Saturday, July 13, 2024

Ask Dr. Louise: Alternatives for treating bladder infections


Q: I have been having one bladder infection after another. Within a few weeks of finishing an antibiotic, I'm back in the doctor's office with another one. Are there any alternatives to repeated prescriptions of antibiotics that can help me?

Neary 20-30% of women have bladder infections that return. Urinary tract infections, also called UTIs, are painful and annoying. Having one over and over again is very frustrating.

Bladder infections are considered recurrent UTIs when you have more than two episodes within six months or more than three infections per year.

Recurrent bladder infections can be one of two types: relapse or reinfection. When appropriate antibiotic treatment is completed and a second bladder infection occurs soon afterward with the same bacteria that caused the previous one, it is considered a relapse.

A recurrent UTI is considered reinfection if the exact same organism infects again after it has been cured or a completely different bacteria attacks the bladder. When you achieve a negative urine culture after completing a course of antibiotics, that is considered a "cure."

How do recurrent urinary tract infections happen?

Most UTIs result from bacteria that migrate from your intestine into your bladder. This can happen when the intestinal bacteria find a way to stick to the skin next to your vagina and urethra, the area where your urine comes out. Once the bacteria can attach to your skin, instead of being washed away every time you urinate, they can multiply.

These bacteria living around your urethra have now established a "base camp," giving them better access to your bladder. If the intestinal bacteria move upstream through your urethra, they can eventually arrive at your bladder. Inside your bladder, if they can find a way to stick to the inside wall, they can establish a new base.

If the bacteria that have traveled upstream from your urethra into your bladder can stick to the cells that line the inside, they won't be flushed away by urine moving through. Instead, they stay and keep multiplying. This is called colonization.

One way to treat recurrent UTIs is a daily dose of antibiotics to keep the bacteria from multiplying. Unfortunately, this eventually causes the bacteria to develop resistance, and the antibiotic no longer works.

To break the cycle of recurrent UTIs, we need to prevent bacteria from colonizing the inside of your bladder.

Several options can help prevent colonization and reduce the frequency of recurrent bladder infections.

1. Cranberry

Cranberry extract can help reduce repeat bladder infections. However, in several studies of cranberry juice to prevent bladder infection, many participants dropped out, implying that it may not be as effective as other types of cranberry. The most common dose suggested is 400mg of cranberry extract twice daily. Regular use of cranberry may increase your risk of developing kidney stones.

2. Methenamine Hippurate

When combined with hippuric acid, methenamine is more effective than methenamine mandelate. The supplement methenamine hippurate changes into formaldehyde in acidic conditions, and when excreted into the urine, it has bacteriocidal action similar to antibiotics used for bladder infections. For best results, take it with 1 gram twice daily of vitamin C to encourage urine acidity.

3. d-Mannose

One of the sugars found in our diet, d-mannose, may help keep the sides of your bladder slippery, discouraging bacteria from sticking to the walls. Unfortunately, there is not much evidence to prove its effectiveness in preventing bladder infections. Taking d-mannose may cause vaginal burning and diarrhea. 

4. Estrogen cream

After menopause, loss of estrogen reduces the concentration of lactobacilli around the vagina. Lactobacilli create an acid environment, interfering with the proliferation of bacteria around the nearby urethra. With fewer bacteria near the urethra, there is less opportunity for bacteria to migrate into the bladder.

Prescription-only vaginal cream applied to “where the water comes out” can reduce the incidence of bladder infections by 30%, which can be effective in preventing recurrent bladder infections.

5. Phenazopyridine

Phenazopyridine is an orange dye that works to ease the burning that recurrent bladder infections can cause. It numbs the signals of bladder distress but does not remove the bacteria infecting your bladder. Phenazopyridine is usually prescribed in addition to an antibiotic for the first 2-3 days to help ease the burning and urgency of a bladder infection. Available both as 100mg and 200mg prescription tablets and as 95mg tablets without a prescription, phenazopyridine colors your urine a bright orange that stains anything it touches.

Dr. Louise Achey, Doctor of Pharmacy, is a 44-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog,

Ó2023 Louise Achey


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