A Naturopathic Approach to Urinary Tract Infections (UTIs) and the association with Irritable Bowel Syndrome (IBS) and Small Intestine Bacteria Overgrowth (SIBO)

Over 50% of women will suffer from a urinary tract infection (UTI) during their lifetime. One-third to one-half of these women will have a recurrent UTI within one year. Recurrent UTI’s are defined as three or more UTI’s in a 12 month period (1). The most commonly used conventional therapies for these conditions are antibiotics. There is increased awareness and concern about antibiotic resistance with repetitive use of these medicines. This growing concern has created an interest in alternative treatments for UTI’s. The purpose of this article is discuss this conditions, the causes, and alternative treatments for cure and further prevention. 

This article will also illuminate the link between UTI’s and an imbalanced gut microbiome, otherwise known as dysbiosis. Gastrointestinal conditions associated with dysbiosis such as Irritable Bowel Syndrome (IBS) and Small Intestine Bacterial Overgrowth (SIBO) are common in those with bladder infections. 


Urinary Tract Infections (UTI’s)

• Definition and symptoms
  • UTI’s are the most common bladder infection and are associated with symptoms such as burning with urination, increased urinary frequency and urgency (in the absence of vaginal discharge), and significant pain. Diagnosis can be made on symptoms alone, though most doctors will require a urinalysis to identify the presence of infection to prescribe antibiotics.
• Causes
  • E Coli from the gastrointestinal system is the cause of 80-85% of urinary tract infections. Sexual activity is researched to be the cause of between 75-90% of these infections in pre-menopausal females, with more frequent intercourse increasing the risk of infection (3). UTI’s in the post-menopausal female are not related to sexual activity, instead they are related to the decrease in estrogen levels and resulting vaginal atrophy and loss of beneficial vaginal flora in this population. Other risk factors include genetics and diabetes. (4)
• Treatments
  • Conventional Treatment: Antibiotics
    • Conventional treatment of UTI’s rely on antibiotics which are estimated to cure 80-90% of uncomplicated UTI’s. The most common antibiotics include nitrofurantoin (commonly known as Macrobid) and trimethoprim sulfamethoxazole (TMP/SMX). Growing concern surrounds the repetitive use of these antibiotics as resistance has been shown to occur, as well as an increase frequency of candidiasis following use (5). 
  • Naturopathic Approach 
    • Prevention
      • As mentioned above, the largest causative factor for UTI’s is sexual activity. It is recommended to urinate and allow for complete bladder emptying post-intercourse as a preventative technique for UTI’s. Drinking enough water is also a known preventative strategy for UTI’s. A study looking at 140 premenopausal women who suffered from recurrent UTI’s were drinking a lot less than the recommended amount of water daily, which is 64 ounces of water a day (6).
  • Probiotics
    • As most UTI’s are the result of E. Coli from the digestive tract, promoting healthy microflora ratios is beneficial in preventing and treating UTI’s. The three Lactobacillus strains; L. acidophilus, L. rhamnosus and L. reuteri have been studied to prevent UTI’s and also showed no increase in antibiotic resistance (7). 
  • Cranberry 
    • This herb has been shown to inhibit the binding of E. coli to the epithelial cells lining the bladder wall. A Cochrane review and meta-analysis revealed that cranberry significantly reduced the chance of developing a UTI. It has also been shown to significantly reduce the biofilm load. This herb has been found to be effective in the form of pure juice, capsules and tableted extracts (8). 
  • Uva Ursi 
    • This herb along with cranberry, is one of the most commonly used antibacterial agents for UTIs. It is best used when the urine pH is more alkaline, above 8, as the main antimicrobial constituent in this herb, arbutin, is released in alkaline urine (8). 
  • D Mannose 
    • This is a simple sugar that like cranberry, prevents adhesion of E. coli to the epithelial cells lining the bladder (8). In a 2014 study that compared d-mannose to nitrofurantoin, d-mannose significantly reduced the risk of recurrent UTI’s and showed a significantly lower risk of side effects (9). 

The Link to Common Gastrointestinal Conditions such as IBS and SIBO 

To read more about IBS and SIBO, please see my original article here - SIBO article). The underlying root cause for both IBS and SIBO is dysbiosis, or an imbalanced microflora in the gastrointestinal tract. There has been an increased correlation with these gastrointestinal conditions and UTI’s (10). An article by Ojetti et al. has identified that the treatment of constipation from SIBO may avoid the reinfection of E. coli in the urinary tract from the rectal reservoir (11). The treatment of IBS and/or SIBO is mentioned in my article referenced above. 


Conclusion: A Well Rounded Approach to UTI’s

There are numerous studies demonstrating the effectiveness of natural substances for prevention and treatment of UTI’s. The most studied of these are discussed in this article including: cranberry, uva ursi, d-mannose and probiotics. The increased prevalence of UTI’s occurring concurrently with conditions such as IBS and SIBO suggests the need to address these gastrointestinal ailments in conjunction with using the above researched therapies for UTI’s. A well rounded approach for UTI’s which addresses dysbiosis in the gastrointestinal tract, as well as using the above natural UTI remedies, shows promise for treatment and long-term prevention of UTI’s. 


REFERENCES
1. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Dis Mon. 2003;49:53-70.
2. Weinstock LB, Kutke CG, Lin HC. Small intestinal bacterial overgrowth in patients with interstitial cystitis and gastrointestinal symptoms. Dig Dis Sci. 2008 May;53(5):1246-51.
3. Abraham, Soman N.; Miao, Yuxuan. The nature of immune responses to urinary tract infections". Nature Reviews. Immunology. 2015 (10): 655–663. 
4. Dielubanza, EJ; Schaeffer, AJ. Urinary tract infections in women. The Medical Clinics of North America. 2011. 95 (1): 27–41. 
5. Bassetti M, Mikulska M, Viscoli C. Bench-to-bedside review: therapeutic management of invasive candidiasis in the intensive care unit. Critical Care. 2010. 14 (6): 244. 
6. Hooton TM, Vecchio M, Iroz A, et al. Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections A Randomized Clinical Trial. JAMA Intern Med. 2018;178(11):1509-1515
7. Beereport MA, ter Riet G, Nys S, et al. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med. 2012;172(9):704-712.
8. Head KA. Natural approaches to prevention and treatment of infections of thee lower urinary tract. Altern Med Rev 2008 Sep; 13 (3):227-44.
9. Kranjcec B, Papes D, Altarac S. D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World J Urol. 2014 Feb;32(1):79-84. 
10. Romańczuk W, Korczawski R. Chronic constipation: a cause of recurrent urinary tract infections. Turk J Pediatr 1993; 35: 181–188.
11. V Ojetti, G Bruno, et al. The prevalence of small intestinal bacterial overgrowth and methane production in patients with myelomeningocele and constipation. Spinal Cord, 2014 volume 52, pages 61–64. 

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