Urinary tract infections - cystitis is an infection in the urine that affects the bladder. It is usually caused by bacteria. The signs and symptoms include pain and a burning sensation on passing urine, the need to urinate often and the feeling of not being able to hold the urine (urgency). The urine may be cloudy and occasionally have blood in it (haematuria). The infection can continue to spread up to the kidneys to cause an upper urinary tract infection with additional back pain, fever, chills with shaking and generally not feeling well. Some people have recurrent infections with an average of two to three in a year.

Some people have recurrent infections with an average of two or three in a year. Urinary tract infections are treated medically with antibiotic drugs, but these are expensive, can have side effects and their use may lead to resistance of the bacteria to antibiotics.

We present some of the evidence from Cochrane systematic reviews about complementary and alternative treatments related to urinary tract infections. This evidence comes from carefully researched reviews of information about clinical trials done to evaluate medical treatments. Studies are only included in these reviews if they meet pre-defined criteria.

CRANBERRIES FOR PREVENTING URINARY TRACT INFECTIONS

Cranberries are used widely for the prevention and treatment of urinary tract infections. The berries contain a substance that prevents bacteria (in this case E. coli) from sticking on the walls of the urinary tract or bladder. This may help prevent infections. People who are prone (susceptible) to urinary tract infections drink the juice or take it in tablets or capsules.

Those most at risk of developing an infection include sexually active women; older people; people whose immune systems are suppressed for example, those receiving chemotherapy drugs or with AIDS; and infants requiring catheters to urinate.

What the synthesised research says

Overall, cranberry products reduced the number of urinary tract infections experienced over a 12-month period. Comparing people receiving a cranberry product to the control groups, the relative risk (RR) of a symptomatic infection was 0.65, (range 0.5 to 0.9).

Cranberry products were most effective in women with recurrent infections, more so than for elderly men and women or people requiring catheterisation.

For example, in one study, eight women (16% of the total) in the cranberry group had a least one recurring urinary tract infection compared with 19 women (39%) in a group taking lactobacillus and 18 (36%) in the control group, in a 6-month period.

How it was tested

The Cochrane review authors assessed 10 controlled studies in which a total of 1,049 participants of all ages were randomised to receive either cranberry products (juice or cranberry capsules) or a control intervention (placebo, water, another drink or no intervention) for at least one month. Cranberrries were taken by mouth, either as a juice (7 studies) or tablets (4 studies).

Three studies evaluated cranberry juice for the prevention of urinary tract infections in elderly populations.

Four studies evaluated the effect of cranberry products in people needing either indwelling catheters or intermittent catheterisation. Two involved people with spinal cord injuries and two were in a total of 55 children also with neuropathic bladders. There was no clinical nor statistical difference in the number of symptomatic infections observed in either the cranberry or placebo groups.

Side effects and general cautions

Side effects were common, on placebo too, and the number of people who withdrew was high in several studies. In some cases this was because they moved away from the area or other reasons such as they were prescribed antibiotics for an indication apparently not related to taking cranberries. Taste of the cranberry juice, caloric load and cost were other factors. Side effects included symptoms of reflux, mild nausea, frequency of bowel movements and one episode of skin redness and itching.

The tablets are not standardized for content and it is not clear how much cranberry product should be taken and for how long. The review authors concluded that cranberries are an option for women bothered by recurring infections but only as one of many strategies, which include hydration and careful use of antibiotics.

People can have the symptoms of urinary tract infection without the high number of bacteria present in urine that is used for a medical diagnosis. However, the main outcome in two trials involving elderly people was the bacteriological not symptomatic or clinical diagnoses. Infections often also occur in clusters with long periods (several months) in-between. This means that trials may need to cover long study periods to take into account the natural course of the problem.

Source

Jepson RG, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD001321. DOI: 10.1002/14651858.CD001321.pub4.

CRANBERRIES FOR TREATING URINARY TRACT INFECTIONS

Cystitis is an infection in the urine that affects the bladder. It is usually caused by bacteria. This urinary tract infection occurs in men, women and children. The signs and symptoms include pain and a burning sensation on passing urine (dysuria), the need to urinate often (frequency) and the feeling of not being able to hold the urine (urgency). The urine may be cloudy and occasionally have blood in it (haematuria). The infection can continue to spread up to the kidneys to cause an upper urinary tract infection with additional back pain, fever, chills with shaking, and general ill feeling. Some people have recurrent infections with an average of two to three in a year.

Urinary tract infections are treated medically with antibiotic drugs, but these are expensive, can have side effects and their use may lead to resistance of the bacteria to antibiotics.

For decades, cranberries have been used widely for the prevention and treatment of urinary tract infections. The berries contain a substance that prevents bacteria (in this case E. coli) from sticking on the walls of the urinary tract or bladder. This may help prevent infections. People who are prone to urinary tract infections drink the juice or take it in tablets or capsules; not everyone likes the taste or some may find it too sweet to drink.

Those most susceptible include sexually active women; older people; people whose immune systems are suppressed for example, those receiving chemotherapy drugs or with AIDS; and infants requiring catheters to urinate.

What the synthesised research says

No firm conclusions on the effectiveness of cranberry juice in treating urinary infections from trials published in the medical literature.

Only a few uncontrolled trials are available. Two of these did show a beneficial effect.

How it was tested

The researchers made a thorough search of the medical literature. They could not find any trials that randomly assigned people with confirmed urinary tract infections to receive cranberry juice with or without standard treatment with a non-active placebo or standard treatment.

Side effects and general cautions

People can have the symptoms of urinary tract infection without high number of bacteria present in urine. This is called urethral syndrome. It is the high number of bacteria that is used for a medical diagnosis.

Not everyone likes the taste of cranberry juice and some find it too sweet. Capsules or tablets may, therefore, be both cheaper and more palatable.

Source

Jepson RG, Mihaljevic L, Craig JC. Cranberries for treating urinary tract infections. The Cochrane Database of Systematic Reviews 1998, Issue 4. Art. No.: CD001322. DOI: 10.1002/14651858.CD001322.