Holistic clinical approaches for persistent urinary tract issues

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By Carolina Brooks, BA, IFMCP

Early on in my clinical practice, I had a patient who had been on long-term antibiotics for chronic cystitis for over nine years. The patient said she no longer wanted to take the antibiotics as she felt they were no longer working and were, as it turned out, causing chronic vaginal candidiasis. Within a few months of a rotation of herbal teas, supplements, and minor dietary changes, her symptoms had completely subsided. While naturopathic approaches have gotten more comprehensive over the years, I think the simplicity of this approach speaks to the power of using the right phytoconstituents, an appropriate method of delivery, and the right strains of probiotics.

In many cases, patients who have experienced urinary discomfort for years and have had negative tests have sent off samples to private functional laboratories and discovered nematodes present, or microbes which standard lab testing don’t usually identify. In most cases, common pathogens include Escheria coli or Enterococcus faecalis. Klebsiella pneumoniae, Proteus mirabilis, Group B Streptococcus, Pseudomonas aeruginosa and Staphylococcus aureus are also uropathogens.

Practitioners may also identify pathogenic bacteria translocating from the bowel or vagina, so it’s useful to check vaginal microbiome health, including ruling out Ureaplasma urealyticum, Chlamydia trachomatis, Mycoplasma genitalium, and drivers of bacterial vaginosis (BV) such as Gardnerella vaginalis.

Women are more prone to UTIs generally but those with BV will see higher rates of UTIs. A 2017 paper in the journal PLOS Pathogens demonstrated that bladder exposure to Gardnerella vaginalis activated dormant Escheria coli infection in the bladder.

Practitioners may also see fungal overgrowth on the urothelium, which can create mixed fungal-bacterial biofilms. Common fungal species include Candida species. and invasive fungi such as Aspergillus species, Cryptococcus neoformans, Mucoraceae species, Histoplasma capsulatum, and Blastocystis species. Many of my patients with chronic yeast issues do not correlate that they might be being exposed to environmental molds, and will often see significant improvement in those symptoms once they start making even simple remediations to their environment with air filters and dehumidifiers. We may also then start to see oxalate and histamine issues, and significant resolution of symptoms when a lower oxalate diet is followed.

Common triggers for urinary tract infection (UTI) and discomfort are sex, stress, use of antibiotics, yeast overgrowth, diabetes, urinary incontinence, kidney stones, and oxalates and estrogen deficiency. A 2011 paper in the Korean Journal of Urology discussed the role of estrogen in reducing pH, stimulating the proliferation of Lactobacillus species in the vaginal epithelium, and inhibiting the colonization of Enterobacteriaceae, a key uropathogen. A 2007 paper in The Journal of Infectious Diseases discussed using topical intravaginal estrogen as an effective UTI prophylaxis.

A simple, early stage urinary tract infection is often easily resolved with herbal tea, which should be infused and drunk cold, alongside key nutraceuticals such as d-mannose and cranberry extract. The issues generally arise for patients when they are diagnosed with interstitial cystitis and prescribed antihistamines and pregabalin, or when chronic infections are mistreated with multiple rounds of antibiotics, which not only facilitate antibiotic resistance, but wipe out the genitourinary microbiome, thus creating a viscous cycle of recurrent urinary tract infections or discomfort.

Herbs for urinary tract issues work best as cold infusion, as this not only flushes the bladder and kidneys, but has direct action on affected tissues, avoids the alcohol content of a tincture, and allows the mucilaginous elements of the herbs to be extracted. This infusion can then be used both as a drink, or in a sitz bath on affected areas.

Key antimicrobial herbs that can be used both prophylactically and for active urinary tract infection include bearberry (Arctostaphylos uva-ursi, buchu (Agathosma betulina), echinacea (Echinacea spp.), plantain (Plantago spp.), and marigold (Calendula officinalis).

Mucilaginous herbs that help to prevent urinary spasms and soothe inflamed tissues include marshmallow (Althaea officinalis), cornsilk (Zea mays), and liquorice (Glycyrrhiza glabra). Yarrow (Achillea millefolium) and dandelion (Taraxacum officinalis) work synergistically with antimicrobial herbs as they have diuretic properties.

A 2016 paper in the journal Pathogens considered the use of intravaginal Lactobacillus crispatus, the oral use of L. rhamnosus GR-1 and L. reuteri RC-14, and the use of cranberry supplementation for effective prophylaxis of infection. Cranberry is known to prevent adhesion of Escheria coli to the urogenital epithelial walls.

Additionally, a 2010 paper in the journal PLOS One discussed the role of vitamin D in stimulating cathelicidin, a human antimicrobial peptide to be produced by epithelial cells in the bladder to maintain urinary tract integrity and protect the urinary tract from the bladder.

Other useful targeted compounds to include in a protocol include quercetin, green tea, ellagic acid found in berries, walnuts, and pomegranates, aloe vera, and d-mannose. Vitamin D also plays a key role in supporting urinary tract health.

References

Beerepoot, M. and Geerlings, S. (2016) Non-Antibiotic Prophylaxis for Urinary Tract Infections. Pathogens. Retrieved from:  https://doi.org/10.3390/pathogens5020036

Gilbert, N.M., O’Brien, V.P., and Lewis, A.L. (2017) Transient microbiota exposures activate dormant Escherichia coli infection in the bladder and drive severe outcomes of recurrent disease. PLOS Pathogens. Retrieved from: https://doi.org/10.1371/journal.ppat.1006238

Hertting, O., Holm, Å., Lüthje, P., Brauner, H., Dyrdak, R., Jonasson, A.F., Wiklund, P., Chromek, M., and Brauner, A. (2010) Vitamin D induction of the human antimicrobial peptide cathelicidin in the urinary bladder. PLOS One. Retrieved from: https://doi.org/10.1371/journal.pone.0015580  

Raz, R. (2011) Urinary tract infection in postmenopausal women. Korean Journal of Urology. Retrieved from: https://doi.org/10.4111/kju.2011.52.12.801

Stamm, W.E. (2007) Estrogens and urinary tract Infection. The Journal of Infectious Diseases. Retrieved from: https://doi.org/10.1086/511526