The People's Perspective on Medicine

What Can You Do To Prevent Recurrent Urinary Tract Infections?

More than half of women will get cystitis at least once in their lifetime. Is there a simple inexpensive way to prevent recurrent urinary tract infections?

Have you ever had a urinary tract infection (UTI)? The symptoms are unpleasant, to put it mildly. First, you may feel a tremendous urge to pee. And when you do urinate, the burning sensation can be unbearable. So, there you are. You have to keep running to the bathroom and each time you dread the burn. Sometimes there is pelvic pain along with the burning. And when you see pink or red urine you know you are bleeding. Get thee to a physician promptly! And if you have fever and chills, make that double fast. Once you have had one UTI there is a good chance you will end up with recurrent urinary tract infections.

Overcoming Recurrent Urinary Tract Infections:

Recurrent urinary tract infections cause a tremendous amount of pain and frustration. Within the first year of an infection as many as 70% of women will have another one. Doctors prescribe antibiotics to treat these UTIs. As a result, some women may end up taking several courses of antibiotics each year.

That many antibiotics can have unforeseen consequences. The ecology of the digestive tract can be upset. Getting the microbiome back in balance can be challenging, especially if you have to take more antibiotics within a few months. Then there is the whole problem of antibiotic resistance. Anything that women can do to prevent infections would be good for them and for the environment.

Water for Recurrent Urinary Tract Infections:

Now, a study shows that a simple lifestyle change can make an important difference in the number of infections a woman might experience (JAMA Internal Medicine, online, Oct. 1, 2018)  The participants in this study were women who had recurrent urinary tract infections and who normally drank less than six glasses of water daily.

The investigators randomly chose half of the women to continue with their usual water-drinking habits. The other half were asked to double the amount of water they drank.

During the next year, those who increased their water consumption had, on average, 1.7 urinary tract infections. Those who had not increased their water intake had 3.2 infections on average.

The authors of this study offer this convincing observation:

“This study is the first randomized clinical trial to evaluate increased hydration for prevention of recurrent cystitis in women. We demonstrated that increasing daily water intake over a 12-month period resulted in an approximately 50% reduction in frequency of cystitis recurrences and a similar reduction in use of antimicrobial regimens… the beneficial effects observed using water, which is safe, inexpensive, and does not select for antimicrobial resistance, are substantial and important.”

Women who are able to drink two or three liters of water daily may have less trouble with recurrent UTIs and should therefore need fewer antibiotics.

Share your own story about dealing with UTIs in the comment section below.

JAMA Internal Medicine, online, Oct. 1, 2018

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I began having cystitis at age 19. By age 35, I had cystitis about every six weeks, I.e., except when on antibiotics. My urologist decided on a surgery wherein he made a small vertical incision in the urethra and permanently stitched a flap open so that the urethra would not collapse again. Haven’t had a single problem since he did this – 34 years ago!

I need help on how to take D-Mannose. I bought it, but do not know how, etc. to take it. Mine is 500 MG. Please help with how much to take, when, with meals or not, etc. Instructions on bottle say to take three capsules one to three times a day. Please help with missing parts of instructions for taking.

I read about D-Mannose. You need the powder form. You put one teaspoon in a cup of water, stir , and drink. It’s a sugar that eats the E.coli in the urine. Take it several times a day and a couple of days until you have no more symptoms. I tried the pills as that is all our health store carried. It helped, but I finished the bottle and still had problems.

After a urologist advised me to order Ellura super cranberry capsules on the web & take one a day, my seven yearly bladder infections decreased to one or two. But when a bladder infection did strike, I suffered from unbearable leg cramps from taking the antibiotics Levaquin, Cipro & Keflex which were prescribed. Then a super doc prescribed Monurol! And it worked like a charm, with no noticeable side effects. Just dissolve a packet in water, drink it & in a few days, no more bladder infection! Have since learned this is the medication many doctors in Europe swear by for bladder infections.

d-mannose is the answer! just a few days of taking it will repair and replenish the bladder environment, to help discourage growth of bad bacteria. using antibiotics only makes matters worse in the long run; along with the bad bacteria, the antibiotic also kills the good bacteria.

Please give dosage, strength of the D-Mannose, how many, how often, take with meals?, etc. Thank you so very much. The D-Mannose I bought is 500 MG. Please help.

I noticed that many mornings, on awakening, I could detect some dampness in my underclothes after sleep, and so I started daily putting on fresh unders just as soon as I wake up, even if I’m not ready to bathe or shower right then. Since I started this, it has noticeably helped to reduce the number of UTIs I have experienced.

I almost completely stopped eating added sugar. That is, I might have some if it’s in a restaurant salad dressing, for example, but I’m learning to choose oil and vinegar. I might have some at Christmas dinner or Thanksgiving. I do eat intrinsic sugar. After I almost completely stopped eating added sugar, I stopped having UTIs. I had had them for about 45 years. (Our sex life has happily rolled right on.) I have found it much easier to quit added sugar entirely rather than just try to reduce it. It makes the whole thing so simple. Within a few weeks of quitting, my threshold for a sweet taste plummeted. Even good celery can taste slightly sweet to me now. (Hard to believe, no?)

Am I the only person with a ureatheral caruncle? It is when your urethra turns to the outside of your body, leaving you open to germs. After years of bloody UTI’s I was referred to a urologist who took one look at my anatomy and said: “You have a caruncle.” They are, in part, a consequence of no estrogen. The treatment has been premarin cream. I have done well on it but when I have weaned off it, the UTI’s have come back. A nice side effect of the cream has been no more hot flashes.

Try drinking half your body weight in ounces of filtered water throughout the day, and don’t allow yourself to become thirsty. Water only, not coffee or sodas!

Having a UTI is not the same as cystitis. Cystitis symptoms are similar to UTI, except there is no infection. I thought I had recurrent UTI’s. The dr kept giving antibiotics, with no improvement. When urine culture were done, no infection was present. I finally went to urologist. For me, oranges, orange juice, highly acidic fruits, and caffeine were triggers for inflammation. Strangely, cranberry juice is ok for UTI, but not cystitis.

Pure cranberry juice mixed with water. I sip on it all day.

Cranberry pills, 3x a week are the answer for me!

My gym told me to wash in the shower daily with Johnson’s baby shampoo. I haven’t had a UTI since.

ALWAYS- empty your bladder after sexual activity to allow the flow of urine to wash out any bacteria introduced during sex.

I was having several UTI’s/yr. I started drinking more water and cut soda’s out completely. I also remember how females should clean themselves. Front to back to keep from contamination of stool. I also purchased a bidet, used all over Europe, not so popular here, but they are wonderful, mine gives me a choice of water temperature, front or back, and amount of pressure. I have not had an UTI since! Johnnie

D-Mannose is the real deal. If I ever feel like a uti might be coming on, I take a half teaspoon of d-mannose powder in water and that takes care of it. Also drinking water, and not a lot of sweets.

The best advice I’ve come across for avoiding UTI’s is to use a bidet or to shower after you have a bowel movement. Women are very susceptible to e-coli contamination due to their anatomy. And since 90%+ of UTI’s are caused by e-coli, you’ve got to be vigilant about cleanliness. D Mannose is also invaluable for keeping bacteria from adhering to your bladder. Doctors are now being advised to avoid prescribing Cipro for uncomplicated UTI’s, thank god.

I was on a trip overseas and couldn’t get any medicine. I could however get all the dried cranberries I wanted. After eating a large bowl two days in a row my symptoms were gone. I get them a lot on trips and will now take more precautions.

For about 3 years, starting in my late 50s, I would get UTI every quarter. Doctors would put me on antibiotics but I’d get UTI 3 months later. I was even in a hospital overnight for observation and tests. Nothing worked. They said it wasn’t interstitial but rather caused by bacteria and a urethra that had changed due to age. Then I read a website run by an RN (link has been misplaced) that recommended vitamin C pills to make the bladder acidic. So, I started taking 500 mg in the morning and 500 mg at night and it’s been 2 years since my last UTI.

Why is the issue of biofilms in the urinary tract not addressed here? – It is well-documented that biofilms are one of the main reasons, if not THE main reason, why UTIs “recur”: in fact they never went away – the offending organism was simply in hiding. No discussion on UTIs is anything like complete without addressing the issue biofilms and biofilm disruptors.

Get checked for celiac disease! Recurrent of any kind of infection could mean celiac is a possible culprit. I was diagnosed in my 60’s and had one nasty UTI after another. When the gluten was eliminated, so were the UTI’s. I’m almost 72 and haven’t had one since!

A couple of years ago I had 2 UTI’s within a period of a couple of months. I’m pretty sure they were caused by antihistamines. My eye doctor had recommended taking an antihistamine each day, whether I needed it or not, to prevent itchy eyes during seasonal allergy time. I think the antihistamine caused urinary retention, which let to the UTI’s. Now I’m careful with antihistamines and take the smallest amount, and only as needed. Also I try to be aware when I might be experiencing urinary retention. Also I do take a cranberry pill that also contains a probiotic, Vitamin C and calcium. Knock on wood, I haven’t had a UTI since. Also I want to add I had reactions to Bactrim and Cipro: anxiety and insomnia.

I’m almost 80, in good health and haven’t had any UTI issues until now. I’ve had a chronic cough/lots of mucous for about 15 years – tried everything but nothing has worked. In the last year, the constant coughing has caused “bladder leakage” with every cough! Tried all the diapers and pads, but hate them and find I get a discharge after using them. Saw a new product, Poise Impressa, a tampon-like item that acts as a bladder support, which comes in three sizes (1, 2, or 3).

Ordered a “sizing kit” and began a trial with the lowest/smallest (1). It was uncomfortable, but I tried it for about 4-5 hours, which is well below the maximum suggested time of 8 hours. When I extracted the “tampon” it was very pink in color. I’m not sure if it was pink to begin with, or it caused some internal bleeding. The next day I had all the symptoms of a UTI. Don’t know if this should be reported somewhere – it’s a great concept and many reviewers say “it’s the best.” If the product could be made in a size smaller than 1#, I’d try it again to avoid bladder leaks and wearing those awful plastic briefs/pads.

TERRY/JOE: Has any info crossed your desks about this great, fairly new product? Thanks so much for all that both of you do for our health!

I started getting one bladder infection after another in my mid sixties. My mother was cursed with this same thing and ended up with damage to her bladder as a result. I am allergic to many antibiotics and cannot take vitamins as I will get kidney stones within a week to ten days of taking them.

I started on Estrace vaginal cream in my sixties, am now seventy six and have only had two bladder infections in all these years. I use it once a week and if I miss taking it for several weeks (which has only happened a couple of times) I inevitably get a bladder infection. It is a prescription, but it completely changed my life.

The D-mannose is a life-saver! After recurring UTI’s, I found this “wonder drug”. I suddenly began having UTI’s about 5 years ago, and after the first one, they seem to be back to back, and were always treated with antibiotics. After using the D-mannose at the end of the antibiotics, that ended the cycle.

I was told that even with antibiotics, a small amount of bacteria can “hide”, and then “jump out” later, which is where the D-mannose comes in. The bacterial bind to the sugars, especially using the treatment dosage, which is a number of capsules following by drinking lots of water a few hours later, then moving on to the preventative dosage.

It is completely safe, even for diabetics. I have suggested this to friends and family, including a cousin who was stuck in the cycle of UTI, antibiotics, UTI, repeat, and my 85 year old mother who was also stuck in the cycle and all reported success! One word of caution: if you have a full blown UTI, it is imperative to treat the infection with antibiotics, then follow with the D-mannose heavy initial dose and then preventative.

D-mannose will not cure an infection. Also, in the case of my mother, my allergist/DO gave me the formula she had come up with after many years of not being able to stop the UTI cycle, especially for “older ladies”, who may fall short of proper hygiene, due to other health issues, mobility, etc. which is contributing factor. She found that it was necessary also to treat with an antifungal vaginally, as bacteria often migrates from urinary tract to vagina, and causes problems again.

Same thing. Never had UTIs until mid to late ’60’s, for whatever reason. Am now using compounded Estradiol twice weekly, (if I remember), and so far so good.

D-Mannose powder works amazingly well. I used to get UTI infections regularly. Haven’t had one in more than 10 years since finding out about D-Mannose. This powder (or capsules) stirred into water and consumed sticks to the bacteria better than the bacteria sticks to the bladder wall.

Most UTIs are caused by e-coli bacteria. This D-Mannose will knock it out. I keep a bottle on hand all the time. Had it a long time and have not opened it yet. Look it up. Do your own research. Great stuff!

I take d-mannose powder and a combo ester c + cranberry pill daily and utis are a thing of the past. Also important to supplement estrogen to prevent them, this can be done locally to prevent systemic side effects.

D-Mannose seems to be working well for me!

I suffered with recurrent UTIs for 17 years. This was likely triggered by adhesions from a C-section. After trying everything I could get my hands on, I finally discovered D-Mannose and never had another UTI. It can be taken as a preventative or can be used to treat a full blown UTI.

I used it as a preventative for several years before the inflammation finally completely died down. Now, I use it only when I feel that twinge. I always have some on hand and I never pack a suitcase without it.

My husband uses it daily and it seems to help with his BPH (benign prostate enlargement). How sad that doctors refuse to tell their patients about this. When I have mentioned it to doctors, they simply dismiss it. Those 17 years of repeated antibiotics have severely damaged my digestive tract. This could have been avoided if I’d known about D-mannose earlier.

Take showers, not baths!

Just a thought, as a nurse:

As we age we become less agile. Twisting our backs becomes more difficult. I’ve found many ‘older’ women find it hard to wipe themselves front to back after voiding using the method of reaching around behind themselves.

Also, I’ve found people tend to take fewer showers as they age as well. I cannot tell you how much dirt I have wiped away from just an arm in order to start an IV on people who have access to showers, but are not showering. Since the alcohol wipes I use to clean the area before starting an IV are white, it is very obvious how much dirt is there. I know fear of showering is a big problem as well – no judgment here. But if the arms are that unclean and so easily washed………

It’s possible to wipe front to back from the front. It’s possible some UTI’s are caused by fecal matter entering the urethra if this procedure is not followed.

I’ve read articles where bidets are very helpful as well – they wash away and help keep the entire area clean. So maybe a bottle like the new moms use? To squirt water on these areas after voiding?

Women who have a problem wiping front to back should try this: Step 1 Pat dry (blot) front area and buttocks if wet. Step 2 Wipe back only (anus) without continuing
forward. And yes, I use a new mom bottle to clean further.

I’m definitely going to try the dmannose because I’m having urinary tract infections and I can’t seem to get straightened up in this sounds wonderful thank you

I had my first, and only UTI at age 59 after playing a lot of tennis, and probably not drinking enough water. I had started to run a fever. We were new snow birds, and the few doctors I called would only see established patients. I googled holistic remedies for UTI, and colloidal silver came up. I went immediately to the health food store and took my first dose in the parking lot. I felt relief quickly and within 24 hours, it was gone!!

I, also, have turned to D-Mannose after becoming discouraged with traditional medical treatment which included many antibiotics, and then GI problems, which I strongly suspect resulted from the frequency of the antibiotic use. I now take D-Mannose daily and have not had a UTI since.

I have just had a bad run of UTIs. The things I found helped the most were Cranberry with D Mannose, Acidophilus, drinking apple cider vinegar diluted in water, drinking baking soda dissolved in water (probably the #1 help over-all), and over the counter Miconazole. I am allergic to almost all antibiotics except Cipro, but that caused foot issues so I won’t take it. Takes longer to heal than if you take prescription medicine but these work–thankfully!

Thank you for the tip. How much ACV and baking soda do you drink dissolved in water/day?

I’m 85 and have had bladder infections twice in my life. Both times, same cause: I ate the wrong thing (tomatoes!!) and had uncontrollable diarrhea. Both times the proximity of diarrhea gave me bladder infection. No more summer tomatoes from the garden, no more bladder infection! It did take me two times to ‘get the message.’

After many UTIS and many rounds of antibiotics, I had my bladder stretched. Have not had a UTI since. It’s been several years. The procedure was easy and painless. It was covered by my insurance.

I was on antibiotics every couple of months for recurrent UTIs for a couple of years. I drank water, cranberry juice and took AZO cranberry tablets. None helped. The urologist wanted to conduct a stretching of my urethra witch I was not on board with. Finally an article in prevention magazine recommended D-Mannose 500 mg every day. It’s available in the health food store. Since I started on that regime, I have been UTI free. In fact, I stopped taking them after about 6 months (which was the recommendation) and I still am UTI free after a year.

At 84 never had a UTI until last spring and since then had “repeated” ones. Finally went to a urologist & he said quit going to the “urgent care” places as their lab work is not definitive: it will show bacteria every time and urine always has bacteria in it. A urology lab is set up to quickly define the entire make-up of the urine which then can be treated specifically. This does 2 things: treats the actual bacteria IF there is one. Often the “dip stick” lab test throws the patient into the antibiotic d’jour which does no good. in fact can develop ‘superbugs’ which may be resistant to anything.

I have had many infections of the urinary tract. It seems like after you’ve had one you are doomed for more. The biggest thing I have learned is not to take CIPRO or LEVAQUIN. They invariably turn up as effective when you have a culture and sensitivity test done, and your Dr. whips out her pen to write for one. Quinolones can cause more problems than they resolve.

I blew out the tendons in my arms and shoulder taking Levaquin. Beware of this drug!!!

You’re right to caution against fluoroquinolones. My nephew needed surgery after treatment with Levaquin, and my grandson narrowly avoided surgery. Dangerous drugs.

Beginning in my 40’s, I had MANY UTIs over a period of 30 years, but have them rarely now, as I have learned several important tips which have reduced the incidence of UTIs for me:
. Drink 8 glasses of water a day for general good health; but, in particular, drink a small glass BEFORE having sexual intercourse, and also a small glass AFTERWARD.
. Avoid caffeine (coffee/tea, colas), as it is a diuretic and takes water OUT of your body. I’ve noticed that it also inhibits my natural thirst, which compounds the lack of drinking water.
. Avoid public hot tubs!
. Move lovemaking to earlier in the day (mornings are always nice, especially if you are retired) or early evening so that there is plenty of time to drink and urinate a few times before going to sleep for the night.
. Be sure both you and your partner have washed your genitals and bottoms with warm soapy water just before making love.
. Always use a personal lubricant generously on both partners, making foreplay special; reapply before intercourse.
. Urinate right BEFORE and right AFTER making love.
My experience is that regular lovemaking is both physically and emotionally healthy. Your body naturally responds in a positive way. As a result, both partners are happy, thus improving caring/concern, trust, respect and overall marital health.

Taking a cranberry pill daily helps tremendously.

When I was a medical student, long ago, we were told that because a woman’s urethra is very short, it is easy for bacteria to travel back up. We were told to teach our female patients to make certain that they have some urine in their bladders when they have sexual intercourse and that they should void as soon as possible after intercourse, to flush out any bacteria in the urethra.
It seemed that those women who followed this instruction had far fewer urinary tract infections.

Forty eight years ago I was plagued by UTIs. My GYN was intuitive enough to have me start taking probiotics, vitamin C and extra acidophilus with pectin. He advised me to limit my sugar intake and eat lots of veggies. It did the trick, I have not been bothered with any UTI problems in over forty years.

See research by Jeffrey P. Henderson at the University of Washington (St.Louis). One of 2 factors: pH of urine. Better to be more alkaline.

About the only thing that has changed in urology in the last 50 years is the magazines in the office waiting room. There is almost no research. More and more women have recurrent UTIs. We need research in urology. Lots of it.

The school in St Louis is named Washington University (WashU) … not trying to be pedantic, just trying to get people to the right source, because you’re absolutely right that WashU is very well regarded!

As a pharmacist I would still recommend cranberry capsules especially a few days BEFORE traveling.

I used to have frequent UTI’s.
Finally, I started drinking about 4 ounces of water with an Alkaline Seltzer tablet in it (generic brand). I also started taking cranberry pills daily.
The most important thing I learned was … after I finished urinating was to lean over. This finishes emptying your bladder. By doing this, I don’t even have to take the Cranberry pills anymore and haven’t had an UTI for a few years.


I will try what you said worked for you. I can dribble for 10 minutes at night. If I don’t, I will need to get up sooner for another bathroom break.


In May, I started out with a GI infection that escalated throughout June. The culprit may have been lettuce. Once that was cleared up, I found I also had a bladder infection. So many antibiotics! The bladder infection came back. I consulted Dr. Low Dog’s book and followed her recommendation. I found a capsule at my local vitamin store that met the recommendation of D-Mannose with cranberry. I took this twice a day until the bladder infection was gone,(no more symptoms) and now take the recommended daily dose to prevent any more UTI’s. It works!

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