Pills and powder supplements might not protect against urinary tract infections, say experts

UNITED STATES – 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 UTIs away!” A cartoon heart twinkles alongside boxes of pills and powders — with “UTIs Suck, You Don’t” scrawled at the centre.

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

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

“It could be that you’re just making expensive pee,” said Dr Erin Higgins, an obstetrician-gynaecologist at Cleveland Clinic.

Bacterial cystitis, the most common type of UTI, occurs when bacteria such as 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 and frequent urination.

Most UTIs are uncomfortable but largely innocuous, said Dr Benjamin Brucker, a urologist and urogynaecologist at NYU Langone Health. In rare cases, however, the kidneys can be infected, leading to fever, chills, lower back pain and vomiting.

Anyone can develop one, 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 per cent will get recurrent UTIs, which usually means three or more cases within a year.

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

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 is unclear whether UTI pills and powders actually prevent infection.

Still, there is some evidence that the individual ingredients in these supplements may provide a slight benefit, especially for people with frequent UTIs. And they are unlikely to have significant side effects, said Dr Monica Woll Rosen, an obstetrician-gynaecologist at the University of Michigan Medical School.

Cranberry, the most common ingredient in UTI supplements, has been touted as an at-home elixir to ward off the infection. There is encouraging, but scant, data to support this. A 2017 meta-analysis found that cranberry reduced the risk of developing a urinary tract infection by 26 per cent in otherwise healthy women with a history of the infections, but the studies had small numbers of participants.

Many UTI 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 UTIs.

“Overall, d-mannose appears to be effective when compared with 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, such as diarrhoea and flatulence, she added, but most people tolerate it well.

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

Doctors are not certain why some people experience recurring UTIs and others never have them. Those who frequently contract UTIs 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 — do not try to hold it for long stretches, Dr Higgins said.

During perimenopause and menopause, women may be at higher risk of UTIs as estrogen levels decrease. Topical vaginal estrogen is the “gold standard” non-antibiotic treatment in this population, Dr Lowder said.

And, true to conventional wisdom, urinating after sex can reduce the risk of developing a UTI by flushing bacteria out of the vagina, Dr Rosen said, although evidence is thin.

If you assume you have a UTI 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.” NYTIMES