Urinary tract infections (UTIs) are no fun. The pain, the burning, the constant need to "go," and the frustration from being unable to—it's enough to make a grown man cry. In the movie The Green Mile, Tom Hanks does an excellent job portraying how awful a UTI can be.
The news is even worse if you're a woman, since your chance of experiencing a UTI at least once in your lifetime is quite high (men do get them, but it's less common). And recurrent UTIs can be especially debilitating.
We asked Dr. Angel Marie Johnson, the director of our Women's Health Center in Dedham, to join us for a Q&A about recurrent UTIs, including her take on a common question: can cranberry supplements help prevent urinary tract infections?
As always, the information below is educational, not medical advice. If you have (or think you have) a UTI, speak to your doctor. Or click here to schedule an appointment with Dr. Johnson or one of our other world-class physicians.
What is a recurrent UTI?
DR. JOHNSON: A recurrent UTI is when you have more than two infections in six months or more than three in a year. These are culture proven, meaning you've given a urine sample to your doctor, they've sent it to the lab, and it grew bacteria.
If you have a patient who meets this threshold, what do you do next?
DR. JOHNSON: Once we've confirmed the patient is indeed experiencing recurrent UTIs, I'll conduct two tests: a renal bladder ultrasound and an office cystoscopy.
The renal bladder ultrasound is non-invasive and is performed in the office (sometimes during the same day as the patient's initial visit). The patient remains fully dressed, and we put a probe on her back (the probe functions similarly to ultrasounds that pregnant women receive).
The probe allows us to see the kidney's structure and make sure there aren't any masses, cysts, structural abnormalities, or stones. Structural abnormalities are common sources of infection. So we want to make sure there's nothing there causing these frequent infections. If there is, then we need to remove that source first before considering preventive measures.
While I can technically "see" the bladder during the ultrasound, it's essentially a black bubble—I can't see inside or properly assess the health of the bladder tissue. This is why I also conduct an office cystoscopy.
The cystoscopy is an office-based procedure as well—and it's short, only about a minute long and only involves minimal discomfort. In the office, I first use a small amount of numbing gel, and then I pass a flexible scope through the urethra into the bladder. I slowly fill the bladder with water. Then, I take a 360-degree survey of the bladder. During the procedure, I note the bladder's shape, appearance, and function. I make sure there aren't any masses or any stones. I look for scarring, areas of thickness, or anything that appears concerning, such as cancer or some kind of injury that might be contributing to the patient's bladder dysfunction and increasing their risk of developing a UTI.
If these two tests don't reveal an underlying source causing the patient's recurrent UTIs, the patient and I discuss preventive measures.
Perfect segue. Talk to our readers about preventive measures. There's a lot of talk—and controversy—regarding cranberry.
DR. JOHNSON: When it comes to UTI prevention, I support the use of cranberry for UTIs caused by E. coli bacteria. E. coli causes the majority of UTIs—upwards of 80%.
[Editor's note: there are many different strains of E. coli. The E. coli often highlighted in the news and related to food contamination is different from the strain that causes recurrent UTIs.]
It's important to note that the bacteria itself doesn't cause the symptoms associated with a UTI. Instead, the human immune system's attempt to fight the infections is what results in the classic "UTI symptoms": burning with urination (dysuria), urinary frequency, urgency, and occasionally blood in the urine or even urine leakage. UTI symptoms commonly change with age as the immune system responds differently as a person ages.
Cranberry is beneficial to prevent UTIs, because cranberries contain proanthocyanidins (PACs), which help prevent E. coli bacteria from binding to the bladder. Instead of developing an infection and the resulting symptoms, you'll simply release the bacteria from your bladder when you urinate since the bacteria aren't binding to the bladder.
Again, cranberry is effective for a UTI caused by E. coli. It does not work for every agent that causes UTIs.
So a person suffering from recurrent UTIs caused by E. coli should drink cranberry juice or take cranberry supplements?
DR. JOHNSON: No. Here's the issue: not all cranberry supplements are created equal. The amount of PACs in the supplement is critical for efficacy. Many different types of cranberry supplements are on the market, but the FDA doesn't regulate supplements. So you don't always know if you're indeed getting the number of PACs that the packaging promises.
In fact, a recent study by a medicine called Ellura, which is one of the newest UTI preventative medicines on the market, looked at different brands of cranberry products. The researchers discovered many packaging labels were inaccurate—many supplements didn't contain the amount of PACs that the labels promised, and some didn't contain any PACs at all. And cranberry juice is also problematic because of the amount of juice you'd need to drink in order to get the right amount of PACs (not to mention the amount of sugar in that juice). So drinking enough cranberry juice for prevention purposes isn't realistic or even healthy on a day-to-day basis.
Is there a cranberry supplement you do like?DR. JOHNSON: At GBU, we use a cranberry supplement through Theralogix called Thera Cran One. It's been independently tested to make sure that its labeling is accurate. We also like TheraCran One because it's been found to be more available in the bladder. When you take a pill by mouth, it gets absorbed by your bloodstream, and then your different tissues seize it. In cases of UTIs, your organ of interest is the bladder, so you need to make sure that the medicine is concentrated in the bladder to prevent infections. And TheraCran One does this.
So I am a supporter of the right cranberry supplements for E. coli predominant UTIs because, again, it is effective, but here's another big caveat: cranberry is rarely effective alone. It's rare that I can just give someone cranberry and she will never have another UTI.
What other preventive therapies do you recommend in addition to TheraCran One for UTIs caused by E. coli?
DR. JOHNSON: Usually, I use TheraCran One in combination with other therapies. For women who have vaginal dryness, or vaginal atrophy, due to lack of estrogen in the vagina, I recommend vaginal estrogen cream. It comes in different forms. There are three different creams on the market. There's an estrogen ring as well as estrogen tablets, suppositories, and capsules that all go in vaginally. So, I would give them cranberry and a source of estrogen.
By doing that, I'm treating both the bladder and the vaginal area. Treating the vaginal area ensures that the vaginal tissue remains healthy. Studies have shown if you have good probiotic bacteria in the vagina, which is called lactobacilli, then that helps protect the bladder from infections, and it helps decrease the person's risk for developing UTIs. When I give one of my female patients both cranberry tablets and vaginal estrogen cream, I'm protecting them in two ways to help decrease their UTIs.
When you recommend cranberry, is that something a woman would be on for the rest of her life?
DR. JOHNSON: Not necessarily. My goal when it comes to UTIs is that I want them to be infection free for six months—to essentially have them fall back into the general risk pool of having one to two infections a year versus an infection every month, or more than two in six months. Also, by having a patient go six months or more without an infection, it allows the bladder to heal. Antibiotics kill bacteria but do not heal the bladder. Healing takes time. As a rule, I have my patients take cranberry supplements for six months.
How do patients get TheraCran One? Do they need a prescription?
DR. JOHNSON: You don't need a prescription. Anyone can order TheraCran One via the telephone or online from Theralogix. If you're a GBU patient, you'll receive a 10% discount (we provide you with the discount code/card). You can get other cranberry products at your local pharmacy, but those are some of the brands that have been shown to not be as effective as previously thought (and, again, there's no way to know if the packaging is accurate regarding the amount of PACs in the supplement). So if you're going to invest in this line of treatment, you want to make sure you're getting an effective cranberry supplement. And, of course, it's important to talk to your physician first. Don't start any sort of supplement on your own without consulting your doctor.
What's the biggest misconception you encounter regarding UTIs?
DR. JOHNSON: The biggest myth is that they're due to hygiene concerns. Here's the truth: If you have a normal functioning immune system and good hygiene, you don't get a UTI because you're dirty. You don't get a UTI because you're wiping the wrong direction. Your body is designed better than that.
You also don't get a UTI because you're wearing the wrong type of underwear. I see women who go out and purchase white cotton underwear, thinking that that will decrease their UTIs. Wearing cotton underwear alone is not going to prevent your UTIs. Many women think that peeing immediately after intercourse will decrease the risk of UTI. That's a point of contention, even in the medical community: it might help; it might not. It's not going to hurt, but it won't prevent an infection that may have already set in.
But I would say the biggest misconception is that women think they are somehow not cleaning themselves appropriately and that more is better. In fact, I see many women who douche, thinking they somehow have to internally clean the vagina. That can hurt more than it can help.
So for most of my patients, I actually have to tell them to do less. Just clean with toilet paper the normal way you would and wipe until clean and that's good. You don't need moist towelettes. You don't need special washes. Because those things can actually inhibit the body's normal regulatory system.
Thanks, Dr. Johnson!
Do you suffer from recurrent UTIs? Are you in the greater Boston area? If yes, consider making an appointment with Dr. Johnson or one of our other world-class physicians.