Skepticism

Ask Surly Amy: Bladder Infections, UTI’s and Cranberry Juice

Hi Amy,

You’ve tackled some medical issues before now (prenatal vitamins, etc), so here’s another one for you. I am pretty susceptible to UTIs. Any woman (or man for that matter) who has been there, knows that it’s no joke. In addition to the, “aaarrrrgh, it burnnnsssss!” pee moments, I also have this stupid ditty that gets stuck in my head every time I wee: “oh lord, it burns when I pee” (to the tune of janis joplin’s “mercedes benz”. Like I said, no joke.

Because I am so susceptible, it’s kind of a pain in the ass to go to the doctor every time for an antibiotic regime, and I just moved to the states, and don’t have insurance yet. In the past, I have pretty much always had to get the antibiotic though I managed to fight one off (I drank a fuck load of cranberry juice, but that might not even be related). Anyway, my question is this: is there any validity to treating UTIs with cranberry, or attempting to raise the acidity levels in the urine?

~Anna

Dear Anna,

First my standard disclaimer: I am not a doctor. The internet is no substitute for seeking care from an actual MD. You should go to the doctor whenever you feel that you may have an infection. To reinforce this fact, I got in touch with an OB/GYN for comment.

I contacted Dr. Jennifer Gunter, an OB/GYN, sex health expert and pain medicine physician to get her take on what to do with recurring bladder infections and to give us the scoop on cranberry juice. Emphasis added by me.

There is no medical evidence that suggests cranberry juice or tablets will treat a bladder infection. If you think you have a bladder infection, while it is OK to take cranberry, you should see your doctor to get the correct diagnosis and be treated with antibiotics.

Cranberry juice and tablets can prevent bladder infections and this has been studied. The optimnal dose is unknown. We usually recommend tablets (juice has calories and that adds up over time, also many people find the pure cranberry juice less than palapatble). For preventing a bladder infection we recommend looking at the bottle and taking what ever the recommended dose is twice a day.

There is no medical evidence that emptying your bladder after sex prevents a bladder infection, although we recommend women (who have a history of bladder infections after sex) do it as it will not be harmful

Some people think that vitamin C 1,000 mg three times a day by mouth can help prevent bladder infections as it makes the urine more acidic which theoretically might make it harder for bacteria to grow. However, there are no medical studies to support this.

For women close to menopause and after menopause vaginla estrogen (prescription) is very effective at preventing bladder infections (more so than cranberry).

~Jennifer

In addition to Dr. Gunter’s comments I want to really reinforce the fact that prior to taking any supplements you should first discuss it with your primary care physician as there is mounting evidence that some vitamin supplements may do more harm than good.

In addition, it has also been established that while drinking cranberry juice prior to onset of infection may be helpful, drinking cranberry juice is no better than water once an infection has set it. Keeping hydrated and flushing your system may have some benefit but yeah, you can drink water for that.

I also want to reinforce the MAY BE as in might be, as in probably more myth than actually helpful part of drinking cranberry juice.

Dr. Mark Crislip an infectious disease specialist from Science Based Medicine Blog writes in his article entitled, wait for it …wait for it …yep: Cranberry juice.

From Dr. Crislip’s article:

There have been a variety of clinical trials, in different populations, to see if cranberry products are of benefit in the prevention of UTI’s and there has been variable efficacy.

There are, I am shocked, shocked to find, problems with the studies.

First, no one has ever done basic pharmacokinetics on proanthocyanidins to see if there is, indeed, proanthocyanidins in the urine of patients who take cranberry products.

Doing clinical trials without determining first if there is sufficient material that CAN be effective, before showing that it IS effective, is the homeopathic, and most SCAM, method of research. No one has been methodical in their evaluation of cranberry juice, so we are left with a hodgepodge of incomplete studies.

Mark mentions a recent published study from January, 2011 that is titled: Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial. You get the idea from the title but feel free to click the link for more detailed anaysis or read Dr. Crislips article.

In conclusion, while there may be some E.coli bacteria fighting qualities to cranberry juice, the story doesn’t end there and there is not enough quality evidence to prove it is actually beneficial. At this point in time your best bet is to still seek out professional care and antibiotics and not to rely on juice or vitamin C, unless you are thirsty …or have scurvy.

And remember that recurring bladder infections could be a cause of an underlying condition, so please do see a doctor!

Got a question you would like some Surly-Skepchick advice on? Send it in! We won’t publish your real name, unless you want us to and creative pseudonyms get bonus points! Just use the contact link on the top left of the page.

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Amy Roth

Amy Davis Roth (aka Surly Amy) is a multimedia artist who resides in Los Angeles, California. She makes Surly-Ramics. She is the fearless leader of Mad Art Lab. Support her on Patreon. Follow her on twitter: @SurlyAmy or on Google+. Tip Jar is here.

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36 Comments

  1. Sadly as I’ve seen, a lot of people resort to this or similar holistic things because they have no health insurance and find it hard to pay $150 to a doctor to get an antibiotic prescription.

    I’d be willing to bet we might see a few less holistic remedies being so popular if everyone had the ability to afford healthcare.

    1. Re: “I’d be willing to bet we might see a few less holistic remedies being so popular if everyone had the ability to afford healthcare.”

      I agree. An interesting study would be to compare the incidences of “holistic remedies”, homeopathy, and quackery in civilized nations with universal health care, to their incidences in the USA.
      Regards, Bob

  2. Oh, I can SO relate to this. I get kidney stones and UTIs on a regular basis. When I was 20 I was penniless, without insurance and got a bad UTI. I went to the natural foods store, bought pure cranberry juice by the gallon as well as tablets and tried to will myself better. Needless to say it only got worse and I ended up at the ER where I was informed that my kidney had begun to abscess and that I was a stupid moron for not seeing a doctor sooner.
    That was $15,000 wells spent.
    but here’s a surprisingly helpful protip my favorite ob/gyn: Always pee immediately after sex. No dozing off in lamby-toes arms. Get up and go pee.

    1. This. I had one year (the one year recently I was uninsured of course) when I had 7 – 8 UTIs in a year. I ended that year by passing a kidney stone. Apparently the two are related frequently and if you’re experiencing a lot of them you should go in to a doctor to make sure it’s not something much much worse (if you’ve never had kidney stones, believe me… they’re much much worse)

  3. This is very timely as I just had a UTI last week. I used to be prone to them, but I follow the same advice given by cloe’s ob/gyn and now I get them very rarely. It had been at least 5 years since my last one.

  4. I used to get frequent UTIs too. My doctor told me that spermicide and spermicidal condoms can increase risk of UTIs. And she told me to always pee after sex. Taking that advice I rarely get them anymore. (I’m not a doctor or a scientist and realize this is anecdotal and that my doctor was talking about me and my body and I don’t know really if it applies to others as well. But you know, if it helps.)

  5. I must admit, I am battling a kidney stone with watered-down cranberry juice and antibiotics, and it definitely seems to soothe the pain (I mistakenly purchased a cranberry juice blend once, and though it was still 100% juice, the blend of grape and cranberry did not help the pain as well as the pure stuff). I have always been susceptible to uti’s, but the addition of cranberry juice with my daily meds seemed to have helped out a lot. I do suspect that it is partly easier to get people to stay hydrated during a uti to prevent possible worse damage, and also partly because it does seem to help with pain (and if so, I’ll take that placebo effect). In any case, the kidney stone is my fault for being dehydrated. In short, if people learn to drink less coffee and tea (which are diuretics) and more 100% juice (which is generally healthful, as always, in moderation), I’m okay with that. It’s not a supplement, and encourages people to stay hydrated.
    I think the main problem is that people don’t have insurance to get prompt medical attention.

  6. Dr Gunter had also said this in her response to me:

    “There is no medical evidence that emptying your bladder after sex prevents a bladder infection, although we recommend women (who have a history of bladder infections after sex) do it as it will not be harmful.”

    I left it out because it didnt seem relevant because she had again stated that there was no medical evidence for it, but I will add it back in to the post since it keeps coming up. :)

    1. Since it keeps coming up, it’s medical evidence, though not well controlled. After all, an accumulation of anecdotes takes on the nature of statistics. Also, the effects of cranberry juice are reported by disinterested parties (unless everyone reporting here owns a cranberry bog!).
      Regards, Bob

  7. If you live in a big town or a city, you can usually go to CVS or Walgreens or similar. They have clinics that will diagnose you with a UTI and give you antibiotics, generally far, far, far cheaper than going to the doctor. And it’s usually quicker and probably also cheaper than going to urgent care.

    ALWAYS get antibiotics. I once had a UTI but did not have any of the normal physical symptoms — I went in because I felt so, so awful, and it turned out that I had a bad cold, a throat infection, an ear infection, and a mild UTI (but it didn’t hurt to pee, so I had no idea!). So even if you think it’s passed, it may not have gone fully away (and will probably present itself again later).

    UTIs are no joke and can turn nasty quite quickly. The last thing you want is to be put into the hospital, when a round of antibiotics would have taken care of it.

      1. The clinic inside CVS is called “Minute Clinic” — http://www.minuteclinic.com/

        And Walgreens is “Take Care Clinic” — http://takecarehealth.com/

        And I imagine other pharmacies/drug stores probably have similar clinics. I think Target may have a clinic, too. Yep! http://sites.target.com/site/en/spot/clinic_services.jsp

        VERY common nowadays. Please note that not each location will have a clinic, but they are becoming more common. I don’t think my home town has one (they have a CVS), but it’s a really small town, hehe.

  8. You moved to a country without a universal health-care service?????????????

    Or, if we are talking about advanced industrialized countries.

    You moved to THE country without a universal health-care service?????????????

  9. Thanks Amy! I really couldn’t validate whether cranberry was an appropriate tool for UTIs or not. I managed to fight off the last one by drinking a fuck load of water, and I took cranberry pills just in case. I think the high volume of water must have helped, thankfully, but I’m such a repeat offender for these. Back in NZ at the first sign, I’d get to the doctors to get an antibiotic (after a particularly lengthy infection that went to the kidneys, I learned not to fuck around).

    My NZ doctor also told me to pee immediately after sex. It doesn’t always help, and I see that Amy has posted that there is no evidence for this working either. Explains a lot.

    Also: thanks Marilove – I will be sure to check Walgreens out. I noticed last time that they had an over-the-counter antibiotic that was strictly for pain control/alleviation, so just assumed that they wouldn’t necessarily have the appropriate antibiotics for treatment.

    1. Walgreen is a pharmacy — they have all the antibiotics you may need, or can get it if it’s not in stock, but none of them are OTC as far as I know…

      You have to get a prescription. Some CVS and Walgreen stores will have clinics which will then have you pee in a cup, diagnose you, then prescribe and sell you the antibiotics.

        1. Yeah, you’re never going to be able to get the antibiotics OTC. But the clinics are generally very cheap and the antibiotics you tend to need for UTIs generally come in generic form, so they usually aren’t too expensive.

  10. Pee easy people, then make sure you squeeze the last drop out. Pelvic floor muscles people and lower abs…. leaving a teaspoon of wee may possibly set up a site for infection.
    If you get infection..take antibiotics.

  11. To prevent kidney stones (and you really do want to prevent them), you need to drink a lot of water. Don’t take massive quantities of vitamin C because it is metabolized into oxalate and calcium oxalate is the major component of kidney stones. What also helps prevent kidney stones is citric acid. That is from lemon juice, not cranberry juice. Citrate specifically inhibits the growth of calcium oxalate crystals.

    You need to drink a fair amount. What I do is get Real Lemon, keep it in the refrigerator and every so often drink about 5 ounces of it and immediately drink a lot of water (to rinse it off your teeth). The usual time when crystals grow is when your urine is most concentrated, which is at night, so that is when I usually drink the lemon juice.

    The way the kidney works, sodium is taken out of the urine first, and then calcium. A low sodium diet reduces the amount of calcium in the urine and that helps.

    Reducing oxalate in the diet is important. Nuts are quite high, so is spinach and rhubarb.

    You want to also try and reduce phosphate. Usually what nucleates crystals in the kidney is calcium phosphate.

    You also want to eat a lot of lettuce. Lettuce has nitrate in it, and the bacteria that cause a UTI reduce nitrate to nitrite and nitrite suppresses biofilm formation, especially under acidic conditions.

    Drinking lots of water is a good preventative for both kidney stones and UTIs.

    1. //[Citric Acid] is from lemon juice, not cranberry juice.//

      Argh, false man… citric acid is not limited to citrus fruits. This is kinda what this post is talking about, that this type of advice dupes people into not getting antibiotics for UTIs.

      Do you have scientifically backed sources for the things you’re saying? Or do you say this based upon your own set of experiences?

      1. both. I had a kidney stone, so I read up on how to prevent them, implmented this and haven’t had one since. I have had twinges, but drinking lemon juice seems to make the twinges go away.

        Citric acid is in a lot of things, but lemon juice is almost pure citric acid. Things like OJ also have oxalic acide in them, more sugar and not as much citric acid.

    2. Unless one lives in a region heavy in limestone formation, in which case, the water filtered into the water table, then processed into tap water is heavily laden with calcium. The problem compounds when one drinks from mountain streams that are also filtering through limestone, without the benefit of additional filtration. Unfortunately, kidney stones are seen as an unavoidable hazard of living in my area. :(

  12. If you get frequent infections it actually might not be an infection – in fact, probably *is not* an infection if it is coming back frequently despite taking antibiotics.

    I spent 18 months getting recurring infections, and getting antibiotics for longer and longer doses (up to two weeks, until the antibiotics made me sick but I was still peeing blood). Finally, the tenth doctor I went to actually checked the pee test results *before* giving me the antibiotics (they don’t actually all do this, they just assume it’s an infection if you’re a woman with the right symptoms!). Negative. She went back through my file, and for all the tests that someone actually ran, they were all negative, including the one that put me in the hospital. No one had ever bothered to check that they’re diagnosis was correct.

    I was sent to a urologist, who actually did a cytoscopy to make sure it wasn’t cancer, and determined it was actually Interstitial Cystitis – like Crohn’s disease, but for your bladder. Your immune system attacks the bladder cells in the absence of any actual infection. He told me it’s actually quite common, and that for most women who have it, it will mysteriously disappear (or sometimes only flare up years apart). Mine has mysteriously disappeared, and I will only get symptoms if I get really dehydrated, or drink nothing but booze and acidic drinks for days on end (what, I found that out in Vegas…).

    He also told me that whatever I did, next time I got the pain, I was to under no circumstances take the antibiotics, and it would go away in a couple days without it, he promised. And he was right. He even said that frequently, women mistake urethral irritation for a bladder infection – again, the doctors don’t necessarily confirm that it is a bladder infection if you present with the “correct” symptoms. “Honeymoon cystitis” may not always been an infection, it might just be an irritation, and again, not require antibiotics.

    I don’t know if your doctors have actually not been jackasses and have confirmed you have an infection each time, but if they haven’t said one way or another -check. Obviously a different situation for me because I’m Canadian, and the total cost to me of the day surgery and the urologist visits was $0, but I had to put it out there, because seriously, my suffering *ended* the moment I got a correct diagnosis – and of course, overuse of antibiotics is a bad scene in both our countries.

  13. Just going to put in my 2 cents here as someone who used to have major problems with with UTI’s. I used to get them ALL the time. I would say on average I got a full blown one once a month. I moved to another country and the doctors started telling me and doing different things apart from all the basic stuff they tell you (wear cotton underpants, make sure you pee often, drink lots of water). First my doctor ALWAYS took a sample of my urine and sent it to the lab to make sure what kind of bacteria was in there. And secondly, she told me to wear house shoes with house socks to make sure that my feet stayed warm and to make sure my kidneys stayed overly warm. Even when it isn’t cold I wear a sweater around my waste to keep them warm. This seems to help a lot and I haven’t had a UTI in ages.
    I can understand why many women end up spending a lot of money on hoo-ha to try to get rid of these damn things. They are so painful and costly that you are willing to try just about anything.

      1. Your kidneys are internal organs with a very large blood flow. They are at internal body temperature. They can’t be at a temperature different than internal body temperature. If you are doing something that you think is causing your kidneys to be at a different temperature, you are very likely mistaken.

        Peeing is a natural function that is necessary to remain alive. It is under autonomic control and is self-regulating. Peeing too much is extremely rare and usually only occurs with pathological dietary habits (using diuretics such as caffeine too much). What kills people then is sodium depletion.

        Sometimes people try to lose weight by restricting fluid intake. This doesn’t work and can be harmful. The way to lose water weight is to reduce sodium intake. For water to be retained in the body, the body requires sodium equivalent to the water being held. If you reduce sodium intake, then there is less sodium available to retain water. (don’t overdo this if you are in a hot environment or need to sweat a lot).

        1. Applying heat to one’s kidneys can indeed warm them to a different temperature. Same as placing a heating pad on the abdomen to treat cramps. Also, did anyone state they were trying to lose weight by restricting fluid intake? Some families are more prone to kidney stones and UTIs than others, which would make it heritable. I do know that having had a baby makes me have to pee more frequently, because those muscles are weaker than they pre-pregnancy. It is not “extremely” rare, because it’s common in women who are/have been pregnant, and also for those who are aging.
          It would also be worthwhile to mention that too much water (hyponatremia) is just as dangerous as too little. Peeing too much may be a body’s way of saying stop.

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