Naturopathic Approaches to Urinary Tract Infections in Elderly

by Andrea McBeth, ND

April 12, 2018

Urinary tract infections (UTIs) are the most common infection in long term care settings.[1] They present a serious problem for elderly patients and the institutions that support them. Identifying and treating the infection is complex and difficult. The presentation in elderly patients is non-specific and can be anything from slight delirium and fatigue to fever and incontinence. There is a large portion of asymptomatic bacteriuria that does not warrant treatment, so UA screening does not always give conclusive results. Progression to kidney infection and sepsis can lead to hospital admissions and, although rare, in compromised individuals, death.

These serious risks warrant that UTIs be taken seriously and treated appropriately with antibiotics. Unfortunately, a balance needs to be struck between treatment and antibiotic stewardship. UTI or suspected UTI is one of the leading reasons for antibiotic use in LTC settings. This is a large contributor to the rise in antibiotic resistant pathogens. The best approach, therefore, is prevention. Luckily, naturopathic medicine offers many tools for prevention and early onset UTI management to help both mitigate and support the responsible use of antibiotics.

Prevention

The risk factors for UTIs in elderly populations are complex. In order to prevent UTIs, care providers must address a wide range of predisposing conditions. Some of the most common risk factors stem from underlying incontinence, neurogenic bladder related to neurodegenerative diseases, and blood sugar dysregulation associated with diabetes. Each of these conditions present a difficult treatment approach in and of themselves. Luckily comprehensive health prevention and naturopathic medicine can help address all of them. In addition, there are a few simple tips and tricks, broadly applicable, that care providers can employ in order to facilitate the prevention of UTIs.

Hydration

The most important and simplest preventative measure is proper hydration. Ensure water, low- sugar juices, and teas are readily available. There are many herbal teas that both taste good and provide plant constituents known to play a role in preventing and treating UTIs."A Systematic Review and Meta-Analysis. The Journal of Nutrition, 147(12), 2282–2288."}" id="fn2" >[2] Cranberry or blueberry juices are particularly effective.[3],[4] Having them available as a drink option can change habits and remind people to continue pushing fluids.

Support the microbiome

We are just beginning to learn about the human gut microbiome and its relationship to other regions of the body colonized by commensal bacteria. Only recently we discovered the bladder is not sterile, but instead supports a healthy microbial ecosystem just like the colon.[5] The bacteria are less abundant but no less important. We also know the female vaginal microbiome plays an important role in keeping vaginal tissue healthy. Each of these separate microbial communities have been shown to play a part in UTI risk.[6],"CVI, 16(1), 29–36."}" id="fn7" >[7],[8] Furthermore, we know that UTI-causing bacteria derive from rectal, perineal, and vaginal regions of the body.[9] It has been shown that probiotics and other supportive prebiotics intended to help the GI microbiome can also support other microbial communities like the vagina."meta-analysis. The Canadian Journal of Urology, 20(1), 6607–6614."}" id="fn10" >[10],"An Official Publication of the Infectious Diseases Society of America, 52(10), 1212–1217."}" id="fn11" >[11]

Even more interesting, there have been research studies on the application of vaginal probiotics as UTI prevention in women.[12],[13] In the preventative avenue, soothing herbal products applied vaginally can be one option for supporting good bacteria. Another tool is topical vaginal oestrogen.[14],[15] The application of topical estrogen, specifically in the form of estriol cream, has been shown to reduce UTIs and support tissue health.[16] Vaginal estrogen also reduces incontinence, which can play a role in UTI risk as well.[17] Topical estriol cream works to normalize vaginal flora and when used in conjunction with probiotics shows an increased reduction in UTIs.[18],"a preliminary report. Curr Ther Res 1993;53:441-3."}" id="fn19" >[19]

Hygiene

Rectal hygiene can play an important role in UTI prevention. As mobility declines, the ability to successfully wipe fecal material after bowel movements diminishes. The residual fecal material then increases the risk of fecal bacteria entering the urinary tract. Using wet wipes to support hygiene is a cheap and effective way to improve wiping. Another application that has recently become economically feasible is the attachment of bidet style water cleansing for normal toilets.

Treatment

Antibiotic therapy is the standard treatment for a UTI. However, antibiotic resistance is a growing concern for elder communities. There is building among policy makers to decrease the unnecessary use of antibiotics, such as in the case of suspected UTIs. The diagnosis of a true UTI is often confused with asymptomatic bacteriauria. As mentioned above, the bladder is not sterile. Therefore, differentiating pathogenic bacteria from commensal bacteria by means of a urinary analysis(UA) can be difficult. Symptom pictures can also vary widely in a population already wrought with comorbidities. Separating infection-induced delirium from neurodegeneration and pharmaceutical side effects can be extremely difficult as well. Up until this point, the default was to prescribe a dose of antibiotics just in case. However, policy makers now know this is an area in which antibiotics are overused and the antibiotic stewardship movement has targeted it for improvement. This is a great reason to integrate herbal/supportive treatment if UTIs before initiating antibiotic therapy.

Listed below are some of my favorite products available for the early support and prevention of uncomplicated UTIs. Herbal protocols involve ingesting herbs that we know play a role in reducing pathogenic bacteria and supporting the growth of healthy bacteria.[20],[21]

Naturopathic support summary

Below is a summary of the recommendations discussed above. Included are links to products I have used and trust, plus helpful online resources. I am not affiliated with any of the brands I recommend. Caution should be used when purchasing supplements. Poor federal regulation means quality is not always what a brand claims. Make sure whatever products you use are from a reputable source and have been third party tested. Every company I have included has good quality products.

Prevention basics

  1. Water and herbal tea intake
  2. Oral Probiotics
  3. Cranberry or blueberry juice
  4. Vaginal suppositories with lactobacillus
  5. Vaginal suppositories with herbs to support healthy flora
  6. Vaginal estriol cream
  7. Hygiene support for rectal wiping
    1. Wet wipes
    2. Bidet style toilet attachments
  8. Incontinence
    1. Address constipation
      1. Magnesium
      2. Senna tea
    2. Prevention for persons with vaginas
      1. Vaginal estriol cream — Prescription
      2. Pelvic floor physical therapy
    3. Prevention for persons with penis
      1. See BPH article

Herbal treatment

My favorite herbal combination formulations for UTI treatment

Mechanisms of herbal components

Many herbs are very helpful in the treatment of UTI associated symptoms. Below is a list of several herbs that would be helpful to look for in formulations.

  1. Reduce microbial attachment
    1. D-mannose powder
    2. Cranberry or blueberry concentrate
  2. Anti-microbials
    1. Arctostaphylus Uva-ursi
    2. Mahonia Oregon Grape (Berberine)
    3. Usnea barbarea
  3. Immunomodulators
    1. Hibiscus
    2. Rose hips
    3. Echinacea
  4. Soothers
    1. Marshmallow plant
    2. Aloe
    3. Corn silk

Footnotes

  1. Centers for Disease Control and Prevention. (n.d.). Urinary Tract Infection (UTI) Event for Long-term Care Facilities, pp. 1–10.
  2. Yarnell, E. (2002). Botanical medicines for the urinary tract. World Journal of Urology, 20(5), 285–293.
  3. {"Fu, Z., Liska, D., Talan, D., & Chung, M. (2017). Cranberry Reduces the Risk of Urinary Tract Infection Recurrence in Otherwise Healthy Women"=>"A Systematic Review and Meta-Analysis. The Journal of Nutrition, 147(12), 2282–2288."}
  4. Guay, D. R. P. (2009). Cranberry and urinary tract infections. Drugs, 69(7), 775–807.
  5. Karstens, L., Asquith, M., Davin, S., Stauffer, P., Fair, D., Gregory, W. T., … Nardos, R. (2016). Does the Urinary Microbiome Play a Role in Urgency Urinary Incontinence and Its Severity? Frontiers in Cellular and Infection Microbiology, 6, 78.
  6. Stapleton, A. E. (2016). The Vaginal Microbiota and Urinary Tract Infection. Microbiology Spectrum, 4(6). https://doi.org/10.1128/microbiolspec.UTI-0025-2016
  7. Brubaker, L., & Wolfe, A. J. (2017). The female urinary microbiota, urinary health and common urinary disorders. Annals of Translational Medicine, 5(2), 34.
  8. {"Kirjavainen, P. V., Pautler, S., Baroja, M. L., Anukam, K., Crowley, K., Carter, K., & Reid, G. (2009). Abnormal immunological profile and vaginal microbiota in women prone to urinary tract infections. Clinical and Vaccine Immunology"=>"CVI, 16(1), 29–36."}
  9. Stapleton, A. E. (2016). The Vaginal Microbiota and Urinary Tract Infection. Microbiology Spectrum, 4(6). https://doi.org/10.1128/microbiolspec.UTI-0025-2016
  10. Kontiokari, T., Laitinen, J., Järvi, L., Pokka, T., Sundqvist, K., & Uhari, M. (2003). Dietary factors protecting women from urinary tract infection. The American Journal of Clinical Nutrition, 77(3), 600–604.
  11. {"Grin, P. M., Kowalewska, P. M., Alhazzan, W., & Fox-Robichaud, A. E. (2013). Lactobacillus for preventing recurrent urinary tract infections in women"=>"meta-analysis. The Canadian Journal of Urology, 20(1), 6607–6614."}
  12. {"Stapleton, A. E., Au-Yeung, M., Hooton, T. M., Fredricks, D. N., Roberts, P. L., Czaja, C. A., … Stamm, W. E. (2011). Randomized, placebo-controlled phase 2 trial of a Lactobacillus crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection. Clinical Infectious Diseases"=>"An Official Publication of the Infectious Diseases Society of America, 52(10), 1212–1217."}
  13. Uehara, S., Monden, K., Nomoto, K., Seno, Y., Kariyama, R., & Kumon, H. (2006). A pilot study evaluating the safety and effectiveness of Lactobacillus vaginal suppositories in patients with recurrent urinary tract infection. International Journal of Antimicrobial Agents, 28 Suppl 1, S30–4.
  14. Beyer, I., Mergam, A., Benoit, F., Theunissen, C., & Pepersack, T. (2001). Management of urinary tract infections in the elderly. Zeitschrift Fur Gerontologie Und Geriatrie, 34(2), 153–157.
  15. Regal, R. E., Pham, C. Q. D., & Bostwick, T. R. (2006). Urinary tract infections in extended care facilities: preventive management strategies. The Consultant Pharmacist: The Journal of the American Society of Consultant Pharmacists, 21(5), 400–409.
  16. Caretto, M., Giannini, A., Russo, E., & Simoncini, T. (2017). Preventing urinary tract infections after menopause without antibiotics. Maturitas, 99, 43–46.
  17. Cranberry Products or Topical Estrogen-Based Therapy for the Prevention of Urinary Tract Infections: A Review of Clinical Effectiveness and Guidelines. (2016). Ottawa (ON): Canadian Agency for Drugs and Technologies in Health.
  18. Caretto, M., Giannini, A., Russo, E., & Simoncini, T. (2017). Preventing urinary tract infections after menopause without antibiotics. Maturitas, 99, 43–46.
  19. Senok, A. C., Verstraelen, H., Temmerman, M., & Botta, G. A. (2009). Probiotics for the treatment of bacterial vaginosis. Cochrane Database of Systematic Reviews , (4), CD006289.
  20. {"Larsson B, Jonasson A, Fianu S. Prophylactic effect of UVA-E in women with recurrent cystitis"=>"a preliminary report. Curr Ther Res 1993;53:441-3."}
  21. DiPasquale, R. (2008). Effective use of herbal medicine in urinary tract infections. Journal of Dietary Supplements, 5(3), 219–228.
  22. I, Andrea McBeth ND, am not affiliated with any the brands I recommend. Caution should be used when purchasing supplements. There is poor federal regulation so many brands are poor quality or not what they claim. Make sure whatever products you use are from a reputable source and have been third party tested. Every company I have included has good quality products.
The information provided is the opinion of Dr. Andrea McBeth and not intended as medical advice or to replace a one on one relationship with a healthcare professional. It is intended to be the sharing of knowledge from research and experience of Dr. McBeth and her community.

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