Prevention of Urinary Tract Infections (UTIs)

Urinary tract infections (UTIs) are some of the most common infections (1). Although anyone can get a UTI, women are more susceptible because they have shorter urethras, which makes it easier for bacteria to ascend into the bladder. At least 60% of women experience a lower urinary tract infection (involving the urethra and bladder) during their lifetime (2). Occasionally, lower UTIs spread to the upper urinary tract (involving the ureters and kidneys). Upper UTIs are more difficult to treat, and have the potential to turn into sepsis (infection of the bloodstream). For this reason, many medical professionals recommend treatment with antibiotics for lower UTIs, before they have a chance to progress (3).

The Importance of UTI Prevention

Many physicians recommend that their patients take certain precautions to prevent UTIs from recurring. Preventative measures are especially important during pregnancy, because recurrent infections are very common (4, 5). Moreover, even asymptomatic UTIs can be extremely dangerous to unborn babies, potentially resulting in premature birth and permanent conditions such as cerebral palsy (CP) or even death. For this reason, doctors should not only recommend preventative measures, but also screen pregnant patients for UTIs and provide prompt treatment if one is detected (for more information on UTIs during pregnancy, click here).

Risk Factors for UTIs

There are many other characteristics that increase the risk for recurrent UTIs, and may necessitate preventative steps. The following are just a few examples:

  • Age (children, the elderly)
  • Young women who are sexually active
  • Men who have sex with men
  • Spinal cord injuries
  • Neuropathic bladders (bladder dysfunction caused by neurological damage)
  • Multiple sclerosis
  • Certain types of cancer
  • Diabetes mellitus
  • Kidney problems
  • Use of urinary catheters (3, 6, 7, 8)

There are numerous means of preventing UTIs, with variable amounts of evidence to back them up. Here, we’ll cover some of the most frequently discussed preventative strategies and treatments.

Preventing UTIs with Medication

Some people with recurrent UTIs take medications in order to prevent them. Depending on individual circumstances, doctors may recommend the following:

  • A single dose of antibiotics taken after sexual activity
  • A low dose of antibiotics or antiseptic taken every day
  • Self-started antibiotics (patients with recurrent UTIs may be prescribed antibiotics that they can take at the onset of symptoms)
  • Vaginal estrogen therapy (9, 10, 11)

Medications to prevent UTIs are usually prescribed after other preventative measures do not work. Although medication may involve more side effects than other strategies, for some patients, it may be necessary in order to prevent recurrent UTIs.

Preventing UTIs Through Dietary Methods

Drinking Water to Prevent UTIs

Drinking water is one of the simplest, cheapest ways to prevent UTIs. Drinking a lot of water will result in more frequent urination, which helps flush bad bacteria out of the urinary tract (12). There is also evidence to back this up: one study of premenopausal women revealed that drinking more water decreases the chance of having a UTI by 48%. In an article for Medscape, Dr. John L. Brusch notes that, “If the urine appears any darker than a very pale yellow, this means not enough liquid is being ingested; increase the fluid intake” (9). Being well-hydrated has numerous other health benefits in addition to UTI prevention, and lacks side effects.

Cranberries/PACs to Prevent UTIs

Drinking unsweetened cranberry juice is one of the most popular strategies for preventing (or even curing, in some cases) UTIs. Cranberries contain a substance called A-type proanthocyanidins (PACs), which can prevent bacteria from adhering to the walls of the bladder. However, it seems unlikely that cranberry juice has a high enough concentration of PACs to be effective. Experts say that success with this method is likely due, at least in part, to improved hydration (13). In other words, drinking more water could have the same effect.

Although more research is needed, preliminary work suggests that there may be certain supplements that do have sufficiently high doses of PACs. A 2016 Cochrane review notes that, “More studies of cranberry capsules or tablets containing PAC amounting at least 36 mg/d, quantified using a standard measure, and taken twice daily may be warranted but potentially only for women with recurrent UTIs” (6). A supplement called Ellura contains this amount, and has been used in research on appropriate dosages (14).  Further studies will elucidate indications for taking Ellura and similar supplements.

D-Mannose to Prevent UTIs

D-mannose is a type of sugar that may help to prevent or treat UTIs. Once it moves into the urinary tract, it can bind to E.coli, preventing the E.coli from infecting cells. Although more research is needed on the appropriate doses of D-mannose for preventing and treating UTIs, preliminary studies suggest that this method can be effective. However, it is important to note that D-mannose is a sugar, and therefore may have some negative side effects. It is especially important for people with diabetes to consult a doctor before taking D-mannose (15).

Probiotics to Prevent UTIs

Probiotics are microorganisms (or “good bacteria”) that can be consumed for health benefits. Some studies have suggested that probiotics can stop infectious bacteria from ascending the urinary tract and prevent UTIs from occuring. However, more research is needed on dosages, types of probiotics that actually work, etc (16, 17).  

Other Dietary Methods

People may be more able to resist bacterial growth leading to UTIs if their urine has a high pH, and if they have higher levels of important metabolites formed in the gut. Diet can influence both urine pH and metabolite production. Calcium supplements and alkalizing agents can be used to raise urine pH, and foods that are high in antioxidants (examples include berries, tea, and dark chocolate) can help with metabolite production (18).

Preventing UTIs Through Hygiene Practices

Although people who practice good hygiene may still struggle with recurrent UTIs, there are certain hygiene-related precautions that can lower the risk. Dr. Brusch recommends the following:

  • Wiping from front to back after using the bathroom
  • Avoiding wiping twice with the same toilet paper/tissue
  • Showering instead of taking baths – sitting in a tub, especially for a prolonged period of time, can allow bacteria to migrate into the bladder
  • Washing from front to back in the shower
  • People with severe, recurrent UTIs may consider sterilizing washcloths. For instructions on how to do this, please click here.
  • Using tampons instead of sanitary napkins/pads. Tampons keep the bladder opening dryer, which prevents bacterial overgrowth (9). However, it is important to note that tampons pose the risk of toxic shock syndrome (TSS), and must be used as instructed (19).  
  • Urinating frequently. This will help flush bad bacteria out of the body before it has a chance to multiply (9).
  • Avoiding irritation of the genital area with allergens (such as feminine deodorant sprays, bubble bath, vaginal creams, soaps, etc). These could change bacterial makeup and increase the risk of a UTI (4).
  • Wearing loose-fitting underwear made of breathable material (cotton is often recommended). This will help prevent moisture from accumulating and leading to bacterial overgrowth (9).

Preventing UTIs: Sexual Activities

Sexual activity is a major cause of UTIs (8, 20, 21, 22).  Fortunately, there are several precautions that can help to reduce the risk:

  • Cleaning the genital area before and after sex (but avoid irritating cleaning substances)
  • Urinating after intercourse. It may also be a good idea to drink two extra glasses of water.
  • Avoiding spermicidal jelly. In addition to killing sperm, this kills healthy vaginal bacteria, which can make it easier for infectious bacteria to multiply (9). Diaphragms and vaginal douching can also increase the risk of developing a UTI (4).
  • Taking a urinary antiseptic or antibiotic after sexual activity, as recommended by a physician (see “Medications”)

Preventing UTI Through Acupuncture

Some evidence indicates that acupuncture may help to prevent UTIs in adult women (23, 24). This may be due to reductions in “residual urine,” which refers to urine that remains in the bladder after urination (24).

Conclusion

There are many different methods for preventing UTIs. Some have strong evidence backing them up, while others are still require rigorous research. If you have recurrent UTIs and are wondering which of these methods (or other strategies not outlined here) may be right for you, please consult a doctor near you.

Sources

  1. CDC – Urinary Tract Infection
  2. Clinics – Cranberries and lower urinary tract infection prevention
  3. Healthline – Everything You Need to Know About Urinary Tract Infection
  4. Sultan Qaboos Univ Med J – Recurrent Urinary Tract Infections Management in Women
  5. American Family Physician – Asymptomatic Bacteriuria in Adults
  6. Cochrane – Cranberries for preventing urinary tract infections (Review)
  7. Urological Science – Prevention and treatment of complicated urinary tract infection
  8. The Lancet – Urinary-tract infection in sexually active homosexual men
  9. Medscape – Prevention of Urinary Tract Infection (UTI) in Women
  10. Mayo Clinic – Urinary Tract Infection (UTI)
  11. American Family Physician – Recurrent Urinary Tract Infections in Women: Diagnosis and Management
  12. Healthline – Water Can Reduce UTI Risk… If You Drink 6 Glasses a Day
  13. Jama Internal Medicine – Cranberry-Containing Products for Prevention of Urinary Tract Infections in Susceptible Populations
  14. BMC Infectious Diseases – Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study
  15. Healthline – Can D-Mannose Treat or Prevent UTIs?
  16. UpToDateRecurrent urinary tract infection in women
  17. Cochrane – Probiotics for preventing urinary tract infections in adults and children
  18. Time – Your Diet May Be Causing Your Urinary Tract Infections
  19. Emedicinehealth – Toxic Shock Syndrome
  20. Am J Public Health – Epidemiology of urinary tract infection: I. Diaphragm use and sexual intercourse.
  21. NEJMA Prospective Study of Risk Factors for Symptomatic Urinary Tract Infection in Young Women
  22. J Gen Intern Med – Sexual Intercourse and Risk of Symptomatic Urinary Tract Infection in Post-Menopausal Women
  23. Clinical Infectious Diseases – Recurrent Urinary Tract Infections Among Women: Comparative Effectiveness of 5 Prevention and Management Strategies Using a Markov Chain Monte Carlo Model
  24. Am J Public Health – Acupuncture Treatment in the Prevention of Uncomplicated Recurrent Lower Urinary Tract Infections in Adult Women

 

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