Bladder infections are a common problem for women, accounting for more than 6
million office visits each year. Men, because of the greater distance between
their bladder and urethral opening, only rarely develop bladder infections.
The primary symptoms of a bladder infection are burning during urination,
frequency of urination, and urgency to urinate, possibly accompanied by pain in
the lower abdomen and cloudy or bloody urine. Occasionally, the infection
spreads upward into the kidneys, producing symptoms such as intense back pain,
high fever, chills, nausea, and diarrhea.
Conventional treatment for bladder infections consists of appropriate antibiotic
treatment guided by urine culture. Recently, a report was released suggesting
that it is appropriate for women with frequent bladder infections to have on
hand a prescription for antibiotics for the purpose of self-treatment when
symptoms arise. Women who have had extremely frequent bladder infections
sometimes take antibiotics continuously to prevent the condition.
Treatment
Principal Proposed Treatments for Bladder Infection:
Women who do not want to use antibiotics may be able to find some help through
the use of herbs. However, if symptoms do not improve or signs of a kidney
infection develop, medical attention is essential to prevent serious
complications.
Cranberry: May Help Prevent Infections
Cranberry juice is commonly used to prevent bladder infections as well as to
overcome low-level chronic infections. The cranberry plant is a close relative
of the common blueberry. Native Americans used it both as food and as a
treatment for bladder and kidney diseases. The Pilgrims learned about cranberry
from local tribes and quickly adopted it for their own use. Subsequent
physicians used it for bladder infections, for "bladder gravel," and to remove
"blood toxins."
In the 1920s, researchers observed that drinking cranberry juice makes the urine
more acidic. Because common urine infection bacteria such as E. coli dislike
acid surroundings, physicians concluded that they had discovered a scientific
explanation for the traditional uses of cranberry. This discovery led to
widespread medical use of cranberry juice for bladder infections. Cranberry fell
out of favor after World War II, only to return in the 1960s as a self-treatment
for bladder infections.
More recent research has revised the conclusions reached by scientists in the
1920s. It appears that cranberrys acidification of the urine is not likely to
play an important role in the treatment of bladder infections; current research
has instead focused on cranberrys apparent ability to interfere with the
bacteria establishing a foothold on the bladder wall. If the bacteria cant hold
on, they will be washed out with the stream of urine. Furthermore, studies
suggest that in women who frequently develop bladder infections, bacteria have
an especially easy time holding on to the bladder wall. When taken regularly,
cranberry juice might fix this problem and break the cycle of repeated
infection.
What Is the Scientific Evidence for Cranberry?
The best evidence for the use of cranberry juice for preventing bladder
infections comes from an unpublished trial presented at the June 2001 meeting of
the American Urological Association. This 1-year double-blind placebo-controlled
study of 150 sexually active women compared placebo against both cranberry juice
and cranberry tablets. The results showed that both forms of cranberry
significantly reduced the number of episodes of bladder infections.
Another double-blind study evaluated cranberry juice cocktail for treatment of
chronic bladder infections. This trial followed 153 women with an average age of
78.5 years for a period of 6 months. Many women of this age group have what are
called chronic assymptomatic bladder infections: signs of bacteria in the urine
without any symptoms. Half of the participants were given a standard commercial
cranberry cocktail drink, the other a placebo drink prepared to look and taste
the same. Both treatments contained the same amount of vitamin C to eliminate
the possible antibacterial influence of that supplement. Despite the weak
preparation of cranberry used, the results showed a 58% decrease in the
incidence of bacteria and white blood cells in the urine.
A double-blind placebo-controlled study evaluated the effectiveness of cranberry
extract in children with bladder paralysis (neurogenic bladder) who needed to
use a catheter. The results showed no benefit.
Finally, a year-long open trial of 150 women found that regular use of a
cranberry juice/lingonberry combination reduced the rate of urinary tract
infection as compared to a probiotic drink or no treatment. However, because
this study was not double-blind, the results are unreliable.
For more information, including dosage and safety issues, see the full cranberry
article.
Uva Ursi: Appears to Be Effective for Acute Bladder Infections
While cranberry is most often used to prevent bladder infections or to treat
simmering chronic infections, uva ursi, also known as bearberry, can be used to
treat the classic painful, acute bladder infection. Uva ursi has a long history
of use for urinary conditions in both America and Europe. Until the development
of sulfa antibiotics, its principal active component, arbutin, was frequently
prescribed by physicians as a treatment for bladder and kidney infections.
The uva ursi plant is a low-lying evergreen bush whose berries are a favorite of
bears, thus the name bearberry. However, it is the leaves that are used
medicinally. We do not know for sure how uva ursi works. It appears that the
arbutin contained in uva ursi leaves is broken down in the intestine to another
chemical, hydroquinone. This is altered a bit by the liver and then sent to the
kidneys for excretion. Hydroquinone then acts as an antiseptic in the bladder.
The European Scientific Cooperative on Phytotherapy (ESCOP) is a scientific
organization assigned the task of harmonizing herb policy among European
countries. ESCOP recommends uva ursi for "uncomplicated infections of the
urinary tract such as cystitis when antibiotic treatment is not considered
essential."
Warning: This herb is definitely not appropriate for kidney infections.
If you develop symptoms such as high fever, chills, nausea, vomiting, diarrhea,
or severe back pain, get medical assistance immediately.
Furthermore, hydroquinone can be toxic. For this reason it is not a good idea to
take uva ursi for a long period of time.
What Is the Scientific Evidence for Uva Ursi?
Surprisingly little research has been done on uva ursi.
Treatment: No double-blind studies have evaluated the clinical
effectiveness of uva ursi. Two studies evaluated the antibacterial power of the
urine of people who were taking uva ursi and found activity against most major
bacteria that infect the urinary tract.
Prevention: One double-blind study followed 57 women for 1 year. Half
were given a standardized dose of uva ursi (in combination with dandelion leaf,
intended to promote urine flow), while the others received placebo. Over the
course of the study, none of the women on uva ursi developed a bladder
infection, whereas five of the untreated women did. However, most experts do not
believe that continuous treatment with uva ursi is a good idea.
For more information, including dosage and safety issues, see the full uva ursi
article.
Other Proposed Treatments for Bladder Infection:
The following treatments are often proposed as treatments for bladder
infections, but there is as yet little to no scientific confirmation of their
effectiveness.
Goldenseal
The herb goldenseal is widely recommended for bladder infections, based on the
antibiotic properties of its ingredient berberine. However, we dont know for
sure if, when goldenseal is taken by mouth, enough berberine accumulates in the
bladder to do anything.
In the past, herbalists would instill goldenseal preparations directly into the
bladder, a process that we do not recommend trying yourself.
For more information, including dosage and safety issues, see the full
goldenseal article.
Other Supplements
Many nutritionally oriented physicians believe that regularly taking vitamin C
and zinc supplements and decreasing sugar in the diet will help improve immunity
against bladder infections. Herbs such as goldenrod, dandelion, juniper,
cleavers, parsley, buchu, and sandalwood may increase urine flow, which could be
helpful for increasing speed of recovery from an infection that has already
occurred. The herb lapacho and the supplement methionine are also sometimes
recommended for bladder infections, but there is no real evidence that they
work.
Although friendly bacteria are sometimes proposed for preventing bladder
infections, a year-long open trial of 150 women found lactobacillus probiotics
ineffective as compared to cranberry juice or no treatment.