What Are Urinary Tract Infections?
Urinary tract infections (UTIs) are a common problem among the ageing population, with prevalence reaching between 20-50% in women over 65 years of age. However, they can affect anyone regardless of gender and age.
Contributing factors include the shorter female urethra (as compared with male), reduced oestrogen levels, decreased urinary concentration, incomplete emptying of the bladder, incontinence, catheters, and certain medications. UTIs can also impact men, especially when combined with prostatic hypertrophy, prostatitis, or urethral stricture.
Symptoms Of UTI May Include:
- Dysuria (painful or difficult urination).
- Frequency and urgency of urination.
- Nocturia (urination at night).
- Haematuria (blood in the urine).
- Suprapubic (pelvic) discomfort.
If left untreated, UTIs can cause polynephritis (kidney infection) which is extremely serious and needs medical attention.
What Are Recurrent Urinary Tract Infections?
UTIs are caused by bacteria present in the urinary tract, most often the E. coli bacteria, and are common in both men and women, with up to 50% of adult women estimated to be affected. Recurrent UTIs are diagnosed when you have experienced more than three UTIs in one year, or two in a six-month period.
What Is Cystitis?
Cystitis is inflammation of the bladder and is often caused by a bacterial infection. It is the most common type of urinary tract infection (UTI), especially in women. Although a UTI is a general term for an infection anywhere in the urinary tract (including the bladder, urethra, ureters, and kidney).
Tips For Prevention of Cystitis
Even though cystitis makes it painful to go to the toilet, it’s important to drink plenty of water during cystitis so that your urinary tract is constantly being flushed out. Try adding a teaspoon of baking soda to your water to alkalise your urine and reduce the stinging pain. Other tips to aid the management and prevention of cystitis include:
- Go to the toilet as soon as you feel the urge, as this reduces the amount of time urine is present in the bladder.
- When going to the toilet, wipe yourself from front to back rather than from back to front (for females)
- Avoid using chemicals or perfumes around the genital region (e.g., deodorant, vaginal douches, spermicidal gels, scented soaps, bubble baths and talcum powder).
- Choose natural fibres such as cotton and bamboo for your underwear and avoid synthetic options, including pantyhose.
- Wash your genitals prior to having sex and go to the toilet afterwards.
- Cranberries have been used to prevent UTIs
All About Cranberries
Vaccinium macrocarpon (Cranberry) is an evergreen shrub that grows in wet habitats in the North-eastern and North Central parts of the United States. It’s also known as American Cranberry, as another variety is grown in Europe. Cranberry is botanically related to bilberry, blueberry, buckberry, cowberry and huckleberry, all of which are members of Vaccinium.
Historical Uses of Cranberry
Historically, cranberry fruits or leaves were used for bladder, stomach and liver disorders, scurvy, as well as diabetes, wounds, and other conditions. In the mid eighteenth-century German scientists thought cranberry was anti-bacterial, which supported its use for urinary infections. Then it was thought the activity came from the acidity the cranberries caused. However, more recent research shows cranberry alters the environment in the urethra and bladder, which prevents the bacteria from sticking to the wall of the bladder.
Fun Facts:
The air pockets in the cranberry make them bounce and float, and this is often a test performed to test how ripe a cranberry is!
Another fun fact is that since the 1920s, American cranberries have been used in cooking to make traditional cranberry sauce for Thanksgiving in America.
What The Research Says:
A Cochrane review (highly regarded study) in 2023 found that cranberry products can help to prevent (culture-verified) UTIs in women with frequent UTIs. Further research was needed for people with bladder emptying problems.
Most of the clinical evidence for cranberry relates to its effectiveness in preventing urinary tract infections in women. Whilst this evidence has been mixed, a 2017 meta-analysis of 7 randomised controlled trials found that cranberry in an extract form effectively reduced the risk of recurrent UTI in healthy women by 23%.
It is thought that the mechanism of action relates to the proanthocyanins (PAC) found in cranberry, which appear to inhibit adhesion of E. coli bacteria to the epithelial cells in the urinary tract, therefore preventing infection. Cranberry PACs have also been studied for their anti-biofilm properties against certain bacteria, which may prove beneficial against antibiotic-resistant bacteria. Using cranberry products more than twice daily may be more effective than once-a-day dosing in reducing the risk of UTI recurrence.
Cranberry Juice Versus Whole Cranberry Fruit Powder
A lot of research on cranberry fruit powder has used the juices, where the concentration of the actives is limited. However, this study examined whether the whole fruit powder from fresh fruit at 500mg/day for six months compared to a placebo could prevent UTIs in 182 women with recurrent UTIs. The results showed that 500mg of whole fruit powder for six months could reduce UTI recurrence rate by 58% compared to placebo while reducing the overall number of UTIs.
Cautions/Contraindications:
- Case reports suggest that cranberry may increase the effect of warfarin. Caution in patients taking antiplatelet and anticoagulant drugs.
- Cranberries contain oxalates which theoretically may encourage kidney stone formation. People with a history of kidney stones should limit their intake.
- There is limited evidence regarding the safety and effectiveness of cranberry during pregnancy and lactation. Before taking any supplementation, please consult a healthcare professional for advice.
References
Bone, K 2007, The Ultimate Herbal Compendium, Phytotherapy Press, Australia
Braun L, Cohen M. Cranberry. Herbs & natural supplements: an evidence-based guide. [Vol. 2]. 4th ed. Australia: Elsevier; 2015. p.247-55.
Fu Z, Liska D, Talan D, Chung M. (2017). An Updated Meta-Analysis of Cranberry and Recurrent Urinary Tract Infections in Women. FASEB J 2017;31(1 Supplement):lb343.
Howell, A. B., Botto, H., Combescure, C., Blanc-Potard, A. B., Gausa, L., Matsumoto, T., Tenke, P., Sotto, A., & Lavigne, J. P. (2010). Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study. BMC infectious diseases, 10, 94. https://doi.org/10.1186/1471-2334-10-94
Ulrey, R. K., Barksdale, S. M., Zhou, W., & van Hoek, M. L. (2014). Cranberry proanthocyanidins have anti-biofilm properties against Pseudomonas aeruginosa. BMC complementary and alternative medicine, 14, 499. https://doi.org/10.1186/1472-6882-14-499
