Probiotic pessaries and other remedies for urinary tract infections

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Urinary tract infections are quite-common in women, though they can affect men too. Normally, the cause of these infections appears to be organisms (such as E. coli) making their way up the urethra (the pipe taking urine from the bladder to the outside) into the bladder where they can ‘set up camp’ on the bladder wall. Women are perhaps more prone to urinary tract infections because the urethra tends to be much shorter than in men (so more chance of the organisms making their way into the bladder before being flushed out during urination). Also, the opening of the urethra to the outside in women is quite close to the anus, a source of potential organisms however scrupulous one’s personal hygiene is. Sexual intercourse can increase the risk of infection (so-called ‘honeymoon cystitis’).

Keeping the bladder well-flushed with urine may help reduce infections for those prone to them. The idea would be to drink enough water each day to keep the urine pale yellow in colour. To combat honeymoon cystitis it is sometimes recommended that women urinate as soon as possible after sex. There is sense in this, but I don’t know how practical or comfortable for women to have sex with a full-ish bladder. To reduce the risk of contamination, wiping front to back after going to the toilet is probably a good idea.

One natural remedy that has been shown to have some value in treating cystitis is cranberry, and in practice I quite-often suggest cranberry supplementation for individuals who are prone to urinary tract infections. You can read more about cranberry and the evidence for it here, here and here. The first of these links includes some information about the sugar D-mannose which also appears to offer considerable protection from urinary tract infections.

Another approach I like to use in practice is ‘probiotic pessaries’. The idea here is to add more healthy bacteria to the vagina and surrounding area, in an effort to keep less healthy organisms at bay in this area. I was interested today to read about a recently-published study in which probiotic pessaries were used in women prone to urinary tract infections [1]. About women used 1 probiotic pessary for each of 5 days, followed by weekly pessaries for 10 weeks. The control group (also about 50 women) received ‘placebo’ pessaries in the same dosing regime.

15 per cent of the women with the active pessary had a recurrence of urinary tract infection over the course of the study compared with 27 per cent of the control group. The difference was not statistically significant, possibly due to the relatively small numbers of people used in this study.

I find a combination approach, perhaps not surprsingly, tends to work best when managing urinary tract infections in the long term. I have also found, in practice, that these approaches almost always lead to a very significant reduction in infection episodes and symptoms associated with this issue.


1. Stapleton AE, et al. Randomized, Placebo-controlled Phase 2 Trial of a Lactobacillus crispatus Probiotic Given Intravaginally for Prevention of Recurrent Urinary Tract Infection. Clinical Infectious Diseases 2011 doi: 10.1093/cid/cir183

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