URINARY TRACT INFECTIONS ARE COMMON and can involve any part of your urinary system (including the kidneys (pyelonephritis), bladder (cystitis), ureters, or urethra (urethritis)).
Urinary tract infections (UTIs) are quite common, with one in five women having a UTI sometime in their lifetime. While UTIs are common among women, they can also occur in men and children. Up to two percent of children develop such infections.
I recently came across a medical quiz at MDEdge.com:
Which of these approaches can reduce the chances of a recurrence of a urinary tract infection?
- A. Routine antibiotics
- B. Daily D-mannose
- C. Drinking more than one gallon daily
- D. Urinate after sex
Before we get to the answer, let’s look at some basics. We’ll examine the urinary tract before turning to potential strategies to dodge recurrent urinary tract infections (UTIs).
Urinary tract anatomy
The urinary tract creates and stores urine, one of our body’s liquid waste products. The urinary tract includes the following:
- Kidneys. The kidneys are located at the back of your body (just above the hips) and are your body’s filtration system. The kidneys remove waste and water from our book, with this waste becoming urine.
- Ureters. These thin tubes carry urine from the kidneys to your bladder.
- Bladder: The bladder stores your urine before it leaves the body.
- Urethra: This tube carries urine from your bladder to the outside of the body.
The urine is sterile — it does not normally contain germs. Urine is the byproduct of our filtration system, the kidneys. Urine normally traverses the urinary system free of contamination. However, bacteria can enter the urinary system from outside the body, creating issues such as inflammation or a urinary tract infection (UTI).
Symptoms of a UTI may include needing to urinate more frequently, pain with urination (dysuria), or pain in your side or lower back. Antibiotics are typically curative.
Who gets urinary tract infections?
Any of us is vulnerable, but urinary tract infections are more common in women.
Women have a shorter urethra (the tube carrying urine out of the body) than men. The female urethra is also closer to the anus, where E. coli bacteria are common.
Older adults also have a higher risk of experiencing cystitis or inflammation of the bladder. Incomplete bladder emptying may be the cause, associated with an enlarged prostate or bladder prolapse (a condition in which the bladder slips out of position).
Those with diabetes or an abnormal urinary system may be at higher risk. Sometimes, individuals with frequent urinary tract infections may use low-dose antibiotics for a given period to prevent infection from recurring. Antibiotic use comes with peril, including a risk of developing resistance or developing other infection types (such as C. diff colitis). Offering antibiotics as a preventative (prophylactic) maneuver is used very infrequently.
Reducing UTIs
Let’s get back to our quiz:
Which of these approaches can reduce the chances of a recurrence of a urinary tract infection?
- A. Routine antibiotics
- B. Daily D-mannose
- C. Drinking more than one gallon daily
The answer, according to MDEdge, is B (daily D-mannose). Let’s look at the German national S3 guideline on uncomplicated urinary tract infection in adult patients:
Along with risk factor counseling and education about UTIs, non-antibiotic treatment options are especially critical for reducing UTI recurrence. Such approaches reduce reliance on antibiotics (and the subsequent development of antibiotic resistance).
Preventative antibiotics are not recommended unless all non-antibiotic therapy options have been exhausted. Other non-antibiotic strategies include so-called phytotherapeutics such as D-mannose.
E. coli bacteria cause 90 percent of urinary tract infections. After entering the urinary tract, these bacteria latch onto cells to proliferate and cause infection.
D-mannose can reduce the chances of suffering from a urinary tract infection. Similar to cranberries, D-mannose inhibits the fimbriae of Escherichia coli and its ability to bind to the bladder lining. Fimbriae are finger-like projections. The bacteria cannot attach to cells and cause infection.
If you contain food or supplements with D-mannose, your body passes the substance through the kidneys and into the urinary tract. While there are only a limited number of studies showing D-mannose helps those who already have an infection, a 2013 study of 308 women who had frequent UTIs showed D-mannose worked as well as the antibiotic nitrofurantoin for preventing UTIs over six months.
I wondered about the strength of the evidence. Did I fail the quiz, or perhaps the quiz wasn’t based on high-level evidence?
A new review puts these relatively small studies in context. Researchers included randomized clinical trials reporting the effect of D-mannose in any combination and formulation to prevent or treat urinary tract infections.
Here are the conclusions:
There is currently little to no evidence to support or refute the use of D-mannose to prevent or treat UTIs in all populations. This review highlights the need for more high-quality RCTs testing the efficacy of D-mannose for UTIs in any population.Despite UTIs being one of the most common adult infections (affecting 50% of women at least once in their lifetime) and growing global antimicrobial resistance, there are very few studies that adequately test this alternative treatment.
We need better evidence, preferably from a single adequately powered randomized clinical trial that compares D-mannose with a placebo.
As for the other answers to our quiz, there is also no high-level evidence that urinating after sex reduces UTI risk. Routine antibiotics are not recommended for most, given the risk of creating resistant populations of microbes. Finally, while drinking sufficient fluids is a good idea, consuming too much (say, more than 1.5 liters) can dilute antimicrobial peptides in urine.
Non-antibiotic approaches with demonstrated effectiveness include local estrogen application. If you want to try D-mannose, Healthline gives us some insights about using it (even as we recognize that the best dose is unclear):
- To prevent frequent UTIs: Two grams once daily or one gram twice daily.
- To treat an active UTI: 1.5 grams twice daily for three days, and then once daily for ten days, or one gram three times daily for 14 days.
D-mannose comes in capsules and powders. To use D-mannose powder, dissolve it in a glass of water and then drink the mixture. The powder dissolves easily, and the water will have a sweet taste.
Finally, consuming fruit juice regularly (especially from berries) may provide value. Still, study results on long-term prevention using cranberry products are inconsistent and not recommended by the updated German S3 guidelines.
Thank you for joining me in this look at reducing recurrent urinary tract infections.
The information I provided in this blog is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you seek medical advice, diagnoses, or treatment. I am not liable for risks or issues associated with using or acting upon the information in this blog.
