BLADDER INFECTIONS AND CRANBERRY JUICE!

Antibiotic resistance has become a big problem in today’s medical world. The overprescribing of antibiotics has enabled bacteria to mutate and develop strains that are resistant to the effect of antibiotics. Nowhere is this more prevalent than in the treatment of urinary tract infections, UTI’s. Resistance to treatment is such a problem doctors and patients are continually looking for alternative treatments, such as cranberry juice, for help.  

Women and bladder infections are two things that go together more than we all would like. Cystitis is the medical term for bladder infection, and it exemplifies Greek and Latin derivatives as perfectly as any term. Cyst- is the derivative for a fluid-filled sac, and -itis is the suffix which means inflammation. So Cystitis (cyst-itis) fits together nicely to say one has an inflamed/infected fluid-filled sac.  

As I mentioned in the “Incontinence” blog, women have a short urethra so it’s very easy for bacteria near the opening (meatus) of the urethra to ascend the distance from outside the opening into the bladder. Bacteria that find their way into the bladder, sit there, multiply, and eventually cause symptoms we recognize as an infection. Those symptoms are frequent urination, an urgent feeling of needing to urinate, and burning during urination. Awakening at night to urinate is common, too. The urine can become cloudy, bloody, or even odorous due to the growth of bacteria. 

The confirmatory test is a urinalysis. A mid-stream specimen of urine is collected in a sterile container. The skin and vaginal lining near the urethral opening should be cleaned before collection so the urine is free of extra contaminants. That is called a clean-catch specimen. Cystitis is diagnosed when white blood cells and/or bacteria are detected in the urine. These are found two ways: one, via a test strip that is dipped in the urine, or two, by centrifuging the urine and looking at the residue at the bottom of the tube under a microscope. Usually both tests are done.

So when the urine is abnormal and symptoms are present, the doctor will prescribe an antibiotic. If the right drug is prescribed, symptoms will disappear quickly, and the infection will, hopefully, be gone forever. Some women, for a number of reasons, are prone to repeated bladder infections. There are tests that determine why and medicines which will help to clear the infection. 

For as long as I have been in medicine, women with recurrent cystitis, or women who can not immediately get antibiotics for their cystitis, were recommended to drink cranberry juice or take cranberry capsules (I didn’t know they existed) to reduce symptoms and the chance of infection. Study after study, and case after case have shown that in certain groups of patients, “consuming cranberry products reduced the risk of cystitis”….in children….and in women with recurrent UTI’s.” In 45 of the 50 studies evaluated by Cochrane, a huge database of medical information and recommendations, cranberry juice, etc. helped to relieve symptoms and reduced the risk of developing a bladder infection. It was actually more effective in children (54%) and men after radiation for bladder or prostate cancer (53%) than for women with recurrent UTI’s (26%). And for nursing home patients or pregnant women, it didn’t seem to help at all. 

I spite of the improvement in bladder symptoms and a reduction in bacterial load (concentration), cranberry products do not have an effect on the infection itself. They do not have an anti-bacterial effect, so antibiotics are still necessary to clear up the infection. A 2021 study from Switzerland concluded that cranberry juice, although it’s an anti-oxidant with health-promoting properties, is unable to kill bacterial organisms. An earlier study, however, showed cranberry juice lowered the number of clinical UTI episodes in women with recent history of UTI, so it does something that helps. 

I had a number of women patients who swore by cranberry juice. The minute they suspected cystitis, they began drinking it regularly and doing so, warded off an infection more times than I can remember. Because it was easier to buy cranberry juice than get a prescription for SMZ-TMP, patients used it fairly often. It was effective until she could bring a urine specimen to the office and get started on an antibiotic. Cranberry products don’t prevent UTI’s, but they certainly tame an inflamed bladder and urethra. Antibiotics are still needed, but until she can get an antibiotic prescription, cranberry juice helps in a pinch.

Reference: Medical News in Brief. “Updated Meta-analysis: Cranberry Products Reduced UTI Risk” JAMA 2023 May 23/30;329(20):1730.

Gbinigie OA, et al. Cranberry Extract for Symptoms of Acute, uncomplicated urinary tract infections: A Systematic Review. Antibiotics 2021;10:1-14.

Maki KC, Kaspar KL, et al. Consumption of a cranberry juice beverage lowered the number of clinical urinary tract infection episodes in women with recent history of urinary tract infection. Am J Clin Nurs 2016 June;103(6):1434-1442.