UTI Treatment: What to Know About Supplements and Prevention - The New York Times

More than half of American women will have a urinary tract infection during their lives. But can supplements really stave that off?

In glossy photos on Instagram, a manicured hand pours powder into a liquid that turns pink, gleaming in the sun. Crushed amber specks shimmer under stubby capsules beside the caption: "Two pills a day can help keep the U.T.I.s away!" A cartoon heart twinkles alongside boxes of pills and powders — with "U.T.I.S SUCK, YOU DON'T," scrawled at the center.

Drinking cranberry juice has long been the prevention strategy du jour. Now, women looking to ward off urinary tract infections can sip pink lemonade and berry-flavored concoctions, or pour pills out of pastel bottles.

Over the last 10 years, a proliferation of products with cutesy names and slick branding marketed to women — U.T.I. Don't Think So, Happy V, VeeTract, Uqora — have dangled the potential of a future without U.T.I.s (though they are careful to caveat that their products are not intended to diagnose, treat, cure or prevent diseases). But gynecologists and urinary health experts aren't sure whether supplements can protect against these infections.

"It could be that you're just making expensive pee," said Dr. Erin Higgins, an OB-GYN at Cleveland Clinic.

What is a U.T.I., anyway?

Bacterial cystitis, the most common type of U.T.I., occurs when bacteria like E. coli travel from the rectum, genital area, or vagina, settle in the urethra and enter the bladder, where they multiply. This can cause abdominal cramping and burning, bloody, frequent urination.

Most U.T.I.s are uncomfortable, but largely innocuous, said Dr. Benjamin Brucker, a urologist and urogynecologist at N.Y.U. Langone Health. In rare cases, however, a U.T.I. can infect the kidneys, leading to fever, chills, lower back pain and vomiting.

Anyone can develop a U.T.I., though women have shorter urethras, making it easier for bacteria to reach the urinary tract and then spread to the bladder. Over half of adult women will get at least one at some point in their lives, and roughly 25 percent will get recurrent urinary tract infections, which usually means three or more cases within a year.

Doctors typically recommend prescription antibiotics to treat U.T.I.s, although in recent years scientists and physicians have raised concerns about infections becoming drug-resistant. Antibiotics remain the leading way to treat U.T.I.s, but concerns may lead patients to seek alternatives for treatment and prevention, said Dr. Stacy Lenger, a urogynecologist at UofL Health and the University of Louisville School of Medicine.

Do supplements help stave off U.T.I.s?

The Food and Drug Administration does not closely regulate supplements, which means there is limited data on whether they are effective. And, without results from large-scale clinical trials, it's unclear whether U.T.I. pills and powders actually prevent infection. (Uqora started a clinical trial for its U.T.I. supplement, but canceled the study in March 2020 because of the pandemic, a representative from the company said. The company has plans to reinstate the study.)

Still, there is some evidence that the individual ingredients in these supplements may provide a slight benefit, especially for people with frequent U.T.I.s — and they're unlikely to have significant side effects, said Dr. Monica Woll Rosen, an OB-GYN at University of Michigan Medical School.

Cranberry, the most common ingredient in U.T.I. supplements, has long been touted as an at-home elixir to ward off the infection. There's encouraging, but scant, data to support this: A 2017 meta-analysis found that cranberry reduced the risk of developing a U.T.I. by 26 percent in otherwise healthy women with a history of urinary infections, but the studies had small numbers of participants.

The American Urogynecologic Society issued a Best Practice Statement for recurrent urinary tract infection in adult women that states "the preponderance of evidence does not support routine use of cranberry products in the care of women with" recurrent U.T.I.s.

In 2020, the F.D.A. concluded that there is "limited credible scientific evidence" to suggest that certain cranberry supplements and beverages would lower the risk of recurrent U.T.I.s.

Many U.T.I. supplements also contain d-mannose, a simple sugar related to glucose. A review of previous studies on the chemical found that it may provide protection against recurring U.T.I.s. "Overall, d-mannose appears to be effective when compared to a placebo," said Dr. Lenger, the lead author of the review. "But that's taken with the caveat that this is a small amount of data." In large doses, d-mannose may cause gastrointestinal side effects, like diarrhea and flatulence, she added, but overall, most people tolerate it well.

Vitamins, especially vitamin C, are also present in many of the supplements that claim to protect against urinary tract infections. Some doctors think that vitamin C can combat bacterial growth, in combination with other supplements, by theoretically acidifying the urine, said Dr. Jerry Lowder, a urogynecologist at Washington University in St. Louis School of Medicine.

"With any therapy, you've got to think: What's the risk, what's the benefit?" Dr. Brucker said. "If there's a low risk, and there's some data that says it might work, it might be reasonable for a doctor to say, let's consider these remedies."

However, because these products are not subject to rigorous oversight, supplement ingredients can vary in quantity or quality. And without the guidance of a medical professional, a patient may inadvertently take a supplement that interacts with their current medication. "The big problem with any of these things is quality control," Dr. Brucker said.

Can anything else prevent U.T.I.s?

Doctors aren't completely certain why some people experience recurring U.T.I.s and others never have them. Those who frequently contract U.T.I.s are often prescribed low-dose daily antibiotics. For the general population, though, there are simple steps to help protect against these infections.

Basic hygiene is essential: Women should always wipe from front to back after using the toilet, to ensure bacteria from the rectum does not travel near the urethra. For both men and women, it is important to stay hydrated, and to urinate throughout the day — don't try to hold it for uncomfortably long stretches, Dr. Higgins said.

During perimenopause and menopause, women may be at higher risk for U.T.I.s as estrogen levels decrease. Topical vaginal estrogen is the "gold standard" non-antibiotic treatment to prevent recurrent U.T.I.s in this population, Dr. Lowder said.

And, true to conventional wisdom, urinating after sex can reduce the risk of developing a U.T.I. by flushing bacteria out of the vagina, Dr. Rosen said, although evidence backing up the effectiveness of that habit is thin.

"There's really no data for it," Dr. Brucker said.

Doctors cautioned against assuming all vaginal irritation or pain is a U.T.I. Common U.T.I. symptoms can also indicate bacterial vaginosis, yeast infections, sexually transmitted infections, urinary incontinence and even bladder cancers. If a patient experiences the symptoms of a U.T.I., and especially if blood is present in their urine, they should seek a medical professional. If you don't have a primary care doctor, urgent care centers can also diagnose U.T.I.s, Dr. Higgins said.

If you assume you have a U.T.I. and reach for a supplement to treat or prevent the infection, "there's harm in not making sure you have a right diagnosis," Dr. Brucker said. "A simple exam can assess for these things. A cranberry supplement can't."

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