Urinary tract infection in women
Urinary tract infections (UTIs) are caused by bacteria and are 10 times more common among women than men. More than 50% of women will have at least one UTI during their lifetime. Most of these infections require treatment with antibiotics. About 30% to 40% of UTIs recur within 6 months after the initial episode. When UTIs do recur, it is often because the treatments used to suppress bacteria seem to work at first, but they do not produce a lasting cure. UTIs can also recur if a woman is infected by different bacteria.
Signs and Symptoms
Symptoms of UTIs include:
- Pain or burning during urination
- The need to urinate more often than usual
- A feeling of urgency during urination
- Blood or pus in the urine
- Cramps or pain in the lower abdomen
- Chills or fever (fever may be the only symptom in infants and children)
- Strong smelling urine
- Pain during sexual intercourse
- Nausea, vomiting, and malaise
What Causes It?
Risk factors include:
- A new sex partner or multiple partners
- More frequent or intense intercourse
- Escherichia coli (E coli)
- Staphylococcus saprophyticus
- Use of irritating products, such as harsh skin cleansers
- Use of irritating contraceptives, such as diaphragms and spermicides
- Use of birth control pills
- Heavy use of antibiotics
- A blockage in the urinary tract (benign masses or tumors)
- A history of UTIs, especially if infections are less than 6 months apart
What to Expect at Your Provider's Office
Your health care provider will feel your abdomen and kidneys for changes and use laboratory tests, such as a urine culture, to find out if you have a UTI. If the usual treatments do not work, your provider will explore the possibility that you have some other condition. Other illnesses, such as sexually transmitted diseases (STDs), can cause symptoms that mimic a UTI.
Doctors may presecribe antibiotics or other drugs to treat UTIs. The course for most antibiotics is 7 to 10 days, though shorter courses of treatment are also available.
Complementary and Alternative Therapies
Some complementary and alternative (CAM) therapies may be helpful for UTIs, but they may not be right for every person. Natural medicines and supplements may interact with prescription medications. Work with a knowledgeable health care provider, and always tell all of your providers about the herbs and supplements you are taking.Nutrition and Supplements
Following these nutritional tips may help reduce symptoms:
- Drink a lot of fluids, such as herbal teas and water. Avoid sweetened fruit juices and other sweetened drinks.
- Cranberries and blueberries contain substances that inhibit the binding of bacteria to bladder tissue. Drinking unsweetened cranberry juice regularly helps lower the risk of UTIs. People who are allergic to aspirin should not consume large quantities of cranberry juice. Cranberry juice may interact with certain medications.
- Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your provider may want to test for food sensitivities. If you are susceptible to UTIs, drinking cranberry juice or taking cranberry pills may help prevent recurrence.
- Eat antioxidant-rich foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
- Eat more high-fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed.
- Avoid refined foods, such as white breads, pastas, and especially sugar.
- Eat fewer red meats and more lean meats, cold-water fish, tofu (if no allergy to soy is present), or beans for protein.
- Use healthy cooking oils, such as olive oil or coconut oil.
- Reduce or eliminate trans fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
- Avoid coffee and other stimulants, alcohol, and tobacco.
- Drink 6 to 8 glasses of filtered water daily.
- Exercise at least 30 minutes daily, 5 days a week.
You may address nutritional deficiencies with the following supplements:
- A multivitamin daily. Containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
- Vitamin C. As an antioxidant and for immune support.
- Omega-3 fatty acids, such as fish oil. To help reduce inflammation and promote general health. Cold-water fish, such as salmon or halibut, are good sources. Fish oil supplements can increase the effects of certain blood-thinning medications.
- Probiotic supplement (containing Lactobacillus acidophilus). For maintenance of gastrointestinal and immune health. There is strong scientific evidence to support the use of probiotics for urological conditions. Refrigerate probiotic supplements for best results. People with severely weakened immune systems should speak wiht their doctors before taking probiotics.
- Grapefruit seed extract (Citrus paradisi). For antibacterial, antifungal, and antiviral activity. Grapefruit may interact with a wide variety of medications. Speak with your doctor.
Natural hormone replacement therapy may help prevent UTIs. Ask your provider about this treatment.Herbs
Herbs may help strengthen and tone the body's systems. As with any therapy, you should work with your provider before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. (5 grams) herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted. Many herbs interact with medications, and may make certain conditions worse, so tell your doctor about any herbal therapies you are using or considering using. The following herbs may be useful for short term treatment of a urinary tract infection.
- Green tea (Camellia sinensis). For antioxidant, anticancer and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
- Cat's claw (Uncaria tomentosa). For anticancer, immune and antibacterial or antifungal activity. Cat's claw can interact with many different medications. Speak to your provider. DO NOT take cat's claw if you have leukemia or autoimmune disease.
- Reishi mushroom (Ganoderma lucidum). For anticancer and immune effects. High doses of reishi may have a blood-thinning effect. Speak to your doctor if you are on blood-thinning medications or medications for high blood pressure.
- Milk thistle (Silybum marianum). For detoxification support. People who have a history of hormone-related cancer should use caution before taking milk thistle as it may have estrogen-like properties. Milk thistle may interact with a wide variety of medications. Speak with your doctor.
- Uva-ursi (Arctostaphylos uva-ursi) standardized extract. You may also prepare teas from the leaf of this herb. Uva-ursi may interact with lithium. There is a possibility that a compound in uva-ursi can have a thinning effect on the retina. DO NOT use daily as long-term therapy.
- Buchu (Barosma betulina). For antibacterial effects. Buchu can interact with lithium and with blood thinning medications. Some health experts advise against using buchu when there is inflammation of the urinary tract or kidney infection. Others disagree. Speak with your doctor.
Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for UTI based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
- Apis mellifica. For stinging or burning pains that tend to worsen at night and from warmth. This remedy is appropriate for people who feel an intense urge to urinate, yet can only do so in drops.
- Aconitum. For early symptoms of UTI, particularly with extremely painful urination that is often described as a hot sensation.
- Berberis. For UTIs with burning or shooting pain during urination that may radiate to the pelvis or back. When not urinating, an aching sensation is present in the bladder that worsens with movement. Pain may also extend to legs and abdomen.
- Cantharis. This is the most common and considered the most effective homeopathic remedy for UTI. This remedy is most appropriate for people who are restless, experience a burning sensation and decreased urine flow (despite a strong desire to urinate), and have increased sexual desire despite symptoms.
- Mercurius. For burning urination and a strong urge to urinate. Symptoms worsen at night and tend to be accompanied by chills and sweating. Urine is dark and only small amounts pass. Burning sensation is often worse when the individual is not urinating.
- Nux vomica. For people who have a constant urge to urinate. Pain is described as needle like. The urge to have a bowel movement may accompany urinary urgency. Some people experience mild, temporary relief from urination and warm baths. Symptoms may begin following ingestion of alcohol, coffee, drugs, or overeating.
- Pulsatilla. For bladder inflammation that begins after an individual develops a sudden chill in hot weather. This remedy is most appropriate for people with an urgent desire to urinate who may be emotional, crave attention, and dribble urine after laughing, coughing, sneezing, or being surprised.
- Sarsaparilla. For women who experience severe pain at the end of urination and who, occasionally, feel compelled to stand to urinate.
- Staphysagria. For UTIs usually associated with sexual intercourse or following extreme embarrassment or humiliation, particularly from sexual abuse. This remedy is most appropriate for those who have an urgent desire to urinate and have the sensation that a single drop of urine is still present even following urination.
Preventive measures you can follow:
- Urinate both before and after intercourse.
- Have your health care provider recheck the fit of your diaphragm if you use one.
- Avoid sex while you are being treated for a UTI.
If you are pregnant, you are at higher risk of developing a UTI.
Appleton J. Arginine: Clinical potential of a semi-essential amino. Altern Med Rev. 2002;7(6):512-22.
Arya LA, Northington GM, Asfaw T, Harvie H, Malykhina A. Evidence of bladder oversensitivity in the absence of an infection in premenopausal women with a history of recurrent urinary tract infections. BJU Int. 2012;110(2):247-251.
Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.
Chan WK, Lam DT, Law HK, et al. Ganoderma lucidum mycelium and spore extracts as natural adjuvants for immunotherapy. J Altern Complement Med. 2005;11(6):1047-1057.
Chen SL, Wu M, Henderson JP, et al. Genomic diversity and fitness of E. coli strains recovered from the intestinal and urinary tracts of women with recurrent urinary tract infections. Sci Transl Med. 2013;5(184):184ra60.
Doron S, Gorbach SL. Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther. 2006;4(2):261-275.
Dryden GW Jr, Deaciuc I, Arteel G, McClain CJ. Clinical implications of oxidative stress and antioxidant therapy. Curr Gastroenterol Rep. 2005;7(4):308-316.
Epp A, Larochelle A, Lovatsis D, Walter JE, Easton W, Farrell SA. Recurrent urinary tract infection. J Obstet Gynaecol Can. 2010;32(11):1082-1101.
Gagyor I, Bleidorn J, Kochen MM, Schmiemann G, Wegscheider K, Hummers-Pradier E. Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial. BMJ. 2015;351:h6544.
Griffin C. Probiotics in obstetrics and gynaecology. Aust N Z J Obstet and gynaecol. 2015;55(3):201-209.
Grover ML, Bracamonte JD, Kanodia AK, et al. Assessing adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection. Mayo Clin Proc. 2007;82(2):181-185.
Guay DR. Cranberry and urinary tract infections. Drugs. 2009;69(7):775-807.
Heitzman ME, Neto CC, Winiarz E, Vaisberg AJ, Hammond GB. Ethnobotany, phytochemistry and pharmacology of Uncaria (Rubiaceae). Phytochemistry. 2005;66(1):5-29.
Hickerson AD, Carson CC. The treatment of urinary tract infections and use of ciprofloxacin extended release. Expert Opin Investig Drugs. 2006;15(5):519-532.
Hoesl CE, Altwein JE. The probiotic approach: an alternative treatment in urology. Eur Urol. 2005;47(3):288-296.
Horl WH. Urinary tract infections. Internist. 2011;52(9):1026, 1028-1031.
Kodner CM, Gupton EK. Recurrent urinary tract infrections in women: diagnosis and management. Am Fam Physician. 2010;82(6):638-643.
Litza J, Brill J. Urinary tract infections. Prim Care. 2010;37(3):491-507.
Marelli G, Papaleo E, Ferrari A. Lactobacilli for prevention of urogenital infections: a review. Eur Rev Med Pharmacol Sci. 2004;8(2):87-95.
Marschall J, Carpenter CR, Fowler S, Trautner BW. Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter: meta-analyis. BMJ. 2013;346:f3147.
Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014.
McMurdo ME, Argo I, Phillips G, Daly F, Davey P. Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women. J Antimicrob Chemother. 2009;63(2):389-395.
Mishra B, Srivastava S, Singh K, Pandey A, Agarwal J. Symptom-based diagnosis of urinary tract infection in women: are we over-prescribing antibiotics? Int J Clin Pract. 2012;66(5):493-498.
Ochoa S, Malaga G. Recommendations of the consensus conference "diagnostic and therapeutic management of urinary tract infection in childhood." An Pediatr (Barc). 2007;67(5):517-525.
Peterson J, Kaul S, Khashab M, Fisher AC, Kahn JB. A double-blind, randomized comparison of levofloxacin 750 mg once-daily for five days with ciprofloxacin 400/500 mg twice-daily for 10 days for the treatment of complicated urinary tract infections and acute pyelonephritis. Urology. 2008;71(1):17-22.
Pigrau-Serrallach C. Recurrent urinary tract infections. Enferm Infecc Microbiol Clin. 2005;23 Suppl 4:28-39.
Quintus J, Kovar KA, Link P, Hamacher H. Urinary excretion of arbutin metabolites after oral administration of bearberry leaf extracts. Planta Med. 2005;71(2):147-152.
Reid G, Bruce AW. Probiotics to prevent urinary tract infections: the rationale and evidence. World J Urol. 2006;24(1):28-32.
Rossignol L, Maugat S. Blake A, et al. Risk factors for resistance in urinary tract infections in women in general practice: a cross-sectional survey. J Infect. 2015;71(3):302-311.
Schindler G, Patzak U, Brinkhaus B. et al. Urinary excretion and metabolism of arbutin after oral administration of Arctostaphylos uvae ursi extract as film-coated tablets and aqueous solution in healthy humans. J Clin Pharmacol. 2002;42(8):920-927.
Schwenger EM, Tejani AM, Lowewen PS. Probiotics for preventing urinary tract infections in adults and children. Cochrane Database Syst Rev. 2015; 12.
Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.
Sufka KJ, Roach JT, Chambliss WG Jr, et al. Anxiolytic properties of botanical extracts in the chick social separation-stress procedure. Psychopharmacology (Berl). 2001;153(2):219-224.
Vahlensieck W, Bauer H. Prevention and alternative methods for prophylaxis of recurrent urinary tract infections in women. Urologe A. 2006;45(4):446-450.
van Pinxteren B, van Vliet SM, Wiersma TJ, Goudswaard AN. Summary of the practice guideline 'Urinary-tract infections' (second revision) from the Dutch College of General Practitioners. Ned Tijdschr Geneeskd. 2006;150(13):718-722.
Vincent CR, Thomas TL, Reyes L, White CL, Canales BK, Brown MB. Symptoms and risk factors associated with first urinary tract infection in college age women: a prospective cohort study. J Urol. 2013;189(3):904-910.
Review Date: 1/1/2017
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.