It’s no fun to deal with chronic UTIs, especially if the only solution you know is to take a low dose of antibiotics indefinitely. While antibiotics are the only FDA approved option to prevent UTI,  there is an alternative strategy to prevent UTI naturally.

Key points of the post:

• Address underlying health issues that cause recurrent UTIs in the first place
• Heal your bladder lining
• Attack bacterial biofilms
• Lower the amount of bad bacteria
• Increase the number of good bacteria
• Change your diet
• Stop smoking and start exercising
• Meditate

#1 Know Your UTI Risk Factors

If you think that sex causes your recurrent UTIs, you are wrong. If you think it’s E.coli bacteria, you are wrong again!

In reality, many of us might have the same type of bacteria present in the bladder but only some of us get recurrent and chronic UTIs.

Moreover, women often go underdiagnosed for a long time and your chronic symptoms might not be, in fact, a UTI. It takes a good and attentive doctor to make the right diagnosis and uncover the real reason for chronic UTIs. Many, unfortunately, jump to prescribe a low-dose antibiotic treatment without asking too many questions, and often without a physical exam.

Always seek out a second opinion when your long-term health is at stakes. There are several known health factors that could contribute to a higher risk of UTIs, the list is long and, yet, not conclusive.

The main thing you need to know is that chronic or recurrent UTIs do not happen in isolation, it is a systemic problem and a variety of health factors have to be assessed.

Female Specific Causes of UTI: Estrogen Deficiency

A healthy woman normally has as a vaginal flora that predominantly includes Lactobacilli bacteria. These bacteria help to maintain healthy pH and deter pathogenic bacteria. Lack of estrogen negatively impacts the amount of Lactobacilli. If instead, the pathogenic bacteria start growing in the vagina, it is easier for them to ascend to your urethra and cause a UTI.

Estrogen is also responsible for the health of your vaginal wall and overall ability of your vaginal epithelium to resist pathogenic bacteria.

If you are premenopausal or underwent a treatment that could have affected your hormone production, request blood work to confirm that your estrogen levels are healthy. Also, make sure your doctor examines your vagina and urethra before prescribing anything. If you were a male, they would definitely look at your prostate so don’t think you are asking for something out of the box.

Tests to request: a blood test to check hormones, physical evaluation.

Imbalanced Vaginal Microbiota

If you keep getting UTIs after sex, the answer might be in your vagina. Good bacteria that live in the vagina are your best friends and the first frontier in deterring pathogenic bacteria that are always present around your anus and on your genitals. Ironically, healthy vaginal flora is the first to come under an attack when you take antibiotics.

If you have been taking rounds of antibiotics for UTI or any other illness, make it your first priority to restore your vaginal flora. We still don’t know how good bacteria “fight” opportunistic bacteria but we know what type of bacteria seem to be more beneficial than others.

Tests to request: Vaginal culture test or PCR vaginal test, even a simple pH-strip test at home.

Pregnancy

Pregnancy is a risk factor, fortunately, you know how long it’s going to last. You’ll eventually deal with it by giving birth:). In the meantime, develop a comprehensive plan to support yourself and your growing baby and jump on a UTI prevention plan as soon as possible.

However, consult with your physician before you take any supplements. Let them know that you want to prevent UTI naturally and bring a list of supplements that you want to try.

Tests to request: Pregnancy test 🙂 your OBGYN will do a regular urine test to check for the number of bacteria in your urine

Male-specific Causes Of UTI

If you are a male who is having regular UTIs, I hope you are seeing a urologist, not a family doctor. In fact, even if this is your first UTI, I’d suggest going to a urology clinic and avoiding GPs altogether.

Things your urologist would & must check for:

• Prostate enlargement
• Prostate infection
• Undiagnosed chronic health issues (for example, diabetes)
• Stones

Once all of the above are ruled out or identified you can start putting together a supplementation plan together with your doctor.

Read more about UTI in men.

Tests to request: Prostate check, ultrasound of kidneys, the urine test to check for stones and bacteria culture

Children: Things To Check

If your kid is prone to UTIs, ask for an ultrasound. As you know, urine flows from the kidneys to the bladder. In kids, due to structural abnormalities, sometimes the opposite is possible. It’s called Vesicoureteral reflux (VUR) which is the backward flow of urine from the bladder into the kidneys. Kids often “grow out” of it but the damage done by rounds of antibiotics sometimes harder to undo.

Also, if your kid suffers from constipation, you have to put your foot down and get him/her off the mac & cheese diet. Laxatives can solve the problem with bowel movements but they won’t solve the fact that diets high in processed foods do not provide enough prebiotics to foster beneficial bacteria in the lower gut. More on this later, but really, he/she has to eat the veggies.

Tests to request: ultrasound (also called sonography) to establish if the kidneys look normal and could also detect structural abnormalities. Ultrasound is painless and not invasive.

There are other tests that could be performed further to confirm the diagnosis and are used to determine if the bladder is emptying properly and involves a catheter. However, before jumping to more invasive tests or agreeing to any procedures, always go for a second ultrasound with a different specialist, preferably in a different busy urology practice.

You can also send a stool sample to the American Gut or UK Gut to see how diverse your child’s the lower gut microbiome.

Elderly

Chronic bacteriuria (high amount of pathogenic bacteria in the urine) that causes no UTI symptoms is a common issue in the elderly. If you have parents in a nursing home and found out that they are given antibiotics for UTI treatment, ask for a urine test to establish the bacterial count.

It’s a known fact that nursing homes overprescribe antibiotics and frequently even when the case does not meet clinical guidelines for UTI treatment.

Tests to request: a urine test to establish the bacterial count.

#2 Heal Your Bladder To Prevent UTI Naturally

Healing your bladder lining is a critical step to prevent UTI naturally and minimize the symptoms after an acute infection.

Unfortunately, repeated UTIs could cause chronic inflammation of the bladder lining (urothelium) this reduces the ability of your bladder to defend itself from harmful organisms and makes it more susceptible to new infections.

It’s also important to manage inflammation during an active UTI because an early severe inflammation response of your body may predispose you to chronic infections.

Urothelium takes a long time to regenerate, up to 200 days. Keep it in mind when planning your diet and supplement therapy and don’t expect results overnight.

Bladder Health: Decrease Inflammation

Herbs

There are many plants that could produce an anti-inflammatory effect on your bladder. However, you must be careful with how much and for how long you are using any herbal products, especially diuretics (decreased blood potassium levels or hypotension may result as a consequence consuming too many diuretics). Certain health conditions are direct contraindications for any type of diuretics,

I’m not going to cover any of that here since it’s better if you consult with a physician prior to including any herbal tea or herbal supplement into your diet. Natural doesn’t mean safe.

• Cornsilk
• Marshmallow root
• Couch grass
• Aloe vera

Cornsilk is a soothing diuretic. Keep in mind that besides being detoxifying and relaxing, it is also a diuretic. Cornsilk contains volatile oils (such as carvacrol, alphaterpineol, menthol, and thymol), flavonoids (maysin and maysin-3′-ethyl ether). It also contains saponins, tannins, sterols, and alkaloids. All these components could be contributing to their soothing anti-inflammatory and diuretic effects.

Marshmallow root- soothing and healing. Contains large amounts of acidic polysaccharides that form a thick, gluey substance called mucilage. Plants that produce lots of mucilage are traditionally known for their soothing, anti-inflammatory effects.

Couch grass (Agropyron repens) the traditional use of Couch Grass is for ailments of urinary tract, bladder, and kidneys. It is alleged to possess demulcent properties, which function in soothing irritation and inflammation. Couch grass also has diuretic properties.

Aloe Vera (Juice or capsules) (more on it here)

Minerals, Vitamins, And Supplements

There are plenty of supplements that could be useful in your strategy to improve bladder health.

Combination of hyaluronic acid (HA) and chondroitin sulfate (CS) demonstrated promising results in restoring bladder urothelium. More on this here.

Vitamin D: If you have been to a doctor since the beginning of the century you might have heard about the importance of preventing vitamin D deficiency. It is well-known that vitamin D plays an important role in the defense against bacterial infections.

Moreover, There are several studies that demonstrate the link between bladder health and vitamin D deficiency. A cynical study concluded that vitamin D deficiency was a factor in women’s susceptibility to UTIs.

Zinc: In animal studies, a deficiency in zinc was noted to affect the morphology of epithelial cells in the urinary tract. Zinc is also critical for your overall immune system support.

Magnesium is another cornerstone micro-element responsible for mitochondrial health. Healthy levels of magnesium are critical for nearly all wound-healing processes.

#3 Fight Bacterial Biofilms

If you have a chronic UTI, there is a high chance that you are fighting bacterial biofilms stuck in your bladder lining. You need to destroy those biofilms in order to win.

I know, this sounds like quackery or Star Wars, but go to Pub Med and search for “Bacterial Biofilms UTI” to see hundreds of research papers on this topic.

The notion that you are fighting a single-celled organism is misleading and harmful. Pathogenic bacteria organize themselves in clusters and deploy a variety of tactics to remain alive at your expense.

Here is a very detailed post about bacterial biofilms and how to deal with them when you want to prevent UTI naturally.

#4 Decrease Number Of Pathogenic Bacteria

Once you start on a path of combating bacteria biofilms, combine it with a supplement that would help you to reduce the number of free-floating bacteria in your urine to prevent UTI naturally.

• Bearberry (Uva Ursi)
• Buchu
• Garlic
• D-Mannose

Bearberry leaves extracts (Uva Ursi): It turns out that there is a molecule in Uva-ursi called arbutin that in urinary tract transforms into ‘hydroquinone’ — a natural, potent antibiotic

Buchu: In 1821 this herb was in the British Pharmacopoeia as medicine for “cystitis, urethritis, nephritis, and catarrh of the bladder.” Later it was included in the US National Formulary for its’ diuretic and antiseptic properties. Its use since has been abandoned but it’s an interesting supplement to include in your arsenal to prevent UTI.

Garlic is my go-to antibacterial herb when it comes to dealing with any bacterial infection. Personally, I take it if I feel the first signs of any infection: a sore throat, UTI, flue, etc. I tolerate it well and have used both raw and tablet versions. While clinical studies are lacking to support the efficacy of garlic for UTI prevention, there is still plenty of interesting lab research done with this herb to support its use.

D-Mannose: I mention D-Mannose in almost every blog post. This is a simple sugar molecule that has pretty rare side-effects but delivers great results for many. In fact, there is a clinical study that demonstrated that D-Mannose as effective as a low dose of antibiotics to prevent UTIs. Read more about what’s D-Mannose and how to take it.

#5 Improve Vaginal Health

It happens so that most UTIs among women are caused by bacteria that live in our own intestines.

The pathogenic bacteria travel from the anal area toward urethra, with a stop in your vagina.

If your vagina has healthy flora (meaning, plenty of healthy bacteria), the circumstances for bad guys are unfavorable and their chances to reach the final destination (your urethra) are lower.

If the vaginal flora is abnormal (yeast infection, wrong pH, BV, etc..), the opportunistic bacteria can grow and multiply in your vagina, and then eventually reach your urethra.

Bottom line, you need healthy vaginal flora to prevent UTIs. Nope, yogurt alone won’t do it, you’ll need special probiotics.

#6 Balance Intestinal Flora

Remember those antibiotics you took for your UTI? Well, they kill bad bacteria but diminish the number of good bacteria, too.

It’s important that you take a full spectrum of probiotics to re-populate your guts with good bacteria. This, in turn, will decrease the number of pathogens in your lower intestines and reduce chances for a UTI.

Also, good bacteria are responsible for a myriad of various important functions that affect your physical and even mental state.

Feed your good bacteria

Now that you are going to spend money on expensive probiotics, it’s better if you make a couple of changes in your diet. Friendly bacteria are picky and need certain nutrients if they are to repopulate your intestines. That’s right, bacteria need to eat to survive and they thrive on a variety of fibers. The more fiber is in your diet from different veggies, legumes, leafy greens, fruits and berries, the better.

For type A personalities who want to take an extra step in the right direction, there is also prebiotics.

Prebiotic is a type of powder that consists of several dried vegetables and a special type of sugars that are known to feed beneficial bacteria (that you are trying to grow) and at the same time, “bad” guys can’t digest that stuff.

Urine pH & BAC

The right diet full of veggies, fruits and berries also naturally alkalizes your urine and introduces all kinds of bioactive compounds aka BAC (phenolic acids, flavonoids, such as anthocyanins and flavonols, and tannins) as well as important micro-elements like magnesium.

Manage constipation

I don’t know why I’m spending so much time convincing you to eat fruits and veggies, but this boring advice is very important. If you need more motivation, though, consider this: constipation is a known risk factor for UTI.

It’s important to poop regularly for two main reasons.

First, regular bowel movements reduce the number of bad bacteria in the lower intestines.

Second, if you poop regularly, nothing compresses your bladder, you have more space in your lower abdomen and therefore better urine evacuation.

#7 Physical Activity & Healthy Habits

Before we talk about healthy habits, make sure to get rid of unhealthy ones, especially smoking.

Smoking

If you smoke, know that this habit directly contributes to bladder inflammation and other processes that ultimately damage urothelial cell integrity.

As a result, you could be more prone to UTI-like symptoms even if you don’t have an active infection.

Exercising

Are you a couch potato? Lack of exercise is a major cause of chronic diseases.

I know, you were probably hoping to find a miracle pill that will forever cure your chronic UTI and here I am, with the boring advice to eat right and exercise. This type of changes could be the most difficult ones, but in the long run, the most beneficial for your systemic health.

Drink more water

Yes, you’ve heard this before, but drinking more and peeing more is an important step in keeping your bladder healthy.

Switch to water, cut down on sugary and caffeinated drinks to promote urinary tract health (and healthier looking skin). Pathogenic bacteria and yeast love sugar, so choose water over soda.

Bathroom Breaks

Does this description fit you: when you are doing something fun you prefer to wait a bit longer before going to a bathroom? If this is you and you are prone to UTIs, you need to change this habit.

Empty your bladder as soon as you feel the need to go. Waiting it out promotes bacterial growth, so don’t wait. Besides, standing up more often and getting away from your desk is also better for your overall health.

#8 Mindfulness And Gratification

Everybody is stressed nowadays, and everybody is stressing the importance of stress reduction. How ironic. Another thing to worry about is how to be more relaxed.

Instead of listing all the negative impacts that stress can have on your wellbeing, let’s focus on couple tactics that could help you to relax and feel happier. My favorite two are: count your blessings (literally), exercise (discussed above), and meditation.

Count Your Blessings

There are multiple studies confirming that the feeling of being thankful helps on the emotional and physical level.

One of the studies confirmed that gratitude related to 23% lower levels of stress hormones.

This is as simple as writing down five things you are grateful for every day. These could be as little or as big as you want.

List everything that pleased you today. Got home early? Acknowledge it and be thankful. Met with a friend for lunch and had a nice chat? Great, write it down. Ate your favorite ice-cream? Put it on the list.

Since being grateful helps you sleep better you could write (or even just think) about what you are grateful for right before you go to bed.

Meditation

Meditation could be a tough habit to work on, but it pays back.

If you never tried it, just know that meditation is easier than you might think. You don’t have to sit in a lotus pose at the sunrise or repeat mantras, you don’t need an expensive yoga mat. All you need is 5 minutes (for starters), comfortable chair, and an intention to practice.

There are many options that could help a beginner and most of them are free. Check out Real Happiness book by Sharon Salzberg that provides a 28-Day program of how to ease into the practice.

Myths about preventing UTI naturally

Cranberry Juice

While Ocean Spray really wants you to believe in health benefits of cranberry juice, the fact that it contains sugar could do more harm than good. For every juice-industry sponsored study that promotes cranberry juice consumption, there is another with opposite findings.

If you personally believe in the power of cranberries, go for a supplement rather than juice.

Peeing Before And After Sex

This would only be helpful if your urine flow is strong enough. Also, unfortunately, bacteria are smarter than this and are able to attach even stronger when facing a urine flow. Therefore, you can only flush out non-pathogenic E.coli that do not have this mechanism of attachment or other pathogenic bacteria. In general, it’s a useful tip to lower the number of bacteria in the urine but it’s not enough.

More Tips For Women

Change Your Contraceptive Methods

If you are using any products with Nonoxynol-9, check with your doctor to see if you could switch to an alternative option. Nonoxynol-9 is a popular component for many spermicides, and it also is known to be linked to UTI infections. As well as if you have an IUD for over a year.

Thongs

The small piece of the material fits right between your butt cheeks and by sliding back and forth it serves as a bridge for E. coli to conveniently transport from point “A” to point “V” so to speak. There are too many ways the bacteria can get into your vagina anyway, so don’t provide it with even more assistance.

Change Menstrual Pads Frequently

Avoid tight jeans and nylon underwear — they can trap moisture, creating the perfect environment for bacteria growth. Same goes for using liners and pads, change them at least every four hours.

Action plan

• Find a doctor who will be willing to assess your health holistically. Sometimes, a naturopathic doctor is a great option for chronic UTI patients.
• Go beyond supplementation, strive for optimal health.
• When choosing what supplements to take, consult with your physician.
• Many supplements could have adverse effects on your health and only your physician knows your personal medical history and if it’s ok for you to take these supplements.
• Always read instructions and side-effects information for any supplement you intend to take.
• Stop taking and seek urgent medical help if you develop any kind of allergic reaction or unusual new symptoms.