Urinary tract infections and inflammations are quite common, accounting for approximately 6 million office visits per year in the United States. Dr. Jennifer Brett, a naturopathic physician from Stratford, Connecticut, says only 60 percent of people with symptoms of urinary tract infections have true infections; the other 40 percent have inflammations. The types of infections and inflammations that Dr. Brett commonly sees are true urinary tract infections, urinary tract inflammations, and interstitial cystitis, a more distressing form of inflammation that can last for months or even years.
The cause of urinary tract inflammations is unknown, but some doctors believe they may be caused by viruses, food allergies, Candida in the colon, hormonal changes, new sexual partners, or vigorous sexual activity. Interstitial cystitis may result from infection by Candida or allergic reactions to foods and additives. “These irritants inflame the pelvis and bladder, and the body responds by increasing blood flow to the area,” Dr. Brett explains. “Pelvic congestion causes further irritation and pressure on the bladder. Again, the body responds by sending more blood. This becomes a vicious cycle.”
Dr. David L. Hoffman, in an article posted on the HealthWorld Online website (www.healthy.net), adds that microcrystals of calcium phosphate in the urine may cause mechanical irritation to the bladder walls, resulting in inflammation.
Dr. David Kaufman, a specialist in women’s urological problems, says that there are basically four types of women at high risk. “The most common patients are young, sexually active females. Another large group at risk are postmenopausal women. In fact, 8 to 10 percent of all women over sixty will get a bladder infection at some point. We also see a lot of patients who are hospitalized. The risk of bladder infection increases about 5 percent per day for every day that a catheter is in place. For this reason, medical doctors try to get catheters out as quickly as possible. The last high-risk group is patients with neurological problems. An example would be multiple sclerosis; patients with MS do not completely empty their bladders.”
Dr. Kaufman says, “Many sexually active women get cystitis as a result of intercourse because the bacteria that normally live in the vaginal vault area get pushed up into the urethra. A woman’s urethra is only about an inch and a half long, while in men it is much longer. In females, it doesn’t take too much for bacteria to migrate from the outside of the urethra to the inside of the bladder. That’s why we see so many more young women than men with bladder infections.
“It is very important for women to know that their partners are not giving them infections. The bacteria are already in the vaginal area and simply get pushed into the bladder during intercourse.”
Dr. Hoffman mentions several other risk factors. One is being diabetic or eating a lot of sugars. Another is use of products such as douches, feminine deodorants, antibacterial soaps, and certain contraceptive creams or jellies that irritate vaginal tissue, making it vulnerable to infection. Using a diaphragm can also irritate the urethra. Excess use of antibiotics will promote growth of bacteria resistant to those drugs, which can make cystitis more likely. Finally, he says, eating foods containing pesticides can cause some types of interstitial cystitis.
Dr. Kaufman says there are many reasons that not all sexually active women get bladder infections. “One of the more interesting ones has to do with the woman’s hormonal balance. We know that there are estrogen and progesterone receptors on the lining cells of the urethra. In some women bacteria sticks to these receptors, a condition that is related to hormone levels. Imagine bacteria as little organisms with Velcro hooks. Picture the lining cells of the urethra with the opposite kind of hooks. Bacteria hook on to the Velcro on the receptor sites. In most women, the urinary stream washes away most bacteria. But in women who have specific hormonal environments, the bacteria are not expelled that easily. These are the women we see in our office with recurrent bladder infections.”
Dr. Kaufman adds that postmenopausal women tend to get urinary tract infections for this reason as well. Their low estrogen levels cause their urethral linings to be “stickier” for bacteria. “One way to treat that is simply to insert low-dosage estrogen cream into the vaginal vault, about once a week,” he advises. “Many women are on estrogen pills, but that does not have the same protective influence on the urinary tract as does estrogen cream.”
Dr. Linda Wharton, a naturopathic physician and acupuncturist from New Zealand and author of Natural Woman Health: A Guide to Healthy Living for Women of All Ages, says recurrent bladder infections reflect a state of lowered immunity and weakened vitality. “Remember that cystitis is an infection. As with all infections, individuals with lowered nutritional status, poor cellular health, and lowered immunity are much more susceptible to infection. Women don’t always develop acute cystitis each time a stray bacterium finds its way into the bladder. Often, women play host to these potentially problem-causing bacteria for weeks or months or even a lifetime without ever experiencing acute symptoms. It is only when the health of the whole body is reduced that an explosion of this bacterial population takes place. This may occur, for example, when a woman goes through a period of great stress, such as a divorce or the death of a loved one.”
Dr. Wharton adds that other causes of cystitis are often overlooked. “Pelvic floor muscles can weaken as a result of pregnancy and childbirth. When these muscles are weakened, the bladder may prolapse and bulge forward into the wall of the vagina. If the back part of the bladder droops below the neck of the bladder, it becomes virtually impossible to empty the bladder properly. This leaves an almost permanent reservoir of urine in the bladder. In time, the stagnant urine becomes a haven for bacteria to multiply, should they be present.” Dr. Wharton also says that a prolapsed transverse colon—due to childbirth, age, abdominal fat, poor posture, or spinal problems—can eventually cause bladder problems.
Over time the prolapsed transverse colon—which lies across the abdomen— sags, compressing the organs beneath it, including the bladder. Blood flow is impeded, and the oxygen-starved bladder becomes ripe for infection. She adds, “This same downgrading of tissue health can occur as a direct result of a chronic back problem. All the pelvic organs receive nervous impulses from the spine, and a chronic lower back problem can interfere with those nervous impulses from the spinal cord.” Dr. Wharton advises women with chronic back problems to see an osteopath or chiropractor.
Dr. Wharton says, “Waste materials are excreted from our bodies through several different channels. The bowels excrete in the form of feces; the lungs gets rid of toxins in the form of carbon dioxide; the skin eliminates toxins as perspiration; and the kidney and bladder pass toxins out in the form of urine. If any one of these waste disposal systems is functioning inadequately, it places an excessive load on the others. If you only manage a half-hearted bowel movement every two or three days, you are placing undue stress on your kidneys and bladder, as accumulated toxins are passed out this way instead. In a sense, then, there is actually a direct link between chronic constipation and repeated urinary tract infections.”
Typical symptoms of urinary tract infections and inflammations are frequent urination, a sensation that the bladder is never quite empty, and a burning sensation upon urination. Often women get up at night to urinate. There may be cramps, and the urine may be dark and foul-smelling. In severe cases, there may be blood in the urine as well.
A diagnosis of cystitis is usually made by collecting a midstream urine sample and testing for the presence of bacteria. If the problem stems from an inflammation, no pathogenic bacteria will be found in the urine, nor will bacteria be found on a vaginal culture.
The conventional treatment for cystitis is a course of antibiotics. Standard therapy for chronic cystitis generally consists of repeated rounds of the same therapy.
In the long term, this practice may actually exacerbate the condition rather than cure it. It is well known that broad-spectrum antibiotics are indiscriminate killers that destroy colonies of friendly gut bacteria along with problem-causing organisms. Once the delicate balance of the normal gastrointestinal microflora has been disrupted, less desirable organisms proliferate, virtually unchecked. These include Escherichia coli, the prime cause of cystitis, and candida overgrowth, a suspected cause of inflammations.
Dr. Kaufman says that antibiotics should be a last-ditch effort, used only when various holistic protocols fail to achieve results. Even then, mild medicines should be used: “What of women who do all the right things, and still come back with bladder infections? In these cases, we need to turn to more traditional medical approaches. The gold standard for treating patients who do everything right and still get infections is a very gentle, bacteriostatic antibiotic. A bacteriostatic antibiotic does not kill the bacteria, but limits bacterial growth. It is gentler on the system, and generally does not cause yeast infections or gastrointestinal problems. I am not big on taking antibiotics, but this is a better alternative than constant infections.”
Dr. Brett reports that radical therapies are sometimes used for persistent cases. “Treatments I have read about in recent medical journals include surgery to cut nerves to reduce irritation to the bladder, hormonal therapy, and even antidepressive medications to help women sleep better, even though this doesn’t get at the root cause of the problem.”
It is important to drink plenty of pure water, about one 8-ounce glass each hour. “If you are in agony and you don’t know what to do, start drinking water and don’t stop,” advises Dr. Wharton. “Stay away from tea, coffee, soft drinks, and alcohol, but drink plenty of water.”
Cranberry, either in the form of unsweetened juice or capsules, changes the pH of the urine, making it more acidic and less hospitable to bacteria. Cranberries also contain powerful antibacterial substances. In fact, studies reveal that as little as 15 ounces of cranberry juice results in an 80 percent inhibition of bacterial growth. Bacteria lose the ability to cling to the bladder wall and must exit the system along with urine. Other research indicates that cranberry juice combined with vitamin C acidifies the urine further. The effect is therefore much greater when both are taken together.
Other drinks useful for temporarily acidifying the urine include lemon juice and water, buttermilk, and 2 teaspoons of apple cider vinegar stirred into a glass of water. Drink any of these substances three or four times a day.
Any time the body is fighting an infection, it tolerates large amounts of C, sometimes as much as 10, 000 to 15, 000 milligrams orally each day (and even more intravenously). For cystitis, or for any infection, take vitamin C to bowel tolerance. (Bowel tolerance is where the stool becomes quite loose, almost to the point of diarrhea.) Vitamin C should be taken every two to three hours since it is water-soluble, which means that it is rapidly excreted from the body. According to Dr. Hoffman, recent studies indicate that ascorbic acid irritates the bladder. For this reason it is best to take vitamin C in the buffered form of calcium ascorbate. Aspartate also irritates the bladder, so avoid vitamins that contain it.
Dr. Wharton says that vitamin C fights infections in several ways. “Vitamin C concentrates in very high levels in the urine and exerts a direct bactericidal effect. It also supports systemic immune system function by helping to activate neutrophils, the white blood cells most involved in the front line defense against infection. It also works to stimulate the production of lymphocytes, which are important for coordinating immune function at the cellular level.”
In addition to vitamin C, think about vitamin A. An easy way of supplementing with this vitamin is to use halibut or cod liver oil capsules, up to 25, 000 IU a day, during acute phases of infection. Vitamin A helps protect the mucous membrane lining of the bladder and urethra from irritation during infection. It also improves antibody response and white blood cell function. Just a word of warning here: if you are pregnant, do not use such high doses of vitamin A, as they have been associated with birth defects. Beta-carotene, with which the body can make vitamin A as it is needed, is a safer alternative.
Zinc is essential for increasing white blood cell activity in response to infection. For acute cystitis, approximately 50 milligrams elemental zinc is needed daily.
One teaspoon daily.
One teaspoon daily.
The classes of herbs used to treat cystitis include antiseptic herbs, demulcents, and diuretics. Antiseptic herbs for bladder infections include uva-ursi, buchu, goldenseal, juniper berries, and garlic. “Think garlic whenever you have any type of infection, including cystitis,” says Dr. Wharton. Demulcents soothe inflamed mucous membranes inside the bladder and urethra, and include marsh mallow root, juniper berry, and corn silk. Diuretic herbs stimulate the production and excretion of urine, which helps to wash out bacteria. Common diuretics are parsley and goldenrod.
Dr. Wharton recommends the following old naturopathic herbal remedies for treating burning urine: “Mix together equal parts of fennel, burdock, and slippery elm. Steep a teaspoon of this mixture in a cup of boiled water for about twenty minutes. Have one cup before each meal, and one before bed.”
She also recommends flaxseed tea or a combination of uva-ursi and buchu: “For either tea, use 1 teaspoon of the dried herbs to a cup of boiling water. Again, let it steep for fifteen to twenty minutes. Then drink one cup, three or four times a day. The results more than compensate for the awful taste.
Dr. Hoffman recommends the following formula for cystitis: Combine two parts corn silk, two parts uva-ursi, and one part buchu. Take 5 milliliters of this tincture three times a day. At the same time, drink an infusion of yarrow, another antiseptic herb, throughout the day.
Dr. Tori Hudson, a naturopath in Portland, Oregon, in her column for Prevention magazine recommends the following combination of herbs, either as capsules or in tinctures: pipsissewa, uva-ursi, echinacea or goldenseal, and buchu.
For two days, take two capsules or 20 to 30 drops every two hours. For the next seven days, take the capsules or tincture three times daily.
Dr. Joseph Pizzorno adds this bit of advice: “After sexual intercourse, women should wipe the opening to the urethra with a dilute solution of Betadine or a strong solution of goldenseal tea to wash away any bacteria that may have been forced up into the urethra.”
Judyth Reichenberg-Ullman and Robert Ullman, naturopathic and homeopathic doctors in Edmonds, Washington, in an article posted on the HealthWorld Online website (www.healthy.net), recommend Cantharis (Spanish fly), a frequently used remedy in cases in which extreme pain in the bladder occurs very suddenly and there is blood in the urine. Staphysagria (stavesacre) is the remedy to use when a bladder infection has developed after having sex (“honeymoon cystitis”). When cystitis is associated with pain in the kidney area, especially on the right side, they suggest Berberis aquifolium (Oregon grape).
Hydrotherapy is another traditional naturopathic method for helping people overcome the discomforts of cystitis. Sitz baths or hot compresses stimulate blood circulation and remove toxins from the pelvic area. Dr. Wharton explains how this is done: “You can use a hot compress by dipping a small hand towel into a basin of water, as hot as you can possibly tolerate it. Wring out the water and quickly apply the cloth to the area just above the pubic bone. As the cloth cools, repeat the process. In total, apply the compress eight or nine times. Repeat this process two to three times throughout the day. It actually feels wonderful and gives quite a bit of local relief to the symptoms.
“Alternatively, you can try making a sitz bath. Fill a small tub with water, once again, as hot as you can bear it. Add 6 drops bergamot oil, and sit in the bath so that water actually covers your pelvis and lower abdomen. Stay there for around half an hour. As the water cools, keep replenishing with fresh, hot water to keep the water up to a hot, even temperature. Just a word of warning: If you have a problem with a weak heart or high blood pressure, hot sitz baths aren’t really for you. You are better off just using a local compress.”
Dr. Wharton reports impressive results in the treatment of chronic cystitis with acupuncture when it is accompanied by lifestyle and dietary changes: “Usually an acute attack of cystitis responds to two to four acupuncture sessions, spaced two or three days apart. Chronic cystitis sufferers often benefit from an extended course of acupuncture treatment to prevent the recurrence of their problem.”
Essential oils can enhance any treatment program, according to aromatherapist Ann Berwick. To help clear up a urinary tract infection, 18 to 20 drops of juniper and cedarwood can be added to 1 ounce of lotion and massaged into the lower abdomen. Also, 6 to 8 drops of juniper, bergamot, or sandlewood can be added to a sitz bath or full bath.
Judyth Reichenberg-Ullman and Robert Ullman caution further that it’s important not only to rest but to pay attention to whatever message your body is giving you with this bladder infection, in order to avoid recurrences. Therefore, consider what might be its underlying cause. They add that breathing into the pain and relaxing can be remarkably effective: “We had one patient who cured a bladder infection solely through visualization and meditation.”
For urinary inflammation not caused by bacteria, Dr. Brett says it is important to avoid foods that encourage the growth of candida, such as wheat, simple sugars, white flour, pastries, candies, alcohol, aged cheeses, vinegar, and even fruit. Avoid known food allergens. It is a good idea to get a test to determine if there are any other foods in the diet that are acting as irritants.
As with bacterial infections, you should drink one 8-ounce glass of water every hour. It is also a good idea to drink a glass of water and to urinate immediately after sexual intercourse. This tends to reduce the bladder irritation that sexual intercourse may cause.
Clothing is important too. Avoid tight-fitting pants, nylon underwear, and pantyhose. They encourage the growth of candida in the vaginal tract, which irritates the bladder and urethra.
Vitamins and herbs may also be useful. For vitamins, take 2, 000 to 6, 000 milligrams of buffered vitamin C and 100 to 200 milligrams of vitaminB6. Also take four to six capsules of evening primrose oil. Herbs that soothe the bladder include althea or marsh mallow, corn silk, slippery elm, and goldenrod. Finally, as with bacterial infections, the homeopathic remedy Cantharis (Spanish fly) is often effective in reducing bladder and urethra irritations.
“The basic way to treat interstitial cystitis,” says Dr. Brett, “is to remove congestion from the pelvis.” The therapies she suggests in cases of interstitial cystitis are listed below. “If you follow these basic guidelines,” says Dr. Brett, “within three to four weeks, you are likely to notice that your ability to sleep through the night is improved and that your cramping and pain during the day is significantly lessened.”
It is a good idea to be tested for food allergies to see if some food is causing an antibody-antigen reaction and irritating the bladder. It is also important to test for candida in the colon because candida can cause irritations and antibody reactions that irritate the bladder. Next, check to see that the hormones are in balance. If they are not, use vitaminB6, evening primrose oil, and herbs to restore hormonal balance.
The two types of exercise that help in cases of interstitial cystitis are aerobic exercise and inversion exercise. Doing aerobic exercise every day helps to remove blood congestion from the pelvis. Aerobic means anything that gets the blood moving, such as walking briskly, jogging, swimming, and bicycling.
Specific exercises for moving the blood involve turning upside down. In yoga, this is accomplished with the headstand or shoulderstand. It can also be achieved by lying on the back, raising the legs up, and performing cycling rotations with the legs. If there is a back or neck problem, however, a simple solution is to use a slant board, which can be made simply with an old door or a couple of one-byfour boards. One end can be placed on the couch, and the other end on the floor. Once it is stable, the person lies upside down, that is, with the head near the floor and the feet near the couch. The blood is automatically pulled out of the pelvis by gravity, and moved into the chest and head. Remaining too long can cause dizziness; five or ten minutes works for most people.
The soothing herbs previously mentioned are useful here as well: marsh mallow, corn silk, slippery elm, and goldenrod.
A low-acid diet decreases irritations. High-acid foods to omit are red meat, dairy, shellfish, and citrus fruits. The diet should include whole grains, beans, and vegetables. Essential fatty acids, such as those found in flaxseed oil, evening primrose oil, and fish oils, can help reduce inflammation. In interstitial cystitis, they are key for reversing the cycle of irritation and blood congestion.
Long-term preventive changes obviously make a lot more sense than simply dealing with each acute infection as it arises. Here are some simple personalhygiene measures to reduce the likelihood of reinfection:
Dr. Hudson suggests drinking one glass of cranberry juice (or the equivalent in capsules) and taking vitamin C every day to reduce the frequency of recurrent attacks of cystitis by creating an acidic environment in which bacteria cannot easily grow.
“Remember that your bladder health reflects your overall health,” says Dr.Wharton, “so take a good look at your lifestyle. Ask yourself, ‘Do I eat a nutritious, balanced diet? Do I get enough relaxation and sleep? Am I under stress?’ Maybe you drink too much coffee or alcohol or smoke or use recreational drugs. If your lifestyle is unhealthy, your body will be too.”
Dr. Brett explains that traditional Chinese medicine views cystitis as the end result of an accumulation of damp and heat in the bladder: “Often there is a weak flow of chi (energy) in the kidney and the spleen meridians. Weakness of spleen energy leads to the formation of damp in the body, which, in turn causes a stagnation of energy. As in nature, whenever anything builds up, there is friction. A stagnation of chi eventually leads to the development of heat, what we in the West interpret as cystitis.
“Spleen chi is easily disrupted through dietary indiscretion. Spleen chi can be damaged by any of the following: overeating; drinking with meals; overconsumption of damp-forming foods, such as dairy products, chilled foods or drinks, and raw fruits and vegetables; and eating greasy foods, such as takeout foods.
“What you do with your mind actually affects spleen energy as well. An overuse of the mind, particularly through chronic anxiety and worry, or through many years of overstudying, also tends to deplete spleen energy.
“When the cooling yin energy of the kidneys is weakened, cystitis becomes much more likely as well. Kidney yin is consumed naturally as we age, but it can also be prematurely diminished as a result of lifestyle. The long-term overwork, stress, and exhaustion that form a part of many American lives these days, along with an overconsumption of alcohol and too much sex, all deplete the vital kidney energy.” Acupuncture, combined with lifestyle changes, can help to balance energy and eliminate cystitis.
An increasing body of evidence is showing the benefits of natural modalities to overall health and well-being. Following is a sample of recent peer-reviewed scientific studies regarding urinary tract infections and inflammations.
In a 2014 study published in World Journal of Urology, researchers determined that D-mannose, a naturally occurring sugar, significantly reduced the risk of recurrent urinary tract infection (UTI), and that its effectiveness was similar to that of the antibiotic Nitrofurantoin but without any side effects. The women in the study received 2 grams of D-mannose powder in 200 milliliters of water daily for six months. Although many studies have examined the use of cranberry juice for UTIs, a 2012 report in the Cochrane Data of Systematic Reviews concluded that its benefits were minimal. However, as reported in 2015 in the International Journal of Molecular Science, cranberry phenolic compounds were found to have anti-adhesive activity against Escherichia coli, which indicates that they could work against bacterial colonization and progression of UTI. Other substances shown to be effective against UTI include ascorbic acid, probiotics, berberine, hibiscus, and pumpkin seed extract.