• Urinary Tract Infection
Principal Proposed Natural Treatments
• Cranberry; Uva Ursi
Other Proposed Natural Treatments
• Buchu; Cleavers; Goldenseal; Goldenrod; Horseradish Combined With Nasturtium ; Juniper; Lapacho; Low-sugar Diet; Mannose; Methionine; Probiotics; Sandalwood; Vitamin C; Zinc
Bladder infections are a common problem for women, accounting for more than 6 million office visits each year. Men, because of the greater distance between their bladder and urethral opening, only rarely develop bladder infections.
The primary symptoms of a bladder infection are burning during urination, frequency of urination, and urgency to urinate, possibly accompanied by pain in the lower abdomen and cloudy or bloody urine. Occasionally, the infection spreads upward into the kidneys, producing symptoms such as intense back pain, high fever, chills, nausea, and diarrhea.
Conventional treatment for bladder infections consists of appropriate antibiotic treatment guided by urine culture. Women with frequent bladder infections may keep on hand a prescription for antibiotics to be used when symptoms arise. Some women may choose to take antibiotics continuously to prevent infection. Certain hygiene habits, such as showering before or urinating after oral sex or intercourse, are commonly said to be helpful, although this has not been proven.
Principal Proposed Natural Treatments
Women who do not want to use antibiotics may be able to find some help through the use of herbs. However, if symptoms do not improve or signs of a kidney infection develop, medical attention is essential to prevent serious complications.
Cranberry juice is commonly used to prevent bladder infections as well as to overcome low-level chronic infections. The cranberry plant is a close relative of the common blueberry. Native Americans used it both as food and as a treatment for bladder and kidney diseases. The Pilgrims learned about cranberry from local tribes and quickly adopted it for their own use. Subsequent physicians used it for bladder infections, for "bladder gravel," and to remove "blood toxins."
In the 1920s, researchers observed that drinking cranberry juice makes the urine more acidic. Because common urine infection bacteria, such as E. coli , dislike acidic surroundings, physicians concluded that they had discovered a scientific explanation for the traditional uses of cranberry. This discovery led to widespread medical use of cranberry juice for bladder infections. Cranberry fell out of favor after World War II, only to return in the 1960s as a self-treatment for bladder infections.
More recent research has revised the conclusions reached by scientists in the 1920s. It appears that cranberry's acidification of the urine is not likely to play an important role in the treatment of bladder infections; current research has instead focused on cranberry's apparent ability to interfere with the bacteria establishing a foothold on the bladder wall. 1-7,30 If the bacteria can't hold on, they will be washed out with the stream of urine. Studies suggest that in women who frequently develop bladder infections, bacteria have an especially easy time holding on to the bladder wall. 8 Thus, when taken regularly, cranberry juice might fix this problem and break the cycle of repeated infection.
The best evidence for the use of cranberry juice for preventing bladder infections comes from a 1-year, double-blind, placebo-controlled study of 150 sexually active women that compared placebo against both cranberry juice (8 ounces 3 times daily) and cranberry tablets. 9 The results showed that both forms of cranberry significantly reduced the number of episodes of bladder infections.
A double-blind study of 376 hospitalized seniors attempted to determine whether a low dose of cranberry juice cocktail would help prevent acute infections. 31 It failed to find benefit, most likely due to the minimal dosage of cranberry: only 10 ounces daily of cranberry juice cocktail . Furthermore, because of the low rate of infections, it would necessarily have been more difficult for this study to produce statistically significant results.
In addition, a year-long open trial of 150 women found that regular use of a cranberry juice/lingonberry combination reduced the rate of urinary tract infection as compared to a probiotic drink or no treatment. 12 However, because this study was not double-blind, the results are unreliable. (For more information on why double-blind studies are so important, see Why Does This Database Rely on Double-blind Studies? )
A review of 10 studies investigated the benefits of cranberry juice or tablets compared to a placebo control in patients susceptible to urinary tract infections. Among 1,049 participants, the researchers found the cranberry products reduced the incidence of urinary tract infections by 35%, a statistically significant amount, over a 12-month period. The effect was most notable in those with recurrent infections. However, many subjects dropped out of the studies early, suggesting that continuous consumption of cranberries is not well tolerated. 38
In another review, researchers analyzed 13 randomized trials involving 1,616 people prone to urinary tract infections (eg, elderly people, people with bladder problems, pregnant women). 41 In 9 out of the 13 trials, the subjects who consumed cranberry-containing products experienced a decrease in the incidents of urinary tract infections. Another review of 16 randomized or quasi-randomized trials with 3,109 people prone to urinary tract infection showed cranberry juice, tablets, or capsules did not significantly reduce the risk of symptomatic urinary tract infection compared to control (placebo, water, or no treatment), antibiotics, or methenamine hippurate. 43
On the negative side, three double-blind, placebo-controlled studies failed to find cranberry extract helpful for preventing bladder infection in people with bladder paralysis (neurogenic bladder). 11,32-33 However, a subsequent study of 47 patients with neurogenic bladder from spinal cord injuries found that the use of cranberry extract tablets over 6 months significantly reduced the risk of urinary tract infection. 39
A double-blind study evaluated cranberry juice cocktail for treatment of chronic bladder infections. 10 This trial followed 153 women with an average age of 78.5 years for a period of 6 months. Many women of this age group have what are called chronic asymptomatic bladder infections: signs of bacteria in the urine without any symptoms. Half of the participants were given 10 ounces per day of a standard commercial cranberry cocktail drink, the other a placebo drink prepared to look and taste the same. Both treatments contained the same amount of vitamin C to eliminate the possible effect of that supplement. Despite the weak preparation of cranberry used, the results showed that the treatment significantly reduced bacteria and white blood cells in the urine.
Uva ursi has a long history of use for urinary conditions in both America and Europe. Until the development of sulfa antibiotics, its principal active component, arbutin, was frequently prescribed by physicians as a treatment for bladder and kidney infections. It appears that the arbutin contained in uva ursi leaves is broken down in the intestine to another chemical, hydroquinone. This is altered a bit by the liver and then sent to the kidneys for excretion. 13 Hydroquinone then acts as an antiseptic in the bladder. (It is, however, potentially quite toxic.)
The European Scientific Cooperative on Phytotherapy (ESCOP) is a scientific organization assigned the task of harmonizing herb policy among European countries. ESCOP recommends uva ursi for "uncomplicated infections of the urinary tract such as cystitis when antibiotic treatment is not considered essential." 14
Despite this recommendation, surprisingly little research has been done on uva ursi. 15
Two studies evaluated the antibacterial power of the urine of people who were taking uva ursi and found activity against most major bacteria that infect the urinary tract. 16,17 While this is interesting, what is really needed is a double-blind trial to discover whether use of uva ursi actually helps people with urinary tract infections, and none have been done.
One study did evaluate uva ursi for prevention of bladder infections. This double-blind trial followed 57 women for 1 year. 18 Half were given a standardized dose of uva ursi (in combination with dandelion leaf, intended to promote urine flow), while the others received placebo. Over the course of the study, none of the women on uva ursi developed a bladder infection, whereas five of the untreated women did. However, this study is a bit of an aberration, because most experts do not believe that continuous treatment with uva ursi is a good idea.
As noted above, hydroquinone is toxic, and for this reason most experts recommend that uva ursi should not be used for more than a couple of weeks.
For more information, including dosage and safety issues, see the full Uva Ursi article.
Other Proposed Natural Treatments
Probiotics (friendly bacteria) have shown some promise for preventing bladder infections. The best results have been seen with an unusual type of of probiotic consisting of a harmless form of E. coli . 34 This double-blind trial enrolled 453 women with an ongoing bladdder infection at the beginning of the study. Participants received either the E. coli or placebo for 90 days, then went 3 months without treatment, and then received treatment again for the first ten days in months 7, 8, and 9. The results showed that as compared to placebo, use of the probiotic led to a 34% reduction of UTIs. However, other studies have failed to find benefit with the use of more common Lactobacillus probiotics. 29,40,42
A preliminary double-blind, placebo-controlled study published in 2007 tested a standardized combination of nasturtium and horseradish , and found some evidence that it might help prevent new bladder infections among people with a history of frequently recurrent bladder infections. 36 This study, however, suffered from numerous problems in design and statistical analysis.
The herb goldenseal is widely recommended for bladder infections, based on the antibiotic properties of its ingredient berberine. However, it is unlikely that goldenseal taken by mouth provides enough berberine in the bladder wall to have any effect.
Many nutritionally oriented physicians believe that regularly taking zinc supplements and decreasing sugar in the diet will help improve immunity against bladder infections. Herbs such as buchu , dandelion , goldenrod , juniper , cleaversparsley , and sandalwood may increase urine flow, which could be helpful for increasing speed of recovery from an infection that has already occurred. The herb lapacho and the supplement methionine are also sometimes recommended for bladder infections, but there is no real evidence that they work.
This topic is also discussed in the Homeopathy database, under the bladder infection chapter.
1. Sobota AE. Inhibition of bacterial adherence by cranberry juice: potential use for the treatment of urinary tract infections. J Urol. 1984;131:1013-1016.
2. Schmidt DR, Sobota AE. An examination of the anti-adherence activity of cranberry juice on urinary and nonurinary bacterial isolates. Microbios. 1988;55:173-181.
3. Zafriri D, Ofek I, Adar R, et al. Inhibitory activity of cranberry juice on adherence of type 1 and type P fimbriated Escherichia coli to eucaryotic cells. Antimicrob Agents Chemother. 1989;33:92-98.
4. Howell AB, Vorsa N, Marderosian AD, et al. Inhibition of the adherence of p-fimbriated Escherichia coli to uroepithelial-cell surfaces by proanthocyanidin extracts from cranberries [letter]. N Engl J Med. 1998;339:1085-1086.
5. Ofek I, Goldhar J, Zafriri D, et al. Anti-Escherichia coli adhesin activity of cranberry and blueberry juices [letter]. N Engl J Med. 1991;324:1599.
6. Howell AB, Vorsa N, Der Marderosian A, et al. Inhibition of the adherence of P-fimbriated Escherichia coli to uroepithelial-cell surfaces by proanthocyanidin extracts from cranberries [letter]. N Engl J Med. 1998;339:1085-1086.
7. Habash MB, Van der Mei HC, Busscher HJ, et al. The effect of water, ascorbic acid, and cranberry derived supplementation on human urine and uropathogen adhesion to silicone rubber. Can J Microbiol. 1999;45:691-694.
8. Schaeffer AJ. Recurrent urinary tract infections in the female patient. Urology. 1988;32(suppl 3):12-15.
9. Stothers L. A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Can J Urol. 2002;9:1558-1562.
10. Avorn J, Monane M, Gurwitz JH, et al. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. JAMA. 1994;271:751-754.
11. Schlager TA, Anderson S, Trudell J, et al. Effect of cranberry juice on bacteriuria in children with neurogenic bladder receiving intermittent catheterization. J Pediatr. 1999;135:698-702.
12. Kontiokari T, Sundqvist K, Nuutinen M, et al. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ. 2001;322:1-5.
13. Frohne VD. The urinary disinfectant effect of extract from leaves uva ursi [in German; English abstract]. Planta Med. 1970;18:1-25.
14. European Scientific Cooperative on Phytotherapy. Uvae Ursi folium (bearberry leaf). Exeter, UK: ESCOP. 1996-1997:1. Monographs on the Medicinal Uses of Plant Drugs, Fascicule 5.
15. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physicians' Guide to Herbal Medicine. 3rd ed. Berlin, Germany: Springer-Verlag; 1998:223.
16. European Scientific Cooperative on Phytotherapy. Uvae Ursi folium (bearberry leaf). Exeter, UK: ESCOP. 1996-1997:2. Monographs on the Medicinal Uses of Plant Drugs, Fascicule 5.
17. Kedzia B, Wrocinski T, Mrugasiewicz K, et al. Antibacterial action of urine containing arbutin metabolic products [in Polish; English abstract]. Med Dosw Mikrobiol. 1975;27:305-314.
18. Larsson B, Jonasson A, Fianu S. Prophylactic effect of UVA-E in women with recurrent cystitis: a preliminary report. Curr Ther Res. 1993;53:441-443.
29. Kontiokari T, Sundqvist K, Nuutinen M, et al. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ. 2001;322:1-5.
30. Di Martino P, Agniel R, David K et al. Reduction of Escherichia coli adherence to uroepithelial bladder cells after consumption of cranberry juice: a double-blind randomized placebo-controlled cross-over trial. World J Urol. 2006 Jan 6. [Epub ahead of print]
31. McMurdo ME, Bissett LY, Price RJ, et al. Does ingestion of cranberry juice reduce symptomatic urinary tract infections in older people in hospital? A double-blind, placebo-controlled trial. Age Ageing. 2005;34:256-261.
32. Waites KB, Canupp KC, Armstrong S, et al. Effect of cranberry extract on bacteriuria and pyuria in persons with neurogenic bladder secondary to spinal cord injury. J Spinal Cord Med. 2004;27:35-40.
33. Linsenmeyer TA, Harrison B, Oakley A, et al. Evaluation of cranberry supplement for reduction of urinary tract infections in individuals with neurogenic bladders secondary to spinal cord injury. A prospective, double-blinded, placebo-controlled, crossover study. SCI Nurs. 2005;22:20-25.
34. Bauer HW, Alloussi S, Egger G, et al. A Long-Term, Multicenter, Double-Blind Study of an Escherichia Coli Extract (OM-89) in Female Patients with Recurrent Urinary Tract Infections. Eur Urol. 2005;47:542-548.
35. Ochoa-Brust GJ, Fernandez AR, Villanueva-Ruiz GJ, et al. Daily intake of 100 mg ascorbic acid as urinary tract infection prophylactic agent during pregnancy. Acta Obstet Gynecol Scand. 2007;86:783-787.
36. Albrecht U, Goos KH, Schneider B. A randomised, double-blind, placebo-controlled trial of a herbal medicinal product containing Tropaeoli majoris herba (nasturtium) and Armoraciae rusticanae radix (horseradish) for the prophylactic treatment of patients with chronically recurrent lower urinary tract infections. Curr Med Res Opin. 2007 Aug 24. [Epub ahead of print]
37. Michaels E, Chmiel J, Plotkin B, Schaeffer A. Effect of D-mannose and D-glucose on Escherichia coli bacteriuria in rats. Urol Res. 1983;11:97-102.
38. Jepson R, Craig J. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2008;CD001321.
39. Hess MJ, Hess PE, Sullivan MR, et al. Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal cord injured patients with neurogenic bladder. Spinal Cord. 2008 Apr 8.
40. Barrons R, Tassone D. Use of Lactobacillus probiotics for bacterial genitourinary infections in women: a review. Clin Ther. 2008;30:453-468.
41. Wang CH, Fang CC, Chen NC, et al. Cranberry-containing products for prevention of urinary tract infections in susceptible populations: a systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2012 ;172(13):988-996.
42. Beerepoot MA, Ter Riet G, Nys S, et al. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med. 2012;172(9):704-712.
43. Jepson RG, Williams G, Craig, JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev . 2012;CD001321.
Last reviewed August 2013 by EBSCO CAM Review Board
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright (C) 2011 EBSCO Publishing. All rights reserved.