Urinary Tract Infections or UTIs are a common problem for women, but men are not immune.

We have posted previously on the topic [1-4]. UTIs are a particularly vexing problem for the wheelchair community, because for most in that category, the bladder does not fully empty out. That goes for elderly ambulatory men, too.

Remedies vary from antibiotics to cranberry juice with various degrees of success. Success here can be defined in two steps:

  1. Eradication of the infection, this is mostly the domain of antibiotics
  2. Prevention of recurrence. This is where most of problem lies.  Powerful antibiotics, like Ciprofloxacin, often have to be used with increasing frequency. The antibiotics can cause damage to the bowel’s beneficial microbes, or flora, as they are called. This in turn makes the person more vulnerable to the next infection, particularly from a bacteria called  Clostridium Difficile.(C. Diff)

 

Clostridium Difficile Wiki Commons

 

The C. Diff can be  a serious problem for the bowels, and bring about colitis. Worse, as we will see, antibiotics by eradicating “good” bacteria such as Lactobacillus, promote eventual re-infection by UTI specific bacteria such as E. Coli [5]

 

UTI bacteria: E. Coli (Wikipedia Commons, NIH)

 

 

E. Coli is not the only possible uninvited guest:  Staphylococcus saprophyticus, Proteus mirabilis can infect too, as well as, but less frequently: Klebsiella spp. Proteus vulgaris, Candida albicans, Pseudomonas spp.

So, what can be done to prevent, or at least decrease the frequency of UTI recurrences?

The most accepted natural defense is cranberry juice, although some studies are not so sure [2]

But another prevention method is through re-population of the beneficial gut bacteria population in order to restore balance. This is the now well publicized probiotics (as opposed to antibiotics) approach for general health, including the immune system [3,4]

Think of probiotics as organic farming... In many organic farming techniques of pest containment, one brings beneficial insects to compete and oppose a predatory insect species. Here too, “beneficial bacteria” is reintroduced to compete with out of balance species, such as Clostridium Difficile, against which the antibiotic was less effective. As for E. coli, the main UTI culprit, the antibiotic usually succeeds in beating back the infection, but at the cost of  casualties on Lactobacillus and others, to use a military metaphor. Now that Lactobacillus has been eradicated too, when E. coli reappears , it will be unopposed.

And reappear it often will, because re-infection may also occur via the blood or lymph even though the bacteria is usually transmitted to the urethra from the bowel.  

In addition, the antibiotic success itself in the bladder is often partial:

Quoting the Drugs Journal [12]:

“…Culture analysis of bladder biopsies taken from women with recurrent UTI symptoms after antibiotic therapy revealed that 8 of 33 (24%) patients had positive bacterial cultures from the biopsies despite sterile urines...” 

 

Urinary Bladder

 

Infectious bacteria can hide and dwells in the bladder wall epithelial tissue, partially shielded from the antibiotics.

 

Urinary Bladder Wall (Epithelium) Harnblase, Urothel, H.E.-Färbung, Wikipedia

Since we are usually more concerned about the gut bacteria, oral supplementation makes sense. However, the gut is not the only location where bacterial balance is required for health.

Since UTIs mostly affect women, the probiotic  bacteria,  usually Lactobacillus are deposited in the vagina because as in the gut, bacteria homeostasis is important.  Because in women, bacteria from urethra, vagina, and bowel interact, re-populating those various areas with the required defensive bacteria has been shown to often work, and decrease UTI frequencies [12]

Keep in mind that probiotics, not only seems to help prevent UTIs, but also helps  contain intestinal infections they can cause,  if they must be taken [13]

Are Lactobacillus probiotics entirely risk free? Quite safe according to the CID Oxford Journal [14]. But Livestrong [15] has a caution for people with:

  • artificial heart valves,
  • weak immune system
  • intestinal damage or recent intestinal surgery

Also, rare problems have been seen in pediatrics. [16]

 

Note:

Diabetes patients are more susceptible to UTIs, quoting and excellent entry by Medscape [17]:

“… High urine glucose content and defective host immune factors predispose to infection. Hyperglycemia causes neutrophil [white blood cells] dysfunction by increasing intracellular calcium levels and interfering with. Vaginal candidiasis and vascular disease also play a role in recurrent infections…”

In other words, high glucose impedes white cell defense efficacy.

Talk to your Doctor about probiotics, antibiotics,  and you!

 

Sources:

  1. medinewsdigest ; Urinary Tract Infections
  2. medinewsdigest ; ”IN BRIEF: A Study Questions The Benefits of Cranberry Juice Against Urinary Tract Infections” ; Oct 2012
  3. medinewsdigest ; “”Antibiotics Can Damage Your Digestive Tract: Can Probiotics Help?” ; Jan 2012
  4. medinewsdigest ; “Are Probiotics Gut Bacteria Good or Bad For Multiple Sclerosis Or Other Autoimmune Diseases? ” Oct 2011
  5. Small Ruminant Research ;”Inhibitory effects of Lactobacillus casei upon the adhesion of enterotoxigenic Escherichia coli K99 to the intestinal mucosa in gnotobiotic lambs” ; 1997
  6. Clin Diagn Lab Immunol. ;” Persistence of Lactobacillus fermentum RC-14 and Lactobacillus rhamnosus GR-1 but Not L. rhamnosus GG in the Human Vagina” ; 2002
  7. camwatcher ; ”Recurrent Urinary Tract Infections? No More or at Least Less Often.” ; Oct 2012
  8. European Review For Medical and Pharmacological Sciences; “Lactobacilli for prevention of urogenital infections: a review” ; 2004
  9. LifeExtension ; Urinary Tract Infections ;
  10. CAMwatcher ; “Recurrent Urinary Tract Infections” ; Oct 2012
  11. JAMA ; Archive of Internal Medicine ; “Lactobacilli vs Antibiotics to Prevent Urinary Tract Infections” ; May 2012
  12. Drugs ; “Probiotics for Prevention of Recurrent Urinary Tract Infections in Women”; 2006
  13. BMJ ; “Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis” ;June 2002
  14. cid-oxfordjournal; “Safety of Probiotics That Contain Lactobacilli or Bifidobacteria ” ; 2003
  15. LiveStrong ; “ACIDOPHILUS VS. LACTOBACILLUS ” ; May 2011
  16. Pediatrics  ; “Lactobacillus Sepsis Associated With Probiotic Therapy ” 2005
  17. Medscape ; “Urinary Tract Infections in Diabetes Mellitus” ; Dec 2011
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