Dealing with chronic urinary tract infections (UTIs) means facing more than the occasional discomfort. It’s like being on a never ending battlefield against an unseen adversary, making simple daily activities a trial.

UTIs happen when bacteria sneak into the urinary system, causing pain and frequent trips to the bathroom.

Chronic UTIs take this to the next level, coming back repeatedly or never fully going away despite treatment. Chronic UTIs are typically diagnosed when a person experiences two or more infections within six months or three or more within a year.

They can happen to anyone, but some are more prone due to their body’s makeup or habits. Women are more likely to get UTIs than men, due to their shorter urethra and hormonal changes during menopause that can decrease the protective lining of the urinary tract. Sexually active people are also at greater risk, as bacteria can be transferred around the area.

Up to 60% of women will have at least one UTI in their lifetime. While effective treatments exist, about 25% of women face recurrent infections within six months. Around 20–30% of UTIs don’t respond to standard antibiotic. The challenge of chronic UTIs lies in bacteria’s ability to shield themselves against treatments.

Why are chronic UTIs so hard to treat?

Once thought of as straightforward infections cured by antibiotics, we now know chronic UTIs are complex. The cunning nature of the bacteria responsible for the condition allows them to hide in bladder walls, out of antibiotics’ reach.

The bacteria form biofilms, a kind of protective barrier that makes them nearly impervious to standard antibiotic treatments.

This ability to evade treatment has led to a troubling increase in antibiotic resistance, a global health concern that renders some of the conventional treatments ineffective.

Antibiotics need to be advanced to keep up with evolving bacteria, in a similar way to the flu vaccine, which is updated annually to combat the latest strains of the flu virus. If we used the same flu vaccine year after year, its effectiveness would wane, just as overused antibiotics lose their power against bacteria that have adapted.

But fighting bacteria that resist antibiotics is much tougher than updating the flu vaccine. Bacteria change in ways that are harder to predict, making it more challenging to create new, effective antibiotics. It’s like a never-ending game where the bacteria are always one step ahead.

Treating chronic UTIs still relies heavily on antibiotics, but doctors are getting crafty, changing up medications or prescribing low doses over a longer time to outwit the bacteria.

Doctors are also placing a greater emphasis on thorough diagnostics to accurately identify chronic UTIs from the outset. By asking detailed questions about the duration and frequency of symptoms, health-care providers can better distinguish between isolated UTI episodes and chronic conditions.

The approach to initial treatment can significantly influence the likelihood of a UTI becoming chronic. Early, targeted therapy, based on the specific bacteria causing the infection and its antibiotic sensitivity, may reduce the risk of recurrence.

For post-menopausal women, estrogen therapy has shown promise in reducing the risk of recurrent UTIs. After menopause, the decrease in estrogen levels can lead to changes in the urinary tract that makes it more susceptible to infections. This treatment restores the balance of the vaginal and urinary tract environments, making it less likely for UTIs to occur.

Lifestyle changes, such as drinking more water and practising good hygiene like washing hands with soap after going to the toilet and the recommended front-to-back wiping for women, also play a big role.

Some swear by cranberry juice or supplements, though researchers are still figuring out how effective these remedies truly are.

What treatments might we see in the future?

Scientists are currently working on new treatments for chronic UTIs. One promising avenue is the development of vaccines aimed at preventing UTIs altogether, much like flu shots prepare our immune system to fend off the flu.

Another new method being looked at is called phage therapy. It uses special viruses called bacteriophages that go after and kill only the bad bacteria causing UTIs, while leaving the good bacteria in our body alone. This way, it doesn’t make the bacteria resistant to treatment, which is a big plus.

Researchers are also exploring the potential of probiotics. Probiotics introduce beneficial bacteria into the urinary tract to out-compete harmful pathogens. These good bacteria work by occupying space and resources in the urinary tract, making it harder for harmful pathogens to establish themselves.

Probiotics can also produce substances that inhibit the growth of harmful bacteria and enhance the body’s immune response.

Chronic UTIs represent a stubborn challenge, but with a mix of current treatments and promising research, we’re getting closer to a day when chronic UTIs are a thing of the past.

Iris Lim, Assistant Professor, Bond University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Cranberry juice has been used medicinally for centuries. Our new research indicates it should be a normal aspect of urinary tract infection (UTI) management today.

While some benefits of cranberry compounds for the prevention of UTIs have been suspected for some time, it hasn’t been clear whether the benefits from cranberry juice were simply from drinking more fluid, or something in the fruit itself.

For our study, published this week, we combined and collectively assessed 3,091 participants across more than 20 clinical trials.

Our analysis indicates that increasing liquids reduces the rate of UTIs compared with no treatment, but cranberry in liquid form is even better at reducing UTIs and antibiotic use.

Are UTIs really that bad?

Urinary tract infections affect more than 50% of women and 20% of men in their lifetime.

Most commonly, UTIs are caused from the bug called Escherichia coli (E.coli). This bug lives harmlessly in our intestines, but can cause infection in the urinary tract. This is why, particularly for women, it is recommended people wipe from front to back after using the toilet.

An untreated UTI can move up to the kidneys and cause even more serious illness.

Even when not managing infection, many people are anxious about contracting a UTI. Sexually active women, pregnant women and older women may all be at increased risk.

Why cranberries?

To cause a UTI, the bacteria need to attach to the wall of the urinary bladder. Increasing fluids helps to flush out bacteria before it attaches (or makes its way up into the bladder).

Some beneficial compounds in cranberry, such as proanthocyanidins (also called condensed tannins), prevent the bacteria from attaching to the wall itself.

While there are treatments, over 90% of the bugs that cause UTIs exhibit some form of microbial resistance. This suggests that they are rapidly changing and some cases of UTI might be left untreatable.

What we found

Our analysis showed a 54% lower rate of UTIs from cranberry juice consumption compared to no treatment. This means that significantly fewer participants who regularly consumed cranberry juice (most commonly around 200 millilitres each day) reported having a UTI during the periods assessed in the studies we analysed.

Cranberry juice was also linked to a 49% lower rate of antibiotic use than placebo liquid and a 59% lower rate than no treatment, based on analysis of indirect and direct effects across six studies. The use of cranberry compounds, whether in drinks or tablet form, also reduced the prevalence of symptoms associated with UTIs.

While some studies we included presented conflicts of interest (such as receiving funding from cranberry companies), we took this “high risk of bias” into account when analysing the data.

So, when can cranberry juice help?

We found three main benefits of cranberry juice for UTIs.

1. Reduced rates of infections

Increasing fluids (for example, drinking more water) reduced the prevalence of UTIs, and taking cranberry compounds (such as tablets) was also beneficial. But the most benefits were identified from increasing fluids and taking cranberry compounds at the same time, such as with cranberry juice.

2. Reduced use of antibiotics

The data shows cranberry juice lowers the need to use antibiotics by 59%. This was identified as fewer participants in randomised cranberry juice groups required antibiotics.

Increasing fluid intake also helped reduce antibiotic use (by 25%). But this was not as useful as increasing fluids at the same time as using cranberry compounds.

Cranberry compounds alone (such as tablets without associated increases in fluid intake) did not affect antibiotic use.

3. Reducing symptoms

Taking cranberry compounds (in any form, liquid or tablet) reduced the symptoms of UTIs, as measured in the overall data, by more than five times.

Take home advice

While cranberry juice cannot treat a UTI, it can certainly be part of UTI management.

If you suspect that you have a UTI, see your GP as soon as possible.

Christian Moro, Associate Professor of Science & Medicine, Bond University and Charlotte Phelps, Senior Teaching Fellow, Medical Program, Bond University

This article is republished from The Conversation under a Creative Commons license. Read the original article.