Conditions:
Bladder Infection
Related Terms
•
Urinary Tract Infection
Principal Proposed Treatments
•
Cranberry, Uva Ursi
Other Proposed Treatments
•
Goldenseal, Vitamin C, Zinc, Low-Sugar Diet, Goldenrod, Juniper, Lapacho, Sandalwood, Methionine, Probiotics
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.
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 cranberry's acidification of the urine is not likely to play an important role in the treatment of bladder infections; current research has instead focused on cranberry's apparent ability to interfere with the bacteria establishing a foothold on the bladder wall.1–7 If the bacteria can't 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.8 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.9 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.10 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.11 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.12 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.13 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."14
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.15
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.16,17
Prevention One double-blind study followed 57 women for 1 year.18 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 don't 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.29
View References
Last reviewed March 2002 by Medical Review Board
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