Bladder Infections – Natural Treatments for UTIs

Urinary tract infections (UTIs) are the second most common infection among adults and account for more than 8 million visits to health care practitioners each year¹. The bacteria Escherichia coli cause most UTIs, but other bacteria can also cause the infection (Table 1). Antibiotic drugs are routinely prescribed for bladder infections. However, there are side-effects associated with the use of antibiotics and their overuse leads to the emergence of drug-resistant bacteria. Therefore, effective alternatives to antibiotic drugs are needed. The following natural treatments for UTIs can be used in conjunction with antibiotics and may offer a safe alternative to antibiotics for many sufferers of UTIs.

Caution: Always consult your healthcare provider if your UTI is associated with serious symptoms (e.g., fever, back pain, significant blood in the urine) or if the infection persists for more than a few days without improvement.

Table 1. Most common bacteria causing UTI ^2,3

1. Drink More Water

One of the simplest natural treatments for UTIs is to drink more water. People who drink less than 1 L of water per day are about 7% more likely to experience UTIs, compared to those who drink more than 1 L of water per day⁵. Furthermore, increasing water intake alone decreases the risk of primary UTIs by 45%⁴.

How does drinking more water work?

In general, stagnant water is a breeding ground for bugs and bacteria. This fact generalizes to the urinary tract.  Drinking more water increases the volume of urine and frequency of voiding; it helps to “flush out” the bacteria that cause UTIs.  A recent study showed that increasing water intake deprives bacteria of adequate nutrition and reduces their growth⁶.

How much water should I drink?

Although no research studies have determined the optimal amount of water to prevent UTIs, consuming at least 2-3 L of water per day should be sufficient. More water may be required if you are in a hot climate and losing water through sweating.  Make sure your urine is pale yellow or almost clear.  The darker the urine, the more dehydrated you are.

2. Bearberry – The Urinary Antiseptic

Long before the advent of antibiotics, a small bush called bearberry was used for centuries as a natural treatment for UTIs. Herbalists use bearberry leaves as a urinary antiseptic to treat bladder and sexually transmitted infections⁷. Research shows bearberry is effective in inhibiting the growth of two bacteria (Escherichia coli and Enterococcus faecalis) that cause UTIs.

Bearberry

How does bearberry work?

Bearberry contains arbutin which is a toxic hydroquinone molecule attached to a sugar. The addition of the sugar to hydroquinone forms the molecule arbutin, and the sugar helps to stabilize hydroquinone. Arbutin acts like a “trap” for some bacteria: the sugar attracts the bacteria and when the bacteria digest the sugar, they release the toxic hydroquinone that generates free radicals and disrupts cell membranes. The bacteria Enterococcus faecalis⁸ and E. coli⁹ appear to be susceptible to arbutin, but not all bacteria are vulnerable.  Therefore, bearberry will not work for all types of infections.

How do I take bearberry?

The active ingredients dissolve in water and alcohol so both teas and tinctures can be used.

• Tincture: 2-4 mL three times per day.
• Tea (dried herb): three times per day

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 Caution: Bearberry is considered safe when used as indicated¹⁰.  However, it should be avoided during lactation and pregnancy because its safety has not been established.  Also, it should not be used for more than 1-2 months because arbutin releases hydroquinone in the acidic environment of the stomach and, in theory, could increase the risk of stomach cancer. 

3. Cranberries – The Anti-Adhesive Herb

Cranberry juice is probably the most well-known home remedy for bladder infections.  Research suggests its use may benefit people suffering from UTIs caused by E. coli ^11,12, Enterococcus faecalis ¹³, Pseudomonas aeruginosa ^14,15, and Proteus mirabilis ^12,16,17.

Cranberries

How do cranberries work?

Cranberries inhibit the enzymatic activity^11,13 and motility of certain bacteria^16,18,19. In particular, cranberries exert anti-adhesive effects^20–22 and prevent certain bacteria from attaching to the cells of the urinary tract.  Both sugars ^23–26 (e.g., mannose) and phenolic compounds^29–31, especially the anthocyanidins, contribute to the anti-adhesive effects. Furthermore, the anthocyanidins are reported to limit nutrients for bacteria, leading to growth inhibition^27,28.

Cranberries in different forms are beneficial in preventing the occurrence and recurrence of UTIs in various populations^32–40. Cranberries reduced urinary tract infections after surgery by roughly 50%⁴¹, even among patients with catheters⁴². Cranberry juice is also effective in preventing UTIs after renal transplantation⁴³. Antibiotics may also be used for the prevention of UTIs, however, a recent study showed that certain antibiotics have very little advantage over cranberry extracts and those using antibiotics are more prone to adverse effects⁴⁴.

Note: some studies failed to show cranberry’s effectiveness in preventing UTIs ^27,45–51.  This could be explained by too low a dose of cranberry anthocyanidins and that some bacteria may not be susceptible to cranberry extract.

How do I take cranberries?

Cranberries can be consumed as the fruit, pills/capsules, powder, or juice.  It is important that an extract contains a high concentration of the anthocyanidins.

• Unsweetened cranberry juice: 120-240 mL/day³²
• Capsules: 2 caps/day (containing 36 mg of anthocyanidins)
• Cranberry fruit powder (500 mg/day) ³⁷
• Dried cranberry: 42 mg/day ³⁴

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Note: When taking a cranberry supplement be certain to purchase from a reputable company that standardizes the product.  A recent survey showed certain berry products (including cranberries) did not contain the desired herb and/or the dose of the anthocyanin was variable⁵².

4. Goldenseal – The Natural Antibiotic

Goldenseal has a long history of use in herbal medicine as a natural antibiotic.  It is used primarily for respiratory and digestive infections but it is also used as a natural treatment for UTIs and sexually transmitted infections ⁵³.

Goldenseal

How does goldenseal work?

Goldenseal contains several antibacterial compounds, including berberine and hydrastine, that disrupt DNA synthesis in bacteria thus inhibiting their growth⁵⁴. In addition, goldenseal contains other phytochemicals that inhibit drug resistance.  Studies demonstrate that goldenseal and/or berberine have activity against several bacteria that cause UTIs including Escherichia coli⁵⁵,  Enterococcus faecalis⁵⁶, Chlamydia⁵⁷, Neisseria gonorrhea⁵⁸.

How do I take goldenseal?

The active compounds in goldenseal are soluble is alcohol but only sparingly soluble in water.  Therefore alcohol extracts, called tinctures, are the best way to take it.

• Tincture (1:5 60% Alcohol): 1 mL  3 times a day

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5. D-Mannose

D-Mannose is a unique sugar found in small amounts in certain fruits, including cranberries and apples. Human studies demonstrate that D-mannose powder reduces the risk of recurrent UTIs^59,60. Moreover, it reduces UTI symptoms including bladder pain and urinary urgency.

 How does D-Mannose work?

Like cranberries, D-mannose has anti-adhesive properties. D-mannose reduces infection by Escherichia coli by preventing attachment of the bacteria to cells of the urinary tract^61,62. The surfaces of urinary cells have receptors with mannose sugars attached.  Bacteria must attach to these receptors before they can infect the cells.  D-mannose prevents attachment by covering the “hands” of the bacteria so they can not grab a hold of the urinary tract and therefore are flushed out with the urine.

How do I take D-mannose?

• D-mannose (powder): 2-3 g/day dissolved in 200 mL water^61,62.

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6. Juniper

Juniper berries

Juniper berries have long been used as a flavouring in food and drink, including gin. Herbalists use the berries for digestive and urinary issues.  In particular, juniper is used as one of the natural treatments for UTIs and also sexually transmitted infection.

How does juniper work?

Juniper berries are rich in essential oils, including terpinen-4-ol, that demonstrate broad spectrum anti-bacterial activity⁶³. These essential oils enhance the effects of antibiotics⁶³.   Furthermore, juniper acts as a diuretic to increase urine production and may help flush of the bacteria⁶⁴.

How do I take juniper?

Essential oils are soluble in alcohol and thus herbal tinctures are appropriate:

• Tincture (1:5 in 40% EtOH): 0.5-1 mL three times a day.

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7. Probiotics

Probiotics should be considered a useful and safe alternative to antibiotics for preventing UTIs⁶⁵.  Limited studies are available ^66,67 but results show that prophylactic probiotic supplementation could reduce the development of kidney infections in children^68,69. Probiotics also reduce UTIs in patients after surgery ⁷⁰. Moreover, research with children shows the addition of probiotics to prophylactic antibiotics treatment is safe and more effective in reducing the incidence of serious UTIs in comparison to antibiotics alone^71,72.

How do probiotics work to prevent UTIs?

Probiotics are “good bacteria” that are used to support the digestive tract. They are different than other natural treatments for UTIs because they are living organisms that improve the gut flora. The bacteria that cause urinary tract infection usually reside in the bowels and typically migrate to the urinary tract and cause infection.  Probiotics (e.g., Lactobacilli) release chemicals (lactic acid) that inhibit the growth of disease-causing bacteria ⁷³ and thus prevent infecton⁷⁴.

How do I take probiotics?

Probiotics alone are not an effective natural treatment for UTIs but can be taken long-term to prevent UTIs.  Probiotics are available in both capsules and powders.  The precise strains and amount of probiotics have not been determined.  Presumably, 30-50 billion CFU mixed strains with Lactobacilli should suffice.

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8. Vitamin D

Although Vitamin D is usually associated with strong bones, it some cased it may help prevent UTIs. Vitamin D deficiency increases the risk of UTIs in various populations^75–77. This led to present research to determine if vitamin D supplementation will lead to a decrease in UTI occurrence and recurrence ⁷⁸.

How does Vitamin D work?

A peptide known as cathelicidin is an important antimicrobial peptide found in the urinary tract. Several studies have shown that vitamin D stimulates cathelicidin expression, thus preventing urinary tract infection in vitro ⁷⁹. But this was not evident among humans^80,81. Furthermore, vitamin D modulates the immune system ⁸² to fight off infections caused by Escherichia coli⁸³. The occurrence of UTIs was found to be lower among those who take vitamin D⁸¹. On contrary, vitamin D supplementation increases the risk of UTIs in infants less than 3 months of age⁸⁴.

How do I take Vitamin D?

Research suggests an intake of 20,000 IU per week of vitamin D3 was found to reduce the occurrence of UTI in adults.

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Summary of Natural Treatments for UTIs

Natural treatments for UTIs can work by different mechanisms.  Drinking more water, taking diuretic herbs (e.g., juniper and bearberry) and anti-adherence therapies (e.g., cranberry and mannose) help flush bacteria from the urinary tract.  Urinary antiseptics (e.g., bearberry and juniper) and natural antibiotics (e.g., goldenseal) compromise bacterial membranes and inhibit bacterial enzymes respectively, thereby inhibiting bacterial growth. Probiotics compete with pathogenic bacteria to reduce the colonization of disease causing bacteria in the gut.  Finally, vitamin D appears to boost the immune system to help the body to fight off infections.   In summary, employing multiple natural treatments for UTIs that work by different mechanisms may be the best strategy to both prevent and treat bladder infections.

Author & Photographer: Matt Gowan, BSc, ND
All images are copyright of Matt Gowan ©2017

Disclaimer: This content is subject to change. The information is intended to inform and educate; it does not replace the medical evaluation, advice, diagnosis or treatment by a healthcare professional. www.nhpassist.com © 2017 NDAssist Inc. and/or its affiliates. All rights reserved.