Antibiotic-free fixes for recurrent UTIs

You’ve finished taking antibiotics for a urinary tract infection (UTI), but here it comes again: that telltale burn.

It’s another UTI — and you’re far from alone. About 60% of women will get this type of infection sometime during their lives, and more than a quarter of this group cope with recurrent UTIs, which can affect the urethra, bladder, and kidneys, according to the National Library of Medicine.

By this point you may be hoping to avoid more antibiotics, wondering instead about UTI treatment at home. Your concern is warranted: while antibiotics are usually effective at knocking back a UTI, taking them long-term can lead to antibiotic resistance, when bacteria evolve into virulent strains that evade treatment. Side effects such as nausea, vomiting, or diarrhea also become more likely, says Dr. Jeannine Miranne, a urogynecologist at Harvard-affiliated Brigham and Women’s Hospital.

But in up to 40% of women, UTIs can resolve without antibiotics, Dr. Miranne notes. Plus, a variety of antibiotic-free preventive strategies can help you break the cycle.

Doctors typically prescribe antibiotics at the onset of hallmark UTI symptoms, which include pain with urination — usually suddenly — as well as blood in the urine and urinary urgency and frequency. However, if you don’t have fever or chills, you may be able to monitor symptoms to see if they quickly subside, says Dr. Miranne. (See “Can you wait out a UTI?”)

Why women are more vulnerable

Most UTIs are caused by E. coli bacteria that migrate into the urinary tract from the vagina, rectum, or skin around the urethra. Even after antibiotic treatment, bacteria can linger in the bladder, or, if they’re living in the genital tract, find a foothold once again — an outcome that, for several reasons, is far more common in women.

First, our urethra (the tube that carries urine from the bladder out of the body) is far shorter than in a man. “Our urethral opening is also very close to both the vaginal and anal openings,” Dr. Miranne explains. That means that sexual activity or poor hygiene habits can more easily spread bacteria from those areas into the urethra, giving them a boost toward the bladder.

UTIs are more common in women after menopause due to hormonal changes that raise the vagina’s pH level, encouraging harmful bacteria to proliferate. Additionally, some women are genetically predisposed to these infections.

UTI relief and prevention strategies

The following antibiotic-free measures can help prevent bacteria from taking hold, discourage an infection from progressing, or alter the microbiome — the trillions of organisms living in and on our bodies — to favor “good” bacteria.

Thwart bacterial growth. Empty your bladder before and after having sex, and wipe from front to back. Also, wear underwear in “breathable” fabrics (like cotton or silk), and change underwear that’s damp. If you wear incontinence pads, change them frequently.

Drink sufficient water. This helps flush bacteria from the urinary tract. Aim to consume about 64 ounces of fluids daily, mostly water.

Don’t hold urine too long. “Try to go every two to four hours,” Dr. Miranne says. “Relax to empty your bladder, then give an extra push to completely empty it.”

Consume cranberry. Dr. Miranne recommends taking medical-grade cranberry supplements containing 36 milligrams (mg) of proanthocyanidins, compounds that help prevent bacteria from “sticking” to bladder walls. But they’re pricey, so a less-expensive option is drinking two 8-ounce cups of cranberry juice each day.

Try D-mannose. Available in powder or pill form, this supplement is a natural sugar that binds to E. coli, which may help flush it out of urine. Dr. Miranne recommends taking 2,000 mg per day. “Research offers conflicting results about its effectiveness in reducing the risk of UTIs, but there’s little harm in taking it,” she says.

Use probiotics. Available in oral pills and vaginal suppositories, probiotics may help restore a healthy balance of microorganisms within the vagina and urinary tract. Look for versions containing Lactobacillus, which is plentiful in both areas.

Consider vaginal estrogen. Low-dose vaginal estrogen — which comes in creams, rings, or suppositories — can restore a normal vaginal pH as well as plump up thinning tissues that might otherwise welcome bacteria. “It’s the best way to prevent UTIs in postmenopausal women,” Dr. Miranne says.

Try methenamine (Hiprex, Urex). This drug, available by prescription and over the counter, is broken down into ammonia and formaldehyde in urine in the bladder, killing bacteria. Its use usually won’t lead bacteria to mutate into stronger versions.

Bear in mind that keeping UTIs at bay often requires a personalized approach that combines two or more of these strategies. But the effort is worth it, because a woman prone to recurrent UTIs can reduce the need for antibiotics, Dr. Miranne says.

Urine culture testing is important in women with recurrent UTIs. The test not only determines the type of bacteria, it also identifies the specific antibiotics that kill it. “That can help us tailor treatment and prevention,” she says.

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