [120].

Taken together, the results of these aforementioned studies demonstrated the potential benefit of probiotics in controlling UTI.

Additionally, site-oriented probiotic therapy has been recognized as one of the most promising therapeutic alternatives for the prevention of UTI in post-antibiotic therapy [112].

While most clinical research showed using these natural substances represents a promising approach, further studies are needed to prove their mechanism of action and clinical effectiveness. It should be noted that formulating these substances in a single dosage form and their side effects and interactions with each other are the main limitations of developing a new formulation.

Try These Simple Home Remedies for UTI: Natural Treatment for UTI

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One of the most common bacterial infections that women suffer from is urinary tract infection (UTI). When the bacteria found in the gut find their way into the urinary tract, it leads to this infection. The symptoms include frequent and painful urination, cloudy urine, diarrhoea and abdominal pain. While prescription drugs may resolve the issue, even home remedies work very well in this regard. The minor infections heal on their own in a few days, while the more serious ones might take a bit longer. Here are some home remedies for urinary tract infections.

1. Have Plenty of Water

Doctors recommend that this is one of the most effective home remedies for treating infections of the urinary tract. Depending on how much one can accommodate, to heal the infection, drinking two to four litres of water helps. As the body produces more urine, the bacteria get flushed out.

2. Urinate Frequently

Don’t hold in your urine as that leads to more bacterial multiplication in the bladder. Empty out the bladder often and as soon as the urge arises.

3. Cranberry Juice – Nips it in the Bud

Drinking cranberry juice is very beneficial in treating UTIs. Cranberry and its juice prevent the growth of E.Coli, the most common culprit that causes these infections.

4. Shun Bladder Irritants

Limit your intake of alcohol, caffeinated drinks, and colas when you have a bladder infection. The high amount of sugar in these drinks provide a perfect breeding ground for bacterial colonization.

5. Probiotics Are Your Friend

The good bacteria found in yoghurt and fermented foods provide a line of defence against the infection-causing bacteria. Eating probiotic-rich foods help to increase the body’s natural bacteria and wards off infections.

6. Wear Loose Clothes

Stay clean and dry by wearing loose-fitting, comfortable clothes. Wear clothes that let your skin breathe and avoid tight clothes. Avoid wearing nylon.

7. Sip on Green Tea

Green tea has an important compound, catechin that has antimicrobial properties. It also works as a diuretic so helps the body flush out the harmful bacteria.

8. Apple Cider Vinegar on an Empty Stomach

Add two tablespoons of apple cider vinegar in a glass of water and have on an empty stomach to ward off bladder infections. It is antibacterial and alkalizes the inner environment of the body.

9. Garlic Power

Allicin, one of the compounds found in raw garlic that stops the growth of harmful bacteria. You could have raw, crushed garlic or have garlic-infused water to stave off urinary infections. Also, read the health benefits of garlic.

10. Gorge on Citrus fruits

Vitamin C increases the acidity in the urine, thus limiting the growth of bladder infections causing bacteria. Also, it boosts immunity.

By following most of these remedies you will be able to treat your bladder infection at home without depending on antibiotics or other prescription drugs.

Also Read: UTI Causes, Symptoms & Treatment 

Disclaimer: The information included at this site is for educational purposes only and is not intended to be a substitute for medical treatment by a healthcare professional. Because of unique individual needs, the reader should consult their physician to determine the appropriateness of the information for the reader’s situation.

Efficient and Cost-Effective Alternative Treatment for Recurrent Urinary Tract Infections and Interstitial Cystitis in Women: A Two-Case Report

Urinary tract infections (UTIs) are among the most common bacterial infections affecting women. UTIs are primarily caused by Escherichia coli, which increases the likelihood of a recurrent infection. We encountered two cases of recurrent UTIs (rUTIs) with a positive E. coli culture, not improving with antibiotics due to the development of antibiotic resistance. An alternative therapeutic regimen based on parsley and garlic, L-arginine, probiotics, and cranberry tablets has been given. This regimen showed a significant health improvement and symptoms relief without recurrence for more than 12 months. In conclusion, the case supports the concept of using alternative medicine in treating rUTI and as a prophylaxis or in patients who had developed antibiotic resistance.

1. Introduction

The urinary tract is a sterile environment in healthy people and remains one of the most susceptible sites for bacterial infections [1]. About 50% of women experience a UTI compared to 12% for men, with a recurrence rate of 25% within 6–12 months [2, 3]. An uncomplicated UTI is one that does not progress to a severe disease in a normal host with no functional or anatomical abnormalities of the urinary tract, and its primary treatment is for symptomatic relief [4]. Furthermore, the predominant etiology of uncomplicated UTIs in young women is the uropathogenic Escherichia coli (UPEC), representing more than 80% of the cases and increasing the likelihood of a recurrent UTI [3, 5]. Recurrent UTIs are defined as two uncomplicated infections occurring within six months or 3 infections within one year after the treatment and complete resolution of the previous symptomatic infection [6]. Evidently, antibiotics are the most commonly prescribed treatment for UTIs, and those suffering from recurrent UTI are given low prophylactic antibiotic doses [7]. However, a major concern arises due to the increased rates of resistance to treatment of UTIs, which makes their management more challenging while seeking the use of more expensive and less effective drugs [8, 9].

This paper reports two cases of females who were treated with a regimen of dietary supplements after being diagnosed with recurrent UTIs resistant to most antibiotics and showed full healing.

2. Case  1

A 28-year-old female presents with a history of rUTI, which started at the age of 11. She suffered symptoms of severe constipation that she treated with herbal laxatives. She experienced episodes of fatigue, pubic pain, loss of appetite, malaise, dysuria, polyuria, urinary incontinence, and macroscopic hematuria. The frequency and severity of the symptoms increased with age, and its recurrence has shifted from occurring once every year to once every 2-3 months after she started having regular sexual intercourse. In addition, she suffered from dyspareunia and urgent urination that were aggravated after tampons usage. Pelvic ultrasound did not show any renal calculi or bladder enlargement, yet it revealed signs of interstitial cystitis.

Different antibiotics were given for treatment including ciprofloxacin (500 mg b.i.d), ofloxacin (200 mg b.i.d) or norfloxacin (400 mg b.i.d), cefuroxime (500 mg b.i.d), or amoxicillin/clavulanic acid (1 g b.i.d). Resistance was developed to these drugs and others were given aiming to prevent the recurrence such as nitrofurantoin (100 mg bid) and fosfomycin (3 g/day), to which she was sensitive. However, the symptoms of interstitial cystitis persisted despite the antibiotic therapy and the patient developed candidiasis that was resolved with fluconazole (150 mg) taken every 5 days after starting antibiotic treatment. Yet the patient became nonresponsive to fluconazole, which was substituted with itraconazole (100 mg bid every 2 days).

One year ago, she started an alternative medical treatment that included simultaneous intake of cranberry tablets (containing 700 mg cranberry extract conc Tit 1%, intake of proanthocyanidin 7 mg, grapefruit seeds dry extract 4/1 100 mg, Orthosiphon titrated dry extract 0.2% 100 mg, intake of sinensetin 0.2 mg, and goldenrod titrated dry extract 10/1 100 mg), probiotics (containing vitamin B1 0.42 mg, vitamin B2 0.48 mg, vitamin B6 0.6 mg, niacin 5.4 mg, vitamin B5 1.8 mg, vitamin B12 0.3 μg, and total milk enzymes: L. rhamnosus, L. acidophilus, Streptococcus thermophilus, Bifidobacterium bifidum, and L. bulgaricus, living cells not less than 2 billion), L-arginine (2 tablets/day, arginine hydrochloride 1000 mg in one serving capsule), and 1 tablet of magnesium at night (magnesium oxide 300 mg in each serving capsule). Following this regimen, the frequency and urgency to urinate decreased and UTI recurred after 2 month. Afterwards, she started taking garlic softgel tablets (serving size 2 softgels: garlic oil 4.6 mg, 500 : 1 concentrate equal to 2300 mg fresh garlic) and parsley seed oil tablets (110 μg, 2000 : 1 concentrate equal to 220 mg fresh parsley). These have shown a decrease in the UTI recurrence to 6-7 months and eventually no recurrence was recorded for the last 12 months. Moreover, the severity of recurrence has decreased and response to antibiotics has become more pronounced. Later when she discontinued garlic intake and became noncompliant to this treatment, UTI reappeared after 2 months.

3. Case  2

A 28-year-old female presented with the history of rUTI since the age of 23. The patient’s symptoms include burning sensations in the lower area with stabbing-like pain, urgency, and dysuria followed by hesitancy. The patient also reported a high frequency of urination, reaching 10 times/hr. In her first recurrent episode, urinalysis revealed pyuria (8–10 WBCs/hpf) and positive nitrites test and E. coli culture. Then, ciprofloxacin was prescribed (500 mg bid for 5 days) and she experienced 2-3 recurrence episodes with positive E. coli cultures. Later on, resistance to ciprofloxacin was developed with pelvic echogram and cystoscopy not showing any abnormality, while urinalysis showed persistent bacteriuria and cultures of E. coli resistant to fluoroquinolones.

Along with recurrent UTI over the years, interstitial cystitis also started in addition to chronic daily symptoms of overreactive bladder, urgency, frequency, and pubic pain. Nitrofurantoin (2 tablets/day) was prescribed along with fluvoxamine (1 tablet t.i.d.) to alleviate symptoms of overreactive bladder. Her previous history included no sexual activity for the last 4 years, persistent constipation, healthy diet and lifestyle, inadequate water intake, and the use of intimate perfumed washing gel fragranced, panty-liners and synthetic polyester lingerie, and back to front wiping hygiene.

With time the patient entered a depression due to the rUTI with persistent E. coli cultures and the chronic interstitial cystitis that remained untreatable. An alternative treatment regimen was prescribed and it included cranberry tablets (1 tablet t.i.d.), probiotics (1 tablet before breakfast and dinner), garlic and parsley (6 tablets at night), magnesium tablets (2 tablets 300 mg each at night), evening primrose oil (2 tablets after lunch), and L-arginine (500 mg, 1 tablet t.i.d.). Several weeks following this regimen, the patient’s symptoms including an overreactive bladder diminished, and urgency, frequency, and pubic pain decreased by 80%. Cultures remained negative and the patient experienced only one interstitial cystitis episode, which was alleviated with L-arginine (1000 mg), magnesium tablets, and sustained hydration.

4. Discussion

The failure of conventional antibiotic therapy to prevent and treat rUTI due to antibiotic resistance represents a major concern in clinical practice nowadays. Hence, alternative therapy has emerged to help many young women relief their symptoms, prevent the recurrence, and decrease the frequency of bacterial resistance [10]. In this study, we report an effective comprehensive, alternative therapeutic regimen for treating and preventing rUTIs, which are nonresponsive to most commonly used clinical protocols and guidelines.

For women suffering from rUTI, conventional management is based on low-dose antibiotic prophylaxis using trimethoprim-sulfamethoxazole (40 mg/200 mg daily), nitrofurantoin (100 mg/day), or cephalexin (250 mg daily) [11]. However, the use of trimethoprim-sulfamethoxazole is limited to patients with resistance rates not exceeding 20% and without allergy to sulfa drugs [5, 9]. However, these antibiotics have potentially fatal side effects, where nitrofurantoin may lead to respiratory distress and liver injury [9]. Additionally, the FDA has recently issued a new warning on fluoroquinolone intake due to its association with a permanent neuropathy and increased risk of retinal detachment [12]. The problem of antibiotic resistance is also on the rise since women with frequent recurrent infections and symptoms can self-initiate a 3-day regimen of antibiotics therapy without consulting a physician. Due to the increasing resistance of uropathogenic bacteria to different antibiotics, carbapenems and ertapenem remain the last line of defense that requires cautious use and are reserved only to cases of recurrent UTI due to ESBL strains of uropathogenic E. coli [13].

Several factors have contributed to the relative success of this treatment regimen. The significance of this regimen is attributed to the fact that the symptoms of UTI disappeared for a longer duration of time compared to previous recurrent UTIs in the described cases. As a result, this regimen may aid in decreasing the use of antibiotics among UTI patients along with the risk for developing resistance to antibiotics. The persistence of bacteriuria in the first case and its absence in the second case could be attributed to the serious compliance to the given regimen of the second patient over the other.

Furthermore, apigenin, the main component of parsley, was shown to possess diuretic effects in addition to anti-inflammatory properties, which are essential in the treatment of UTIs [14, 15]. Garlic in turn is well known for its antibacterial, antifungal, and antiviral properties, which are attributed to diallyl thiosulphate (allicin) and other sulfur containing compounds [16, 17]. Garlic also exhibits antioxidant, anti-inflammatory, and immune-modulatory effects that aid in the treatment of interstitial cystitis [18]. Very few studies have been conducted on the effect of garlic in the treatment of UTIs, but one study has revealed that garlic had a significant effect on attenuating the virulence of Pseudomonas aeruginosa in vivo, in an experimental UTI model [19]. Therefore, the combination of garlic oil and parsley in pills could have a synergistic effect on bacterial growth and proliferation. Moreover, cranberry contains significant amounts of D-mannose, which is able to adhere to the bladder epithelium, thus interfering with the adherence of E. coli and causing it to simply wash away during urination [20]. The importance of cranberry has been shown in a randomized clinical trial that demonstrated a decrease in UTI recurrence over a period of 6 months [21]. Besides, a recent study examined the use of cranberry pills as prophylaxis of rUTI in women and found that it reduced the recurrence rate to 1.1 per year, and it was the most cost-effective method of all other therapies tested [22].

During sexual activity, the urinary tract may be colonized by bacteria that move from the bowel or vagina [23]. Hence, oral probiotics preparations are used to help repopulate the normal flora in the GI tract. Probiotics are thought to aid the GI tract or vagina to resist invasion and adhesion of uropathogens, regulate intestinal flora, decrease constipation at the right doses, enhance the immune system, and increase the population of Lactobacillus that modulate local pH [24]. A Dutch double-blind trial has shown that a preparation containing Lactobacillus rhamnosus decreased antibiotic resistance as compared to trimethoprim-sulfamethoxazole [25]. Other studies have shown that Lactobacillus preparations restored and maintained the normal flora in women [26], increased the number of lactobacilli [27], improved vaginal health [28], and caused a relief from symptoms of UTI in women [29]. Hence, restoring a balanced microbial flora is essential in the presence of various UTI-promoting factors such as synthetic lingerie, intimate perfumed washing gel, and tampons. Besides, the aforementioned protocol has a component with anti-inflammatory activity, which makes it useful for both UTIs and cystitis.

The oxidation of L-arginine by nitric oxide synthase results in the formation of nitric oxide (NO), which exhibits antibacterial, smooth muscle relaxation, hormone releasing, and immune modulating properties [30]. Furthermore, a high concentration of NO can inhibit the growth of different microorganisms, decrease oxidative stress, and regulate and regenerate bladder uroepithelial cells, as well as alleviating and treating interstitial cystitis [31]. Thus, L-arginine can play an important role as a prophylaxis after treatment of UTIs to prevent the development of new infections as well as the treatment of an overreactive bladder. Alternatively, magnesium produces a double effect since it can aid in reducing constipation, hence decreasing the recurrence frequency, as well as relaxing the smooth muscle of the bladder leading to less frequent urination [10].

In light of the current common clinical outcomes of UTIs, the need for alternative therapeutic modalities to antibiotics has become more crucial, especially for rUTIs. In addition, the increased rate of hospitalization and its costs increases the risk of acquiring ESBL-producing E. coli that are resistant to several antibiotics [10]. The current alternative approach is a comprehensive regimen that can work effectively not only in prophylaxis but also in rUTI, due to its anti-inflammatory and bacteriostatic components. Hence, women having a first episode of acute UTI can follow this regimen to prevent future recurrence. Overall, this comprehensive treatment regimen can be initiated whenever symptoms reappear, with positive bacterial cultures, and L-arginine will be used particularly to relieve patients from overreactive bladder without conferring risk of pyelonephritis. This regimen can also be used alone or complementary to conventional treatment modality, and if the symptoms did not resolve within 3 days, patients can continue on a 7-day regimen along with antibiotics to decrease their urinary tract bacterial load.

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

Authors’ Contribution

Anthony Mansour and Essa Hariri contributed equally to this work.

UTI Home Remedies – the Most Searched vs. the Most Researched

If you’ve suffered from frequent UTIs, we’re guessing you’re no stranger to UTI home remedies. In fact, it’s almost impossible to avoid home remedies in a search for recurrent UTI treatment.

Article Quick Links

• The top 10 most searched UTI home remedies  >>>>
• D-mannose for UTI  >>>>
• Probiotics – oral and suppository  >>>>
• Oregano oil, yeast and UTI >>>>
• Vitamin C for UTI >>>> 
• Always research UTI natural remedies before you try them  >>>>

There Is No Single Natural UTI Remedy That Will Cure All UTIs

While we aren’t about conveying a message of good vs. bad when it comes to UTI treatment, we want to issue the same caution about UTI home remedies that we have for UTI antibiotics…

There is no single natural UTI remedy that will cure all UTIs.

The cause of your recurrent UTI is very unlikely to be the cause of the next person’s recurrent UTI. And the only way you can discover the cause of your UTIs is to seek accurate testing.

Only when you know what’s causing your UTIs, can you begin to look for the right treatment.

Don’t cherry pick UTI home remedies from forums just because an online stranger sounds very convincing.

Don’t find someone whose story sounds similar to yours and commit to the natural UTI remedy they swear by.

And think about this: If their UTI remedy works “every time” they get a UTI, but the UTIs keep coming back, there’s a good chance the remedy isn’t working. It may be relieving their symptoms, but it’s probably not addressing the chronic infection that’s causing their symptoms to return over and over again.

The goal of any UTI treatment should be to clear an underlying urinary tract infection permanently, not temporarily.

What Do We Know About UTI Home Remedies?

Unfortunately, there is a very real lack of studies around natural remedies for urinary tract infections.

Even those remedies that everyone has heard of struggle to be backed by credible evidence.

We just don’t know how most natural UTI remedies work or if they really work at all.

If you’ve ever wondered why doctors don’t often recommend natural remedies. This is the answer…

Without solid evidence, they can’t. Natural remedies are not included in evidence based treatment guidelines, because there isn’t enough evidence yet. So doctors not only don’t know if natural UTI remedies work, they also have no guidance on how you should take them.

It’s really important to note here…

Just because we don’t know IF many UTI home remedies work, it doesn’t mean they don’t work.

Consider This Before You Try A Home Remedy

Not knowing if or how something works comes with a set of problems you shouldn’t ignore:

1. Plants are made up of chemicals, just like everything else. Without studies to test these chemicals, we don’t know if they are safe short term or long term.
2. We often don’t know which organisms natural UTI remedies are effective against, if any.
3. We may not know how much to take, how often you should take it, or how long you need to take it for the best results.
4. The products are not standardized. How do you know if the particular product you buy is strong, or weak, or high or low quality? How do you even know it’s the product it says it is?

Studies into natural remedies is an area that requires urgent attention. We need answers to these questions.

There is plenty of evidence that some herbal compounds can be as or more effective than antibiotics in certain cases, but we don’t know if they work the same way on pathogens in the urinary tract.

If you use UTI home remedies, or are considering trying something, it pays to do a little research so you can make a more informed decision about what you’re putting into your body.

Although studies are lacking, you can often find helpful information online if you look in the right places. We’ll provide a few tips on what to look for below. But first, let us do some of the work for you.

You can also learn more about non-antibiotic UTI remedies that may help, in our expert video series.    

The 10 Most Searched UTI Home Remedies

So, we realize you’re probably used to seeing post after post about the top UTI home remedies.

That’s not what we’re about. I mean, the whole introduction was about how little evidence there is around most UTI home remedies, so recommending specific treatments would be kind of hypocritical.

Instead of pushing a list of remedies to try, we took a look at what people are searching for. We figured it would be more useful to find the ten most searched for UTI home remedies, then provide an overview of the evidence for each.

Just to clarify, when we say UTI home remedies, we are referring to any remedy you can self-administer without a prescription. This might be an over-the-counter pharmacy product, something you can order online, or ingredients you would typically find in your pantry.

Take a look at the research below, you might be surprised about some of the things you thought you knew. Then you can decide whether you want to go ahead with that purchase you were considering.

UTI Home Remedies People Search For Online

This is not a list of recommendations. This is a list of UTI home remedies that have gained enough attention to be searched online. Popularity is not the same as effectiveness:

1. D-Mannose
2. Cranberry
3. Probiotics
4. Uva Ursi / Bearberry
5. Wild Oregano Oil
6. Vitamin C
7. Pau D’Arco

We haven’t managed to find enough research into the following, so you won’t find more information on these below:

1. Baking Soda
2. Colloidal Silver
3. Apple Cider Vinegar

Pay no attention to the order above. Search volumes change all the time, but these are consistently among the top UTI home remedies people are looking for.

Again, this is not a list of recommendations.  

1. D-Mannose For UTI Treatment

D-mannose is a simple sugar (monosaccharide) found in a variety of fruits, plants and trees, but it also occurs naturally in some cells in the human body. It plays a crucial role in reactions involving certain proteins.

It is suggested that D-mannose, when used for urinary tract infections, may inhibit certain bacteria from sticking to bladder lining cells. If the bacteria cannot stick to the lining, they cannot colonize the bladder and cause an infection.

For this reason, D-mannose has rapidly gained popularity as a UTI home remedy. But does it work? We’ve looked into the science behind it and explained everything you need to know in an extended article.

Learn more about how D-mannose is thought to work, how much to take for UTI, and what to look out for: Read the full article about D-mannose.

Get in touch with us for more information about D-mannose products.

2. Cranberry For UTI Treatment

Cranberry, in different forms, is often touted as being effective in treating and preventing urinary tract infections. It has been used in folk medicine as an all-round urinary tract health supplement for centuries.

How Cranberry Works For UTIs

Previously, it was believed cranberry worked against UTIs by acidifying the urine due to its hippuric acid content. This effect has since been found to be insignificant.

It is now suggested that cranberry proanthocyanidins (PACs) at high enough concentrations, can inhibit some types of bacteria from sticking to the walls of the bladder.

Unfortunately, this substance is not found in high concentrations in cranberry products and this effect has also been found to be insignificant.

What The Cranberry Research Tells Us

There are numerous studies into the effectiveness of cranberry as a UTI home remedy. At least two of these studies have been funded by cranberry beverage brands, which raises questions over potential bias.

Even so, we have included one of these studies in the list, and you can read it if you so desire.

Cranberry studies:

1. Effect of Cranberry Capsules on Bacteriuria Plus Pyuria Among Older Women in Nursing Homes
2. Cranberries for preventing urinary tract infections
3. Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial
4. Consumption of a cranberry juice beverage lowered the number of clinical urinary tract infection episodes in women with a recent history or urinary tract infection *

*This study was funded by Ocean Spray

What was tested:

• Whether drinking cranberry juice decreases the chances of a recurrence of UTI.
• Evaluation of cranberry juice/concentrate, cranberry tablets and capsules when used to prevent urinary tract infections.
• The effectiveness of cranberry capsules on the presence of bacteria and white blood cells in the urine over a period of 1 year.

What was found:

• Although some small studies demonstrated a small benefit for recurrent UTIs, this was negated when larger studies were included.
• Many participants dropped out of trials because consuming cranberry products over long periods was undesirable.
• Cranberry capsules did not have a significant effect on the presence of bacteria or white blood cells in the urine of older females living in nursing homes.
• Drinking cranberry juice twice daily did not decrease the incidence of a second UTI among otherwise healthy college age females with an acute UTI.

What you need to know about cranberry:

• All the above mentioned studies tested cranberry products for the prevention of UTI.
• There have been no randomized clinical trials which assessed the effectiveness of cranberry juice for the treatment of UTIs.
• Other preparations (such as powders) need to be quantified using standardized methods to ensure the potency, before being evaluated in clinical studies or recommended for use.

Summary on cranberry for UTI:

• At present, there is no good quality evidence to suggest that any cranberry product is effective for the treatment of UTIs.
• Cranberry juice does not appear to have a significant benefit in preventing UTIs and may be unacceptable to consume in the long term.
• Currently, cranberry juice cannot be recommended for the prevention of UTIs.
• Cranberry products (such as tablets or capsules) were also ineffective in preventing UTI.

CONCLUSION: Cranberry products cannot be recommended for prevention or treatment of urinary tract infections. As far as UTI home remedies go, this one has little to back it.

UPDATE, 2020: The FDA has just released a statement after evaluating a petition by Ocean Spray to allow health claims to be made about cranberry products. The FDA found that limited and inconsistent scientific evidence exists to support health claims made about cranberry products and UTIs.

3. Probiotics For UTI Treatment

UTI home remedies aside, we all know that probiotics, or ‘good bacteria’ play a crucial role in gut health and immunity. Now, with the relatively recent discovery that the urinary tract is not sterile, research into how probiotics may help prevent urinary tract infections has picked up speed.

Not only that, but according to Dr. Krystal Thomas-White, our scientific advisor, probiotics have the potential to influence multiple organ systems through their effect on the intestinal tract.

How Probiotics Work For UTIs

The ways in which probiotics may help prevent infection of the urinary tract are still not fully understood.

Pathogens that cause infection in the urinary tract typically originate from the intestine, then colonize the entrance of the vagina and the opening of the urethra. From there, a UTI can escalate to the bladder and kidneys.

There are around 50 microbial species that inhabit the vaginal tract and hundreds found in bladders. These different species play an important role in the prevention of infection.

When the healthy balance is disrupted, it increases the susceptibility to colonization in the vagina and urinary tract by pathogens.

Specific species of probiotics can help restore beneficial levels of ‘good bacteria’ and make it more difficult for pathogens to multiply.

It is believed probiotics may help prevent infection in part by maintaining the optimal vaginal pH and by producing antimicrobials that kill pathogens.

They may also alter the surfaces of the vagina or bind to the pathogens themselves and reduce the ability of pathogens to adhere.

What The Probiotics Research Tells Us

Given the close relationship between vaginal flora and UTI, studies often cover both and you will note this in the results below. Studies have focussed on evaluating the use of oral probiotics, as well as probiotic vaginal pessaries, with some very promising results.

Probiotics studies:

1. Non-Antibiotic Prophylaxis for Urinary Tract Infections
2. Role of probiotics in urogenital healthcare
3. Vaginal Microbiota and the Use of Probiotics
4. Natural Approaches to Prevention and Treatment of Infections of the Lower Urinary Tract
5. Efficacy of Lactobacillus vaginal suppositories for the prevention of recurrent cystitis: A phase II clinical trial

What was tested:

• The effectiveness of different strains of probiotics on vaginal health
• Whether different strains of probiotics reduce the recurrence of UTI
• A comparison of the effectiveness of oral and vaginal probiotics

What was found:

• Specific Lactobacilli strains may prevent adherence, growth, and formation of uropathogenic bacteria.
• The use of vaginal pessaries with Lactobacillus crispatus in premenopausal females was associated with a significant reduction in recurrent UTI.
• Oral capsules with Lactobacillus rhamnosus and Lactobacillus reuteri in postmenopausal females are promising.
• Probiotics containing Lactobacillus rhamnosus and Lactobacillus fermentum were shown to normalize the vaginal flora, reduce recurrence of UTI, and may be a possible long-term therapy for pregnant females and those susceptible to UTI.
• Insertion of Lactobacilli into the vagina provides a better cure rate than using an antibiotic alone.
• For some females, up to 77%, episodes of recurrent UTI may be reduced for at least one year after discontinuing use of vaginal probiotics. 
• In vitro (outside of a living organism) studies have shown that Lactobacillus strains can disrupt bacterial vaginosis and yeast biofilms and inhibit the growth of urogenital pathogens.

What you need to know about probiotics:

• The abovementioned studies focussed on the prevention of UTI and the reduction of recurrence, rather than the treatment of UTI.
• As yet, there are no studies specifically evaluating the effectiveness of probiotics on bacterial biofilm infections of the bladder.
• The natural balance of vaginal flora differs between premenopausal and postmenopausal females and treatment options will therefore also differ.
• Different strains of probiotic work differently, and you cannot assume that all probiotic strains will have the same benefits.

Summary on probiotics for UTI:

• The mechanisms behind how lactobacilli function to prevent infection are still not fully understood.
• Specific strains of oral and vaginal probiotics have been shown to be effective in reducing the recurrence of UTI, and in restoring a healthy balance of vaginal flora.
• Further research is needed to confirm whether probiotics are effective as a treatment for recurrent UTIs.
• Studies are required into whether probiotics are useful for bacterial biofilm infections of the bladder.

CONCLUSION:  Probiotics are one of the most promising on our list of UTI home remedies. Vaginal pessaries with Lactobacillus crispatus and oral probiotics with Lactobacillus rhamnosus and Lactobacillus fermentum may significantly reduce recurrent UTI in premenopausal females. Oral probiotics with Lactobacillus rhamnosus and Lactobacillus reuteri may reduce recurrent UTI in postmenopausal females.

Get in touch for more information on how to find the right probiotics for UTI.

4. Uva Ursi / Bearberry For UTI Treatment

Arctostaphylos Uva ursi, also known as Bearberry, is an evergreen shrub that is mainly found in the Northern hemisphere. It produces red berries, however, only the leaves are used in herbal medicine.

Uva ursi is one of the most commonly used herbal treatments for UTIs and it is commercially available as crushed leaf or powder. Its high availability in some regions makes it one of the go to UTI home remedies for many.

How Uva Ursi Works For UTIs

Uva ursi works as an antimicrobial and has been shown to act against E.coli, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus and 70 other urinary tract bacteria. It is believed the antimicrobial action is due to arbutin and hydroquinone, constituents of Uva ursi. It also contains tannins that help to shrink and tighten mucous membranes, which in turn helps to reduce inflammation and fight infection. Importantly, arbutin is only released in alkaline urine, which means Uva ursi may have little benefit if the urine is acidic.

What The Uva Ursi / Bearberry Research Tells Us

As with most natural UTI remedies, the study into the effectiveness of Uva ursi is very limited. The following studies are by no means conclusive, and do not all specifically deal with urinary tract infections.

Uva ursi studies:

1. Prophylactic effect of UVA-E in women with recurrent cystitis: a preliminary report
2. Limited effectiveness of over-the-counter plant preparations used for the treatment of urinary tract infections as inhibitors of the urease activity from Staphylococcus saprophyticus
3. The urinary disinfectant effect of extract from leaves uva ursi. (Article in German)
4. Natural Approaches to Prevention and Treatment of Infections of the Lower Urinary Tract

What was tested:

• The effectiveness of standardized extracts of Uva ursi leaf and dandelion root and leaf for UTI prevention.
• Whether over the counter Uva ursi products can inhibit the multiplication of Staphylococcus saprophyticus, a urinary tract pathogen.
• The effect of Uva ursi dried leaf on healthy people.

What was found:

• Standardized extracts of Uva ursi leaf and dandelion root and leaf resulted in a significant reduction of UTI occurrences in females with chronic UTI.
• Uva ursi reduced the activity of Staphylococcus saprophyticus in a soluble solution and helped prevent the increase in pH that normally occurs due to bacterial activity.
• Consumption of Uva ursi dried leaf resulted in a significant amount of arbutin in the urine – a constituent of Uva ursi with antimicrobial activity.
• Uva ursi appears to have a diuretic and anti-inflammatory effect, greatly increasing urine output, which may assist in flushing pathogens from the urinary tract.

What you need to know about Uva ursi:

• Some constituents, such as hydroquinones, are toxic, and can cause serious liver damage. Many UTI home remedies come with potential risks.
• At present, there has only been one study that evaluated the effectiveness of Uva ursi for the prevention of UTI.
• As yet, there are no studies specifically evaluating the effectiveness of Uva ursi as a UTI treatment, or for use on bacterial biofilm infections of the bladder.

Summary on Uva ursi for UTI:

• Uva ursi may be helpful in the prevention of UTI.
• More research is needed to evaluate the effectiveness of Uva ursi in humans.

CONCLUSION: There is not enough evidence to recommend Uva ursi for the prevention of urinary tract infections, and as yet, there is no evidence to recommend Uva ursi for the treatment of urinary tract infections. More study is required.

FOR AUSTRALIAN READERS: Arbutin, a naturally occurring component of some herbs and food, is considered to be at levels too high in Uva ursi to meet requirements of the Therapeutic Goods Association (TGA). Due to this, Uva ursi is no longer available in any Australian medicines or supplements.

5. Wild Oregano Oil For UTI Treatment

Origanum vulgare or wild oregano oil belongs to the Lamiaceae family and is mainly found in Mediterranean countries. In terms of the rising popularity of particular UTI home remedies, oil of oregano is quickly moving up the list.

While there are many in vitro (outside a living organism) studies focussed on the antimicrobial activity of wild oregano oil, there are no studies that specifically evaluate the use of wild oregano oil for the treatment in humans or for the prevention of UTIs.

How Wild Oregano Oil Works For UTIs

The main components of wild oregano oil are the isomer phenols carvacrol and thymol. Carvacrol in particular has been the subject of numerous studies, as it has been demonstrated to have strong antimicrobial properties. The antibacterial activity of carvacrol has been put down to its effect on the structure and function of bacterial membranes. At high enough concentrations, carvacrol severely damages cells.

What The Wild Oregano Oil Research Tells Us

Although wild oregano oil has demonstrated strong antibacterial and antifungal properties, there have been no studies in humans to evaluate its effectiveness for the treatment or prevention of UTI.

Wild Oregano Oil studies:

1. The antibacterial activity of oregano essential oil (Origanum heracleoticum L.) against clinical strains of Escherichia coli and Pseudomonas aeruginosa
2. Antimicrobial Activity of Carvacrol: Current Progress and Future Prospectives 
3. Origanum vulgare essential oil affects pathogens causing vaginal infections
4. Sensitivity of Candida albicans to essential oils: are they an alternative to antifungal agents?

What was tested:

• The antibacterial activity of wild oregano oil.
• The activity of carvacrol (a constituent of wild oregano oil) against biofilm development.
• The antimicrobial and antifungal activity of carvacrol bearing essential oils.
• Wild oregano oil as an alternative antimicrobial agent against vaginal infections.
• The antifungal activity of wild oregano oil as compared to the most common antifungal drugs.

What was found:

In vitro (tested outside of a living organism)

• Oregano oil was active against all tested strains of E.coli and Pseudomonas aeruginosa, but strains of E.coli were more sensitive to the oil.
• Carvacrol was demonstrated to be effective against the usual biofilm development in S. aureus and S. enterica serovar Typhimurium, S. epidermis bacteria and candida species
• Escherichia coli 1, E. coli 2, Staphylococcus aureus 3 and Candida albicans isolated from vaginal infections were found to be susceptible to wild oregano oil.
• Wild oregano oil displayed greater antifungal activity than the most common antifungal drugs against Candida albicans.

In vivo (in-animal testing)

• When placed in the ear canal of rats, Carvacrol effectively treated infections of the middle ear caused by pneumococci or Hemophilus Influenza.
• Oral candidiasis (fungus) in immunosuppressed rats disappeared completely from the tongue mucosa in the animals treated with carvacrol.

What you need to know about oregano oil:

• As we’ve indicated, none of these studies were completed in humans. While the antimicrobial activity of wild oregano oil has been demonstrated in laboratory testing and in some animals, much more study is needed around its effectiveness and safety in humans.

Summary on oregano oil for UTI:

• The outcomes obtained by testing so far encourage further testing in humans.
• Testing for the effectiveness of wild oregano oil for treatment of UTI is required.
• The data reported above emphasize the potential of carvacrol as a new antimicrobial agent, with possible effectiveness for the treatment of biofilms.
• Carvacrol (found in wild oregano oil) appears to be an antimicrobial agent that could be useful for difficult-to-treat infections.

CONCLUSION: There is currently insufficient evidence to recommend the safe use of wild oregano oil to treat urinary tract infections. Further study is urgently required as this herb has demonstrated great potential for the treatment of a variety of illnesses and may be beneficial as a UTI home remedy.

6. Vitamin C For UTI

Most people are now familiar with Vitamin C and its place amongst possible UTI home remedies. It’s a dietary supplement most of us have taken at one time or another; it’s particularly renowned for boosting the immune system. But can it help for recurrent or chronic urinary tract infections?

At this point in time, with the research currently available, the best answer we can give is: maybe.

Vitamin C shows promise as a therapy for specific bacteria, and the mechanism by which it is thought to work is quite cool. In short, it may cause certain bacteria to eliminate themselves.

But if Vitamin C is potentially only helpful in some cases, how do you know when to try it?

We’ve collected relevant research on Vitamin C, and summarized it all for you in a handy guide that covers when Vitamin C may be helpful, and how to take it.

Learn everything you need to know about Vitamin C for urinary tract infections.

7. Pau D’Arco For UTI

Pau d’arco goes by many names, including its botanical names Tabebuia avellanedae and Tabebuia impetiginosa, and Lapacho, which is most often used to describe the tea made from its bark.

What we’re most interested in, is whether pau d’arco, by any name, benefits sufferers of recurrent UTI.

First, we looked to long established herbal medicine practices, and how pau d’arco has been used traditionally, then we looked to science.

While some studies have been conducted into potential benefits and antimicrobial activity, these have mainly been in vitro (outside the human body) or in mice. There are also side effects to consider.

Our findings highlight how little is known about pau d’arco, and how it acts in the body. What we did discover, we’ve summarized in our article on pau d’arco benefits for UTI, and how to take it.

Always Research UTI Natural Remedies Before You Try Them

While we are firm believers in a holistic approach to health, there are a number of reasons a scattered approach to UTI home remedies is unlikely to be effective…

1. Most UTI home remedies are not supported by scientific evidence (this doesn’t necessarily mean they don’t work, but we can’t be sure they do)
2. The lack of research around home remedies means dosage information is inadequate
3. Those remedies that have been studied often target a specific organism; one that may not be the cause of your UTI
4. The quality of many supplements is questionable, and thorough research is required before selecting an option.

Do Your Own UTI Research

You can sign up and personalize some of these, so they’ll send you any new information on topics you request.

It’s always a good idea to do a little reading about a product you’re thinking of taking. And if that reading is about the evidence to back a product, even better.

Be sure to read articles and studies with a grain of salt. Bear in mind that many studies are funded by the pharmaceutical companies that make the drug being tested, and the summarized material you end up seeing may be biased.

You can get a quick gauge of whether a research paper is interesting to you by reading the abstract, which is a brief overview of what you’ll find within the paper.

Sure, some of them are extremely complicated, but you can find some super interesting and helpful information out there.

By tracking research into non-antibiotic treatments for UTIs, we aim to enable you to make more informed decisions about how and when to use UTI home remedies.

You can also explore our expert video series to learn more about non-antibiotic alternatives as a chronic UTI treatment.

To get answers to commonly asked questions about chronic and recurrent UTI, visit our FAQ page. Share your questions and comments below, or get in touch with our team.

Natural Remedies for Bladder Infections and UTIs

Love to read? Enjoy the article below. Don’t have time? Click the player to listen.

Urinary tract, and especially bladder infections (cystitis) are super common – over half of us will have at least one at some point in our lives, up to 20% of all women have some urinary discomfort or a bladder infection every year, and as many as 20% of us gals will have a recurrence 6 months after a bladder infection. That’s a lot of bladder infections!

Bladder and kidney infections are both types of urinary tract infections. This article will focus on natural approaches to nipping bladder infections in the bud. I do not talk about kidney infections because they almost always require antibiotic treatment, whereas, mild common bladder infections often respond well to natural therapies. By treating bladder infections naturally, when possible, you can avoid the overuse of antibiotics which can wreak havoc on your gut and microbiome, and as a result over time, especially when you have to take them regularly for recurrent bladder infections, have a bigger impact on your health.

For a complete review of preventing bladder infections, you can read that article here. In the podcast above, I discuss both.

Bladder Infection Symptoms

The most common symptoms of a bladder infection are frequent (and sometimes terribly painful) urination, urgently needing to pee, aching, cramping, or pressure above the pubic bone (that bony ridge down low in the front of your belly), and feeling tired, unwell, or low energy (malaise). You might notice blood in your urine (or on your toilet tissue), something up to 40% of women with a bladder infection experience.

They can make you feel awful enough to have to miss work, and untreated, can progress into more serious kidney infections which can make you really sick.

In a bladder infection, symptoms usually come on pretty suddenly, and there is no fever with a bladder infection. In contrast, kidney infection symptoms generally come on gradually, and there is usually fever, chills, nausea, and low back pain. Antibiotics are important for kidney infections, but bladder infections in healthy adult women who are not pregnant can often be treated naturally.

In young, sexually active women, sudden onset of painful urination can also be due to chlamydia infection, or more rarely gonorrhea, so getting a urine culture that includes these tests is a good idea.

Vaginal yeast infections can also cause irritation of the urethra, leading to bladder-infection like symptoms, so consider this as a possible cause if you’ve been struggling with symptoms of a vaginal infection (itching, burning, thick or odorous vaginal discharge) and also consider getting a urine and vaginal culture done in this case if you’re not sure what’s going on.

Both in the prevention and treatment of UTI, the main goals are:

• support your body’s natural defenses against infection

• restore microflora balance and health
• promote bladder pH that is inhospitable to harmful bacteria
• prevent bacteria from adhering to the wall of the bladder

A Natural Approach to Bladder Infections

Herbal and nutritional remedies can be excellent alternatives to antibiotics for treating bladder infections and preventing them from recurring. They can help to kill off the harmful bacteria, reduce irritation and inflammation in the urinary tract, boost immunity, and restore healthy flora in the vagina and gut.

Below is the plan I have my patients follow at the onset of bladder infection symptoms. Each part of the plan is important – so don’t skip anything unless there’s something in the plan you know you don’t tolerate.

You can expect symptoms to start to improve after 12-24 hours, though they might initially get worse over the first few hours while treatment is kicking in. Symptoms should be significantly better in 24-72 hours, with complete resolution in 5 days. Because of the high recurrence rate of UTIs, I recommend following this plan for 1 week, after which I suggest you go to the prevention plan above for another week.

This treatment is NOT intended for pregnant women; please see my book The Natural Pregnancy Book for UTI in pregnancy. The plan below is safe while breastfeeding, but if you have a UTI in the few weeks after birth, please also see your midwife or doctor for appropriate recommendations.

General and Dietary Treatment

• Cut out all sugar in your diet for 5 days
• Drink 6 to 8 – 8 oz. glasses of water each day
• Urinate at first urge – don’t hold your urine!
• Avoid sex during treatment and for a few days after

Nutritional Supplements for Bladder Infections

• Take 4 probiotic capsules daily for 2 days, then 2 capsules daily for 5 days. The probiotic should contain Lactobacillus species, and if you have a vaginal infection as well, make sure it also contains Lactobacillus reuteri and rhamnosus
• Take 1000 mg. vitamin C every 4 hours for 2 days, then 500 mg. every 4 hours for 5 additional days

Herbal Remedies for Bladder Infections

• Drink 8 oz. of cranberry juice every 4 hours for 3-5 days, then 16 oz/day for a week,  or take Cranberry-d-mannose, 2 capsules twice daily, or if powder, 1 tsp. twice daily for 1 week, or take cranberry extract capsules 400 mg. every 2 hours for 48 hours, and then every 4 hours for 5 days
• The most effective herbal preparations for bladder infection are herbal infusions because they flush through the urinary tract. Here’s a simple and effective preparation: Mix 1/3 ounce each of uva ursi leaf, marshmallow root, and yarrow blossoms and place in a quart sized mason jar or a 4-cup French press. Steep for 1 hour then strain out the liquid or plunge the French press. Dose: 1/2 -1 cup every 4 hours, taken hot or cold. This preparation will keep refrigerated for 48 hours. You can get these herbs from Mountain Rose Herbs; I suggest ordering them overnight mail if you need them right away. Keep them on hand if you tend to get UTIs or
• If you don’t want to make this tea, you can use any of the following products instead: Cranberry Bladder Defense by Planetary Herbals, Cranberry ReLeaf by Herbs, Etc., Herb Pharm Urinary Support + Calm Waters, or Uva Ursi capsules + Marshmallow Root capsules by Nature’s Way. Take these products as directed on the package but take every 2 hours for the first 24 hours, then every 4 hours for the next 5 days.
• If you are experiencing spastic, cramping bladder pain, also take 30 drops of cramp bark tincture plus 30 drops of wild yam tincture and 5-10 drops of kava kava tincture (avoid the kava kava if you have any liver problems or are taking other medications) every 2-4 hours for the first 24 hours, and reduce to every 4-6 hours for the next 24 hours.

When to See Your Doctor & When to Use an Antibiotic

While natural self-care is incredibly empowering, my goal in providing this information is not to encourage you to avoid necessary antibiotics. But I do want you to have the information that can help you avoid rounds of unnecessary antibiotic treatment when a natural, effective approach is available. If you have fever, chills, and lower back pain, this is more likely to be a kidney infection, so see your doctor right away, and yes, antibiotics are appropriate. Similarly if you are pregnant and have a kidney infection antibiotics – and sometimes even hospitalization for IV antibiotic treatment — may be appropriate. If you are pregnant and have a bladder infection, unless you are working with a medical doctor or midwife truly skilled in the use of herbal and natural remedies, and sometimes even then so, a short course of antibiotics may be appropriate to avoid the risk of preterm labor or development of kidney infection, both of which can occur in pregnancy due to UTI.

For young girls (under 10 years old) with urinary tract infections, and when there is a kidney infection in any woman at any age, antibiotics are considered appropriate.

If you do require an antibiotic, take it along with a daily probiotic as discussed above to UTI treatment, and then continue the probiotic for 3 months after, along with starting the protocol above for UTI recurrence prevention.

Therapeutic potential of medicinal plants for the management of urinary tract infection: A systematic review – Shaheen – 2019 – Clinical and Experimental Pharmacology and Physiology

4.1 Prevention of UTI

Recurrent UTI may be prevented by identifying the causes and its prompt treatment (Figure 1). According to The National Institute for Health and Clinical Excellence guidelines, recurrent UTI may be prevented by curing constipation, improving the dysfunctional elimination syndromes and guiding the patients to drink more fluid so that bladder remains clean from the microorganisms.32

Alternative strategies to manage UTIs both in males and females. Data to reconstruct the figure were adopted and modified from different sources79-83

4.2 Prophylaxis

Urinary tract infection can be prevented in the following ways.

4.3 Post intercourse regimen

Some studies showed that only prophylactic antibiotics alone are not enough for the prevention of UTI in sexually active people. It is reported that if they use some drugs after intercourse, the infection may be prevented. The use of spermicidal cream containing nonoxynol-9 in combination with antibiotics is prescribed to prevent infection.33, 34

4.4 Topical treatment

Some topical creams are also used for the prevention of UTI especially the creams that contain povidone and iodine. These creams are antiseptic and used to suppress the inflammatory processes locally. Topical vaginal estriol prevents UTI in post-menopausal women by modifying the vaginal flora.35

4.5 Functional foods

Some foods can also play a preventive role in UTI such as cranberry juice; it has anti-adhering activity that inhibits E. coli from adhering the bladder walls.36 Meta-analysis showed that 35% decrease in infection had been found in females with recurrent UTI using cranberry for 12 months. McMurdo et al37 reported that cranberry extract (500 mg/kg) administered for 6 months decreased the UTI to the same level as the trimethoprim (100 mg). Sialic acid is found in cranberry extract that has anti-inflammatory and painkilling effect. It can assist in alleviating manifestations of UTI. Cranberry is not suggested in active UTI but is effective in decreasing the rate of recurrent UTI37 (Figure 1).

4.6 Vaccines

Vaccines for UTI have not been discovered properly until now. In some people, extracts of bacterial antigens were given orally for immunization against microorganism and the study results showed that it is good in stimulating the immune system and decreases the severity of infection.38 Some researchers used the extract of FimH to stimulate the immune system through vaginal application, but the results are not encouraging.39 No research on vaccines for UTI has reported reaching to phase III trials. No vaccine is more effective than antibiotic prophylaxis. Studies reported that the innate and adaptive immune responses to the microorganisms of UTI are responsible for the inflammatory action causing UTI by suppressing the innate immune system leading to the reduced cytokine production and neutrophils.40 Re-infection stimulates the specific T cells which are responsible for the immunity.41 A number of studies have been conducted to discover a vaccine for UTI but no valuable results have been achieved so far.42, 43 There is a dire need to conduct more studies for the development of the vaccine for UTI.

4.7 Immunoprophylaxis

Immunoprophylaxis plays an important role in the prevention of recurrent UTI, and these are taken through the oral route as an alternative to antibiotics. It was investigated that Uro-Vaxom E. coli extract (Terra-Laba, Zagreb, Croatia) as oral immune prophylaxis significantly prevents the UTI throughout more than 6 months.44 Furthermore, Schulman et al45 reported that the plants extracts are efficient; effective and tolerable for UTI treatment as well as decrease the use of antibiotic resulting in reduced rate of recurrent UTI.

4.8 Probiotics

Lactobacillus is a probiotic, well reported for the prevention of UTI and it may be given orally or vaginally. Lactobacilli create an unfavorable environment so that the urinary microorganisms cannot survive in urine.46 Scientists are now focusing on the role of probiotics in the management of UTI and have proven that it is beneficial against different microorganisms. It is observed that probiotics have a protective role in the UTI.47 Reid et al48 reported that probiotic Lactobacilli prevent the UTI by strengthening the immune system and decreasing the ascending rate of microorganisms from the rectum, therefore, can interact with colonization and survival of pathogens. Lactobacillus plantarum and Lactobacillus rhamnosus showed the anti-adherence activity of E. coli to gastrointestinal tract in vitro. This may be due to an increase in the production of mucin, which has a protective action on the epithelial cells, and it inhibits the adhesion of microorganisms. Another study showed that oral Lactobacillus rhamnosus (1 × 109 CFU/1 billion) and a Lactobacillus reuteri (1 × 109 CFU/1 billion) could recover the vaginal Lactobacillus 96% compared to 53% in controls49-53 (Figure 1).

4.9 Antibiotic treatments

The standard treatment of lower UTI is comprised of cotrimoxazole, amoxicillin, and nitrofurantoin. These drugs are prescribed for a single dose or a short course of 7–14 days. For upper UTI cotrimoxazole or amoxicillin are used for the short course of 7–14 days. For UTIs, the first treatment choice is antibiotics, but now the E. coli strains have become resistant to antibiotics worldwide. Currently, the combination of trimethoprim and sulfamethoxazole (TMP-SMX) is the standard treatment of UTI but the bacteria have become resistant to these drugs also, so quinolone antibiotics have now overtaken TMP-SMX as the choice to treat UTIs. Researchers predicted that resistance might develop to these drugs as well.54

Many studies have been conducted which showed that antibiotic prophylaxes greatly decreased the chances of infection. Antibiotics suppress the activity of microorganisms. Nitrofurantoin is a very effective antibiotic used for the prophylaxis of UTI because it suppresses the rectal flora. The results of this therapy are variable; sometimes it showed 100% results, but sometimes the patients suffered from UTI while having the antibiotic prophylaxis. The reason may be that some microorganisms are resistant to some antibiotics.55, 56

4.10 Medicinal plants

Medicinal plants have been used since ancient times, because they have beneficial effects, to treat and control various disorders.57 Due to fewer reported side effects, cost effectiveness, easy availability, lack of bacterial resistance and tolerance towards the patients with UTI even at the start of the 21st century, medicinal plants have gained more and more popularity as well as reliability worldwide.57 Moreover, 80% of the world population and more than 30% of pharmaceutical formulations are dependent upon medicinal plants, as reported by WHO.58 The exact mechanism of herbal medicines used to treat UTI is still not well understood due to lack of research, but it was reported that phytochemical constituents acted as nutraceuticals and immunomodulators, boost body oxidant status or provided antioxidant compounds, prevent attachment of microbes as well as halt the proliferation or multiplication of microorganisms and some might act as microcidal (Figure 1). These diverse properties of medicinal plants are due to the presence of various phytochemical constituents including alkaloids, anthraquinones, flavonoids, glycosides, phenols, saponins, steroids, sterols, tannins, terpenoids, triterpenoids, phytosterols, hydrocarbons, mono and sesquiterpenes, phlobatannins and many others medicinal plant secondary metabolites. Flowers, leaves, bark, fruit, seeds and even whole parts of medicinal plants were ingested to treat UTI and these parts or their extracts are consumed orally as sole preparation or might be mixed with different other foods or drinks like water, honey, milk, juices and black pepper etc. The dose of herbal preparations also depends upon sex, age and current health status of the patient.59 So, this review article will be helpful to find out natural remedies effective in the management and treatment of UTI. Some of the commonly used herbs with the main phytochemical constituents responsible for their effect are described below with their common name, family, botanical origin and functional use for the treatment of UTI and their mode of actions are given in Table 1.

Table 1.
Commonly used herbs for urinary tract infection

4.10.1

Vaccinium macrocarpon

Belongs to family Ericaceae. The common name is cranberry. It prevents the attachment of bacteria to uroepithelial cells. It contains catechin, anthocyanidin, flavanols, quercetin, myricetin and phenolics that are supposed to be responsible for such activities.23

4.10.2

Tribulus terrestris

It belongs to the family Zygophyllaceae. The common name is Kharkhasak, Gokhru. It is diuretic, anti-cancer, anthelmintic, antibacterial and aphrodisiac. It contains active constituents for therapeutic values such as gitogenin, chlorogenin, tribuloside, kaempferol, rhamnose, saponins, stigmasterol, β-sitosterol, neo-tigogenin, hecogenin, tribulosin, neohecogeninglucoside and cinnamic amide.60

4.10.3

Trachyspermum copticum

It belongs to family Apiaceae. The common name is Ajwain. It is antimicrobial due to terpinene, p-cymene, beta pinene, thymol, xylene, palmitic acid and oleic acid.61

4.10.4

Cinnamomum verum

It belongs to family Lauraceae. The common name is Dar chini, Cinnamon. It is antioxidant and antibacterial. It contains phytochemicals such as camphor, cinnamaldehyde, eugenol, trans-cinnamyl acetate and proanthocyanidins.62

4.10.5

Hybanthus enneaspermus

It belongs to family Violaceae. The common name is spade flower. It is antioxidant, antidiabetic and antibacterial. It contains flavonoids, phenolic, terpenes, alkaloids, phenols, saponins, anthraquinones, glycosides and tannins that possess therapeutic values.63

4.10.6

Phyllanthus amarus

It belongs to family Phyllanthaceae. The common name is Jangli Amli. It is hypoglycemic, hypotensive, diuretic and antibacterial. It contains tannins, flavonoids, triterpenoids, lignins, gallic acid, geraniin, corilagin, niranthin and phyllanthin.64

4.10.7

Moringa oleifera

It belongs to family Moringaceae. The common name is Sohanjna. It is antipyretic, anti-inflammatory, and antibacterial. It contains thiocarbamate glycoside, acetylated carbamate, amino acids, tocopherol, moringine, spirochin and kaempferol.65

4.10.8

Terminalia chebula

It belongs to family Combretaceae. The common name is Hareer, har. It is hypolipidemic, antibacterial. It contains chebulin, tannic acid, gallic acid, beta sitosterol, fatty acids and betulinic acid.66

4.10.9

Allium sativum

It belongs to family Amaryllidaceae. The common name is Lehsan. It is hypolipidemic and antimicrobial. It contains volatile oil, allicin, alliin, acrolein, phytocidin, diallyl-disulphide and diallyl-trisulfide.67

4.10.10

Ocimum sanctum

It belongs to family Lamiaceae. The common name is Tulsi. It is antibacterial, antipyretic, anti-inflammatory, analgesic and antipyretic. It contains flavonoids, polyphenol, flavonols, flavones, carnosic acid, beta sitosterol, luteolin, myrtenal, apigenin, rosmarinic acid, eugenol, vicenin and orintin.68

4.10.11

Zingiber officinale

It belongs to family Zingiberaceae. The common name is Adrak, Sondh. It is antibacterial, digestive and anti-inflammatory. It contains zingiberene, zingiberol, α-zingiberene, shogaols, gingerols and dihydroparadols.69

4.10.12

Boerhavia diffusa

It belongs to family Nyctaginaceae. The common name is Biskhapra. It is antibacterial, antioxidant and antidiabetic. It contains arachidic acid, behenic acid, saturated fatty acids, vitamins C, lignin, phenolics, steroids, glycosides and boeravinone B.70

4.10.13

Apium graveolens

It belongs to family Apiaceae. The common name is Celery seed. It is diuretic, antioxidant and anti-inflammatory. It contains succinic acid, beta sitosterol, falcarindiol, oplopandiol, lunularic acid, lunularin, 5,8-dimethoxy psoralen, trans-cinnamic acid, isofraxidin, trans-ferulic acid and eugenic acid.71

4.10.14

Arctium lappa

It belongs to family Asteraceae. The common name is Burdock. It is antimicrobial and diuretic. It contains arctigenin, arctiin, lignins, flavonoids, caffeoylquinic acid, cynarin, chlorogenic acid, caffeic acid, quercetin, quercitrin, luteolin and rhamnoside.72

4.10.15

Juniperus communis

It belongs to family Cupressaceae. The common name is Juniper. It is diuretic and antibacterial. It contains oxygenated sesquiterpene, monoterpene hydrocarbons, β-pinene, limonene, sabinene and myrcene.73

4.10.16

Mentha piperita

It belongs to family Lamiaceae. The common name is Peppermint. It is antispasmodic and antibacterial. It contains menthone, menthol, limone, menthofuran and pulegone.74

4.10.17

Taraxacum officinale

It belongs to family Asteraceae. The common name is Dandelion. It is diuretic and antibacterial. It contains nitriles, norisoprenoids, methyl branched aliphatic acids, phenylacetic acid and dehydrovomifoliol.73

Natural Urinary Tract Infection Remedies in Dogs

Herbal Remedies

There are several safe herbs to give your dog during the painful time of experiencing a urinary tract infection. There are several anti-inflammatory herbs readily available in your local health food store. Juniper berry helps to filter impurities in the kidneys causing the dog to urinate more and ridding the body of toxins which may cause the UTI or inflammation. Urva ursi is a natural astringent helping with any minor bleeding or inflammation. Parsley leaf is a diuretic which can also increase the production of urine helping the dog rid the body of toxins causing pain and inflammation. Marshmallow root is a herb which may help reduce the level of bacteria and minimize inflammation. 

Please be aware that herbal remedies can be toxic if provided in the wrong dose and it is important to consult your vet before considering them, as they may not be appropriate for your pet.

Diet Changes/Additions

Cranberry and blueberry are great preventive fruits which can be easily added to your dog’s diet to support their urinary tract. Many better quality dog foods will contain these ingredients already.

Apple cider vinegar can be added to your dog’s water bowl in small amounts and may ward off an infection. Balancing your dog’s pH levels can also be accomplished by adding fresh lemon juice to their water bowl. 

Feeding your dog a healthy diet

https://wagwalking.com/wellness/industry-changes-healthier-dog-food

 with high moisture content will also assist in cleaning out the urinary tract and keeping their system healthy. Always be sure to provide your dog with plenty of fresh drinking water. Flushing through their urinary tract regularly will be the best prevention your dog has against developing recurring urinary tract infections.

Supplements

Your veterinarian can recommend products to supplement your dog’s diet. Your local pet store may also have various products you can offer your dogs as treats or add to their meals to help prevent urinary tract infections. Most of these products will be natural supplements which include ingredients such as cranberry, echinacea, or other herbs to remedy inflammation within the dog’s urinary tract.

Time for Rest

If your dog is showing early signs of a urinary tract infection, you can begin natural treatment right away. While treating the UTI, be sure your dog gets plenty of rest and drinks lots of water. Keep your dog comfortable and calm, to help him recover quickly.

Bacterial cystitis, symptoms, course of the disease and treatment

Causes of the disease

Bacterial cystitis refers to uncomplicated lower urinary tract infections. This is a disease accompanied by inflammation of the mucous membrane of the bladder. In women of reproductive and premenopausal age, the disease occurs for the following reasons [30]:

• sexually active;
• frequent change of sexual partners;
• use of spermicides for contraception;
• violation of personal hygiene rules.

For older women, a risk factor is the presence of a previous UTI, atrophic vaginitis, bladder catheterization, and urinary incontinence. The risk of developing inflammation of the bladder increases significantly during pregnancy. [thirty]

In men, inflammation of the bladder mucosa, as a rule, does not develop on its own. It is usually preceded by complicated forms of UTI. For men, transmission from an infected sexual partner can be a risk factor.The causative agent of uncomplicated UTI is opportunistic pathogens such as Escherichia coli, Enterobacter, Klebsiella species, Staphylococcus saprophyticus, Proteus. [thirty]

Bacterial cystitis in women: symptoms, diagnosis and treatment

Often, the disease begins with a sudden, strong and frequent urge to urinate, and most often they are false. When urinating, patients have a burning sensation, cramps, pain. The amount of urine decreases, and at the end of the act of urination, blood drops may be observed.[7]

Discomfort in the pelvic area is a characteristic sign of inflammation. In some cases, there is an increase in body temperature, nausea, vomiting. Urine with cystitis usually becomes cloudy, acquires a pungent odor. One of the typical manifestations of the disease is also urinary incontinence and hematuria (the presence of red blood cells in the urine). [7, 30]

The presence of bacterial cystitis can be suspected on the basis of patient complaints, as well as data from the anamnesis.To determine the dominant pathogen, a bacteriological culture of urine is performed. [7]

It is especially advisable to conduct such a study with suspicion of pyelonephritis, atypical clinical picture and ineffectiveness of treatment. Bacteriological culture is necessary for complicated and recurrent inflammation of the bladder mucosa. [7]

With exacerbations of the disease after intercourse, a study of the bacteriological contents of the vagina is also carried out.This allows you to identify uropathogens, exclude sexually transmitted infections. [7]

Women with recurrent uncomplicated urinary tract infections are additionally assigned an ultrasound of the bladder to exclude malignant neoplasms, pelvic organ prolapse, and neurogenic bladder disorders. [thirty]

One of the most effective treatments for bacterial cystitis in women and men is antibiotic therapy. Uncomplicated bacterial cystitis is most commonly treated at home with empirical antibiotics.To reduce the intensity of the manifestation of the symptoms of the disease, an abundant drink and pain relievers are additionally prescribed. [7]

Recently, antibiotic resistance has been increasing in causative agents of cystitis, which greatly complicates the search for effective therapy. Therefore, doctors are forced to look for alternative treatments. [7]
Phytolysin ® herbal preparation for the treatment of cystitis

An herbal diuretic is widely used in the complex therapy of uncomplicated urinary tract infections.The use of phytopreparations in conjunction with short courses of antibiotics is especially important. [19]

Fitolysin® is available in a convenient form – a paste for preparing a suspension, which is absorbed much faster than tablets and delivers active substances to the inflammation focus [2]. It contains 9 plant extracts and 4 essential oils [6]. The components of the drug contain flavonoids, saponins, phytosterols, trace elements, vitamins. [26]

In the treatment of bacterial cystitis, the drug demonstrates a high degree of effectiveness due to its pronounced anti-inflammatory, antispasmodic, and diuretic effects [6].The herbal remedy for cystitis Fitolysin® has several advantages: a convenient form of release, a wide spectrum of action (relieves inflammation, reduces pain and spasms) [2, 5]. The presence of an international GMP certificate indicates that the drug is manufactured in accordance with the rules of good manufacturing practice [3].

An herbal diuretic increases urine output (urine volume), which is one of the key considerations in treating uncomplicated urinary tract infections. Studies show that the use of herbal diuretics, which include Phytolysin®, with antibiotics may be more effective than antibacterial monotherapy.[26]

How to treat urinary tract infections

What are urinary tract infections

Urinary tract infections ^{are inflammatory diseases that occur when microorganisms enter the urethra (urethritis), bladder (cystitis), ureters or kidneys (pyelonephritis). In women, these organs are affected 4 times more often than in men, but in the latter, the incidence increases after 50 years.}

How urinary tract infections occur

Inflammation is usually caused by E. coli, which lives in the rectum. In women, the opening of the urethra is located ^{close to the anus, so it becomes easily infected. And due to the fact that the urethra is short, germs quickly get to the bladder. The length of the urethra is also to blame for the fact that inflammation can be caused by sexually transmitted infections (STIs): chlamydia, gonorrhea, herpes or mycoplasma.}

In men, E. coli can also get ^{into the urethra from the rectum.But most often, inflammation develops in chronic prostatitis. The thing is that an enlarged prostate compresses the neck of the bladder and prevents it from emptying. Urine stagnates and creates conditions for the multiplication of bacteria and damage to the urinary organs.}

When the risk of developing an infection increases

Urinary tract infections are more likely to occur with the following factors ^:

• Frequent change of sexual partners. This makes you more likely to get an STI.
• Certain lubricated contraceptives. Condoms, diaphragms, or spermicides can spread bacteria to the vulva with vigorous friction.
• Menopause. Estrogens support the tone of the urinary tract, as well as the growth of normal vaginal microflora. In women, when menopause approaches, the synthesis of hormones decreases, so the urinary tract becomes more vulnerable to microorganisms.
• Kidney stones. They interfere with the flow of urine, which increases the risk of infection.
• Low immunity. For example, with diabetes mellitus, a pathology of the immune system, a person loses his natural defense against microbes.
• Developmental anomalies. In people with congenital malformations of the urinary system, urine may stagnate due to curvature or narrowing of the organs.
• Use of a urinary catheter. It is a thin tube that is passed through the urethra into the bladder of some bedridden patients. Germs can enter the catheter and cause inflammation.
• Operation on the urinary organs.During it, there is a risk of infection.

What are the symptoms of inflammation of different parts of the urinary tract

The disease is not always accompanied by visible signs. In some people, especially in old age, it is asymptomatic. But most people notice dysuric disorders in themselves. This is ^:

• Constant urge to urinate.
• Burning sensation when urinating.
• Frequent trips to the toilet, with very small portions of urine.
• Turbid urine with an unpleasant odor.
• The color of urine is red, pink or dark like cola. This is a sign of the appearance of blood.

Other symptoms depend on which part of the urinary system is inflamed.

Urethritis

This is the name of an infectious lesion of the urethra ^{. Usually accompanied only by dysuria. Sometimes there is discharge from the urethra. There is no fever and no malaise.}

Cystitis

This is an inflammation of the bladder. A person complains of pain in the pelvis or above the pubis, a feeling of discomfort, sometimes blood appears in the urine.But in general, this does not affect performance and activity.

Pyelonephritis

This is the name of the inflammation of the kidneys. A person complains of severe pain in the lumbar region or in the side, his body temperature rises, and chills appear. Sometimes pyelonephritis is accompanied by nausea and vomiting.

Why are urinary tract infections dangerous?

There can be several options ^:

• Transition to the chronic stage. Occurs when inflammation is not treated.The risk is higher if the person has had two similar cases in the past six months or four in a year.
• Kidney damage in pyelonephritis. Then acute or chronic renal failure develops, due to which you can even die.
• Formation of an abscess. In severe 9052 cases, a purulent focus may form near the kidney. And sometimes germs enter the bloodstream and cause sepsis, a deadly infection.
• Complications of pregnancy. If a woman has a urinary tract infection while carrying a baby, there is a risk that she will be born with a low birth weight or prematurely.
• Urethral stenosis. In men, frequent inflammation of the urethra leads to its narrowing due to the proliferation of connective tissue.

What to do if there are signs of urinary tract infection

You need to see a doctor. He can diagnose himself or refer him to a urologist.

To make an accurate diagnosis, doctors use the following examination methods ^:

• Urine analysis. White blood cells, red blood cells and bacteria can be found in it, and this will confirm the inflammation.
• Bacterial inoculation. Collected in a sterile container, urine is transferred into a dish with a special nutrient medium and colonies of bacteria are grown to determine what type they belong to and what antibiotics they are afraid of.
• Ultrasound, CT or MRI. Used to study the structure of the urinary organs.
• Cystoscopy. This is a method of examining the inside of the bladder using a thin, flexible tube with a video camera.

How urinary tract infections are treated

To kill bacteria, doctors ask ^{to drink antibiotics.And to reduce unpleasant symptoms, they may recommend over-the-counter pain relievers.}

In case of severe infections, you have to go to the hospital. In this case, antibacterial drugs are administered intravenously.

If urinary tract inflammation recurs frequently, your doctor may prescribe low-dose antibiotics for a six-month course of treatment.

Sexually active women are sometimes given a single dose of antibiotics after each intercourse. And during menopause, estrogen drugs may be needed.

How to avoid catching urinary tract infections

Doctors at the Mayo Clinic Research Center give these recommendations ^:

• Drink plenty of fluids, especially water. She will dilute the urine, going to the toilet will become more frequent, so bacteria will be flushed out of the urinary tract.
• Drink ^{cranberry juice. It changes the pH of the urine to an acidic side, so bacteria cannot multiply and the risk of infection in the urinary tract is reduced.}
• Observe hygiene. Wipe from front to back after urinating and defecating.
• Empty the bladder after intercourse. This will help flush out any bacteria that may have entered the urethra.
• Do not use cosmetics that irritate the skin and mucous membranes of the genital organs. Also, women are not advised to do douching or apply powders.
• Change your method of contraception. If diaphragms, lubricated condoms, or spermicides are causing a flare-up, it’s best to find another way to prevent pregnancy.

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Urolithiasis (Urolithiasis) – WMT High-Tech Clinic

Urolithiasis – the formation of stones in the organs of the urinary system. Stones can grow and be found in any part of the urinary system: in the kidneys, ureters, bladder and urethra.

WHAT ARE THE SYMPTOMS OF URINE STONE DISEASE?

With urolithiasis, patients almost always experience renal colic.They appear suddenly and do not diminish with physical activity, last from several hours to several days. The pain may be accompanied by nausea or vomiting.

Most patients have hematuria – an admixture of blood in the urine. With physical activity, hematuria increases. It is important to note that the color of urine will be red only if the urine flow from the kidney is not disturbed. If the stone blocks the urinary tract completely, the color of the urine will not change.

The most reliable sign of the presence of urolithiasis is the passage of stones or sand in the urine.After the stones have passed away, the pain syndrome decreases. Concrements up to 7 mm in diameter can leave the body on their own.

REASONS FOR THE DEVELOPMENT OF URELINE DISEASE

The formation of stones in the body occurs due to a change in the qualitative composition and amount of urine, due to a change in the acidity of urine, an increase in the concentration of salts and the precipitation of insoluble compounds.

Urolithiasis can be caused by various factors, they are divided into 3 large groups:

• Factors related to human behavior or the external environment:
  • Hot climate
  • Consumption of water with a high salt content
  • Drinking hard or salt water
  • Consumption of large quantities of spicy and sour food
  • Sedentary lifestyle
  • Harmful working conditions, etc.
• Internal factors:
  • Use of calcium supplements, for example, for bone fractures
  • Disruption of the production and functioning of enzyme systems
  • Diseases of the endocrine system: hyperparathyroidism, diabetes mellitus
  • Diseases of the digestive system: peptic ulcer, inflammatory diseases of the digestive system, dysfunction of the liver, etc.
• Changes in the organs of the urinary system:
  • Hydronephrosis – enlargement of the renal pelvis caused by impaired urinary outflow from the kidney
  • Pyelonephritis – inflammation of the renal tissue
  • Consequences of urinary tract infection
  • Nephroptosis – kidney prolapse
  • Kidney or abdominal injury
  • Benign prostatic hyperplasia, etc.

DIAGNOSTICS OF URELINE DISEASE

At the first examination, the doctor asks the patient to indicate the nature and duration of pain, their relationship with physical activity. Laboratory tests are mandatory: general and biochemical analysis of blood, urine.

The urologist determines the presence and location of stones using ultrasound diagnostics. However, not all stones can be detected by ultrasound, so computed tomography (CT) is done. The examination allows not only to detect the stone and its localization, but also to determine its density, shape, to assess the degree of urinary outflow disturbance.

TREATMENT OF URINE STONE DISEASES

For small stones up to 7 mm, doctors in most cases use conservative treatment. It includes stopping an attack of renal colic and therapy aimed at expanding the lumen of the ureter: relaxation of the muscle wall, physical activity, etc.

Surgical treatment includes several options:

• Lithotripsy – a method of crushing stones using different types of energy: laser, shock wave, ultrasonic.At the WMT clinic, urologists perform all types of lithotripsy.
• Transurethral operations. The doctor carries out crushing and removal of the stone through natural ways.
• Laparoscopic surgery. Operations, during which the doctor makes 2-3 punctures up to a centimeter in size, inserts a special device into the holes and crushes the stone with it. During laparoscopic surgery, the doctor can not only remove the stone, but also carry out reconstructive surgery.
• Open surgery – is used extremely rarely due to the emergence of minimally invasive operations with low trauma and rapid patient recovery.

RECORD ON RECEPTION

At the WMT Clinic, urologists select a treatment method that is suitable for a specific case of a specific patient. Five types of hardware installations and constantly practicing doctors make the treatment process comfortable, and recovery takes only 2-4 days.

Sign up for a consultation with the urologist of the WMT clinic by phone 8 (861) 206-03-03 or leave a request on the website.

90,000 Treatment of diseases of the urinary and reproductive systems in the sanatorium

Treatment of diseases of the urinary and reproductive systems in the sanatorium

We care about our guests and are taking action to combat the spread of the COVID-19 virus.We care about the safety of our guests.
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Large indoor pool 25m

Children up to 4 years old stay free of charge

Convenient location – 100 meters to the medical park and the pump room with mineral water

Free luggage delivery to the room

Daily animation program

VIP service in superior rooms

Unique treatment programs

The main factors that have a beneficial effect on patients with diseases of the kidneys and pelvic organs are mineral waters, thermal procedures and dietary nutrition.Such diseases often occur in a chronic form, periodically tormenting the patient with bouts of pain and reducing the quality of life. If you do not take action, this condition can result in serious complications. Therefore, many doctors recommend a spa treatment to their patients. And one of the best climatic and balneological resorts is the Shakhtar sanatorium in the city of Essentuki.

Indications for treatment in the sanatorium

All diseases of the kidneys and urinary tract respond well to treatment with mineral waters.They have a diuretic effect and are effective in chronic glomerulonephritis, pyelonephritis and cystitis, as well as in urolithiasis. Cleansing the kidneys and urinary tract from infection and inflammation, as well as normalizing mineral metabolism, these waters prevent the development of complications and reduce the number of exacerbations.

Treatment in a sanatorium is also effective for diseases of the reproductive organs. Special programs improve the condition of women with menstrual irregularities, inflammatory diseases of the genital organs, pathological menopause.Special techniques created by the specialists of the sanatorium help with some forms of infertility. Men are also shown treatment at the Shakhtar sanatorium. Here they can improve the condition of prostatitis, urethritis, cure erectile dysfunction and other sexual disorders.

Procedures applied at the Shakhtar sanatorium in Essentuki

In addition to mud and iodine-bromine baths, mineral showers and a special daily regimen, the treatment of diseases of the urinary and reproductive systems in the Shakhtar sanatorium is carried out using the following procedures:

• drinking mineral water, herbal teas, oxygen cocktails, “Biobacton” drink;
• magnetotherapy, laser therapy, electrophoresis;
• Remedial gymnastics, Nordic walking, water aerobics;
• mud rectal and vaginal tampons;
• massage.

After a course of treatment at the Shakhtar sanatorium, the quality of life of men and women improves, urination function is normalized and the functioning of the genitals is restored. If you are worried about any malfunctions in the pelvic organs, you need to come to the Shakhtar sanatorium. Here you will have a good rest and restore your health.

Spa programs

Program “Gastroenterological program”

Tours from 12 days

Prevention of relapses and exacerbations in chronic gastrointestinal diseases.

90,000 Urinary tract infections – bacteriuria, uncomplicated cystitis, pyelonephritis, urethritis, postcoital cystitis

Hello! Today we will talk about infections of the genital tract, namely: asymptomatic bacteriuria, uncomplicated cystitis and uncomplicated pyelonephritis.

Urinary tract infections are very relevant for urologists, as a practitioner is faced with a similar problem every day. When we talk about a urinary tract infection, we must say that there is an inflammatory process, but there are no clear signs of kidney disease.

If we are talking about bacteriuria (the presence of bacteria in the urine), then we must say that these bacteria are not only present in the urine, but also actively multiply.

Classification of infections

There are many classifications of urinary tract infections.

According to the European recommendation of urologists, there are complicated and uncomplicated urinary tract infection . The world famous Food and Drug Administration (FDA) also adheres to this classification.

Urinary tract infection, if we are talking about uncomplicated , implies the presence of an inflammatory process in the lower urinary tract – we are talking about cystitis, or the upper urinary tract – this is pyelonephritis in non-pregnant women without obvious signs of anatomical and functional changes from the outside organs of the urinary system.

If we are talking about complicated urinary tract infections , we must talk about all other infections. These are infections in pregnant women, in men, in persons with immunodeficiency, in patients with diabetes mellitus.

Also shared catheter-associated infection. It lies in the fact that this infection in humans occurs after catheterization for 72 hours, or against the background of the existing permanent drainage, catheter. This can be nephrostomy drainage, for example, installation of a pregnant woman for acute gestational pyelonephritis with impaired passage of urine.

Also isolated urosepsis . It is an acute condition associated with a life-threatening urinary tract infection in men with a catheter. This is due to multiple organ failure, hypotomy and tissue hypoxia.

Asymptomatic bacteriuria

Asymptomatic bacteriuria, or asymptomatic bacteriuria. This situation does not threaten humans, but the presence of bacteria is already commensal colonization. Asymptomatic bacteriuria protects against superinfection with virulent uropathogens.

* If we talk about the statistics and etiology of asymptomatic bacteriuria, asymptomatic bacteriuria is observed in 1% to 5% of all healthy premenopausal women.
* If we are talking about men or older women, then this figure rises to 19%.
* If we are talking about patients with diabetes mellitus, then this figure ranges from 0.7% to 27% of cases.
* If we are talking about spinal patients, then this figure ranges from 30% to 60% of cases.

Criteria for the diagnosis of asymptomatic bacteriuria

Asymptomatic bacteriuria is the presence of two positive tests for the presence of bacteria in the urine culture taken at intervals of 24 hours. At the same time, a clinically significant increase is 10 * 5 CFU / ml in the average portion of urine.

* If we are talking about men, then one portion of urine (also medium) is enough.
* If we say that culture for microbiological examination was taken
with the help of a certain urethral catheter, then the bacterial content in urine exceeding 10 * 3 CFU / ml is representative.

At the same time, asymptomatic bacteriuria on the part of ultrasound diagnostics has no characteristic changes. The maximum that we can see with adequate filling of the bladder (and this physiological capacity should correspond to at least 250-300 ml) is a kind of hyperechoic suspension. The thickness of the bladder wall is not increased and the upper urinary tract is not involved. That is, the kidneys do not have any changes on the part of ultrasound.

Endoscopic examination is not required for diagnosis.
X-rays are also not required for diagnosis.

In this diagnostic test, ultrasound examination of the bladder with determination of residual urine can be used to confirm asymptomatic bacteriuria.

The presence of residual urine can provoke the growth of microorganisms in the urinary system. Antibiotic therapy consists in the eradication of the pathogen.

If we are talking about asymptomatic bacteriuria in pregnant women, then this is a very important screening, and it must be recommended without fail.

Treatment of asymptomatic bacteriuria can reduce the risk of low birth weight and premature birth.

Treatment of asymptomatic bacteriuria

Today, there are several types of antibiotic therapy.

1. Monodose – use of the drug once, and this type of treatment is effective, however, there is scientific work that the use of a monodose can lead to the so-called birth of children with low body weight.This also requires evidence-based medicine, but such works exist.

2. Short course antibiotic therapy 2 to 7 days.

3. Long-term use of antibiotics from 8 to 14 days.

4. Continuous course is antibacterial therapy with the pathogen retained in a clinically significant titer and the presence of a threat from the fetus in that the inflammatory process
persists, and we cannot reduce it. That is, urine tests are not always
with severe leukocyturia and bacteriuria in a content of at least 10 * 5 CFU / ml.

Diabetes mellitus and asymptomatic bacteriuria

Diabetes mellitus (even compensated) increases the risk of the presence of asymptomatic bacteriuria. Moreover, untreated and asymptomatic bacteriuria cannot be the cause of diabetic nephropathy.

Screening with well-controlled diabetes mellitus for asymptomatic bacteriuria is not required.

Asymptomatic bacteriuria after catheter

What about the presence of inflammation in the tests in people with asymptomatic bacteria who are with an indwelling catheter? This is more typical for men after urinary retention.Antibiotic therapy in this situation is not indicated, since there is a biofilt on the simulators, which will constantly maintain the microbial mass.

If the patient has asymptomatic bacteriuria and complaints of urine odor with mild dysuria, the use of Urotropin may be recommended, plus drinking plenty of fluids.

Uncomplicated bacterial cystitis

Uncomplicated bacterial cystitis is an acute situation, either suddenly or recurrent after hypothermia in non-pregnant women of the premenopausal period.
Half of women worldwide have experienced uncomplicated cystitis at least once in their lives. Until the age of 24, at least one in three women could have cystitis.

Risk factors : sexual intercourse, use of spermicidal lubricants, change of sexual partner, urinary tract infection in childhood, the presence of an inflammatory process, the presence of cystitis in the mother.

The clinical diagnosis of is not straightforward, since it is based on complaints. This is an acute situation that has arisen, irregularities in the bladder and this is painful urination of a cutting nature, a burning sensation.

If a large volume of the bladder mucosa is affected by the area, an episode of hemorrhagic cystitis may occur, that is, blood impurities in the urine. In this situation, an endoscopic method for confirming acute uncomplicated cystitis is not required, cystoscopy is not required, and X-ray diagnostic methods are also not required.

Treatment: a short course of antibiotic therapy is prescribed.
If antibiotic therapy does not help, and the inflammatory process persists, in this situation, confirmation by microbiological studies of bacterial growth is required and antibiotic therapy should be carried out according to the results of culture.

Routes of origin:
* ascending route of infection – from the urethra;
* hematogenous – may occur after a respiratory illness. episodes of cystitis may occur.

Cystitis in pregnant women

Cystitis in pregnant women is no different from cystitis in non-pregnant women. Antibiotic therapy is carried out according to the antibiogram, but only we are forced to limit the range of prescribed antibiotics according to the state of pregnancy.

Recurrent urinary tract infection is a condition in which 2 recurrent episodes of the inflammatory process occur within 6 months, or 3 episodes within one year.

Risk factors for are the same as for uncomplicated urinary tract infection. This is an infection of the urinary tract in childhood, the presence of inflammation from the side of gynecology.
At the same time, we treat the inflammatory process and try to recommend treatment by a gynecologist, treatment of colpitis, candidiasis.

Urinary tract infections in postmenopausal women

If we are talking about urinary tract infections in postmenopausal women, it is important to mention conditions such as urinary incontinence, atrophic vaginitis due to estrogen deficiency, cystocele, residual urine.

Treatment is that there is always identification and elimination of risk factors, antimicrobial prophylaxis. Also,
treatment uses immunoactive prophylaxis, the use of drugs that increase the resistance and protective nature of the bladder mucosa.Interferons can be used, can be used to treat probiotics, preparations containing vitamin C, herbal preparations. The herbal preparation Kanefron, which is now prescribed to many, has proven itself well.

Uncomplicated pyelonephritis

Uncomplicated pyelonephritis – an acute situation of pain in the lumbar region on the affected side, with a sharp rise in body temperature to febrile digits and painful urination.This situation, if it is an uncomplicated form, can be treated on an outpatient basis.

Ultrasound examination of the urinary tract is coming to the fore in the diagnostics . A characteristic change in the inflammatory process is the edema of the renal parenchyma, a decrease in the echogenicity of the parenchyma. We must assess the impairment of adequate urine flow in the upper urinary tract. We look at the lack of expansion of the pelvis-pelvis system.
If the calyceal system is dilated, this is an obstructive situation in which we must assess the degree of dilatation.

With a slight expansion – 1-2 cm – can be done on an outpatient basis. If there is an expansion of more than 2 cm, even if it is associated with obstruction of the ureter by the pregnant uterus (in my practice, there was an obstruction of 5 cm), hospitalization is necessary here for the installation of internal drainage.

Inflammatory process in the kidney – to confirm the diagnosis, we can use magnetic resonance imaging, computed tomography. Magnetic resonance imaging is used in pregnant women.
Computed tomography is used to rule out the causes of obstruction, such as the presence of a stone anywhere in the ureter.

Microbiological studies of urine analysis are mandatory. In 90% of cases, intestinal flora can be diagnosed: these are Escherichia coli, enterococcus, klebsiella, staphylococcus, streptococcus, urease-producing microorganisms.

Treatment should always include adequate antibiotic therapy.There can be antibiotic prophylaxis and treatment for up to 14 days under the supervision of general health.

Basically, this is what I wanted to tell you.

Questions from ether patients

Question 1.
“Can chronic pyelonephritis affect an episode of non-developing pregnancy?”

We do not believe that chronic pyelonephritis can be the cause of an episode of missed pregnancy. Chronic pyelonephritis is a chronic condition.In this situation, it is a permanent focus of infection. Any provoking factor (it can be hypothermia, lack of adequate urination, when a woman suffers for a long time) can provoke the activity of this chronic pyelonephritis.
But chronic pyelonephritis cannot affect the missed pregnancy episode.

Question 2.
“How to distinguish cystitis from urethritis? Frequent attacks, constantly antibiotics.”

Very good question. Urethritis is an inflammatory process in the urethra.The urethra of a woman is different from that of a man. It has a shorter length (approximately 5 cm), the external opening of the urethra opens on the eve of the vagina in the area of ​​the adhesions of the labia minora, which can be the cause of the so-called ascending route of infection.

If we are talking about an urination disorder, then urethritis is more characterized by a burning sensation at the beginning of urination, and cystitis is characterized by discomfort in the lower abdomen, a violation of dysuria (urination) throughout the entire act.

Diagnostics.
The most typical inflammatory process after intercourse, we can prescribe a microbiological study – culture from the urethra. It is imperative to examine a woman for infections: ureaplasma, mycoplasma.

With cystitis, a genital infection can also be the cause, but most often, if we are talking about a bacterial form, it is Escherichia coli, enterococcus, staphylococcus, streptococcus, klebsiella.

Is it necessary to constantly take antibiotics in this situation? Here it is very important to determine the cause – what causes frequent attacks of the inflammatory process?

If we are talking about cystitis, then differential diagnosis of the uncomplicated form of cystitis and the interstitial form of cystitis is necessary – this is a lesion in the deeper layers of the bladder.This diagnosis requires diagnostic cystoscopy, up to a pinch biopsy, which determines the nature of this inflammatory process: ulcerative or non-ulcerative form.

To eliminate frequent episodes, intravesical instillations can be recommended – this is the use of hyaluronic acid preparations – chondroitin sulfate, which increases the function of the glycosaminoglycan layer and the bladder wall.

With regard to urethritis, in terms of the onset of the inflammatory process, a correct diagnosis is necessary.The cause may be a cyst of the urethra. It is very important that the woman is seen by a urologist. A polyp in the urethra can also cause urethritis. A very thorough diagnosis is also needed here.

I do not think that antibiotics are constantly needed, in each case it is necessary to understand individually.

Question 3.
“What recommendations would you give on the management of frequent postcoital cystitis?”

Very good question. Sexual intercourse should always be with an empty bladder.If you consciously approach this issue, hygiene measures should be observed, both men and women should urinate. It is possible to treat the genital tract with Miramistin, or with a 20% chlorhexidine solution. After completing intercourse, it is imperative to urinate.

There are recommendations that recurrent episodes of postcoital cystitis require exclusion of vaginal ectopia of the external opening of the urethra.

We can recommend the introduction of hyaluronic acid into the space between the urethra, which will allow the urethra to move away from the vagina, or some intervention methods – surgical – transposition of the urethra.That is, this situation will further minimize the risks of postcoital cystitis.

We also recommend vaginal delivery. If a child is born, he still moves the urethra a little bit. This allows you to achieve long-term remission of postcoital cystitis.

Do you need constant antibiotic therapy as a prophylaxis of postcoital cystitis?
There are many works on this topic. There are recommendations for antibiotic therapy for at least 3 days after intercourse.Someone recommends and within 2 weeks – that is, a long course of antibiotic therapy.
In each specific situation you need to understand individually, you need to look at the cause of postcoital cystitis.

Question 4.
“In childhood, the symptoms were acute cystitis, sometimes even with hematuria. The urine test is always good. How does this happen? As a result, the walls of the bladder are now thickened” .

Probably, here it is correct to speak about chronic cystitis, or interstitial cystitis.In this situation, it is very important to carry out endoscopic examination – diagnostic cystoscopy, if episodes of cystitis persist – up to
biopsies of the bladder wall.

If it was a one-time episode of cystitis with an admixture of blood, the so-called hematuric form of cystitis, and in the future it does not bother you, I do not think it is worthwhile to carry out a diagnostic cytoscopy with a biopsy.