Performance from the Inside Out

Nutrition Education and Coaching

Non-Pharmaceutical Management of Urinary Tract Infections Post Spinal Cord Injury

Jayden Chapman, MS, RD, METS I

For most of us with a spinal cord injury (SCI), urinary tract infections (UTI) are part of life. Antibiotics can be essential and life saving, but also have side effects, and over time can lead to antibiotic resistance. We may not be able to prevent all UTIs, but here are some of the most effective non-pharmaceutical strategies for prevention and treatment that are backed by current research.

Hydration

The most important, and perhaps most obvious habit to maintain is staying well hydrated. Dehydration causes concentrated urine to sit in the bladder for longer periods of time. This is an ideal environment for bacteria to flourish and take hold. Drinking at least 64 ounces of fluid per day helps to flush out bacteria. Emptying the bladder regularly and completely also helps to get rid of bacteria. Allowing the bladder to become too full irritates the lining of the bladder, making it more susceptible to infection.

Functional Foods

Functional foods have health promoting compounds beyond the essential nutrients they provide. Cranberry juice is the most well researched functional food in relation to UTIs. Compounds found in cranberry make it harder for bacteria to adhere to the walls of the urinary tract. Some studies have shown two to three cups of unsweetened cranberry juice per day to be as effective as prophylactic antibiotics, with none of the associated risks or side effects. Two to three cups of cranberry juice may be hard to get down, in which case cranberry concentrate is also an option. Some other functional foods that may help are blueberries, garlic, and yogurt.

Vitamin C

Vitamin C makes your urine more acidic, which makes it harder for bacteria to grow. Vitamin C also supports the immune system, which helps fight off infections. Many fruits and vegetables are good sources of vitamin C, including bell peppers, citrus fruits, leafy greens, and potatoes. During an active infection, some studies show that high doses of vitamin C can help treat UTIs. Recommendations are as high as 1000 mg per hour up to 10 times per day, stopping or reducing the dose if diarrhea occurs. This is more vitamin C than you can get from food. The research is mixed on how effective this is, but it is an inexpensive and low risk intervention.

Probiotics

Probiotics are “good” bacteria that make it harder for harmful bacteria to multiply. Most of the bacteria in your body lives in the gut, but there are unique types of bacteria all over the body, including in the urinary tract. Probiotics are especially important if you’re taking antibiotics, which don’t only kill harmful bacteria; they kill the good bacteria too. This creates an opening for an imbalance called dysbiosis. Probiotics can help restore balance to the microbiome. Food sources of probiotics are fermented and cultured foods, including yogurt, kefir, sauerkraut, miso, and kimchi. Probiotics can also be taken as a supplement. Look for a product that has multiple strains of lactobacilli.

Fiber and Exercise

This is more related to preventing constipation. When the bowel doesn’t empty appropriately it puts pressure on the bladder, causing irritation. 20-30 grams of fiber per day helps keep things moving. Good sources of fiber include beans, avocados, pears, prunes, and whole grains. Regular exercise also helps prevent constipation, as does spending time on your feet if possible.

D-mannose

E. coli is the cause of 75-90% of UTIs. D-mannose is a simple sugar that adheres to E. coli bacteria, preventing them from adhering to the walls of the urinary tract. For prevention, 1-2 teaspoons dissolved in water daily is usually sufficient. During an active infection, one teaspoon every two to three hours is recommended, continuing for two to three days after symptoms have resolved.

Avoid Bladder Irritants

Bladder irritants are compounds that cause inflammation and create an environment that promotes bacterial growth. Bladder irritants include caffeine, carbonation, alcohol, refined sugar, and artificial sweeteners.

Work with your healthcare team

Lastly, it’s always important to communicate with your healthcare team if you have symptoms of an infection so they can monitor and assess the situation. Let your providers know what supplements you take so they can check for interactions.

Summary:

Urinary tract infections may be unavoidable following a spinal cord injury, but drinking plenty of water and maintaining a diet that incorporates functional foods and is high in fiber and vitamin C can help to minimize them. Supplements can also aid in prevention and treatment when taken appropriately. Always communicate with your healthcare team if you have symptoms of a UTI, and let your providers know what supplements you take.

  • Drink plenty of water
    • At least 64 ounces per day for most people
  • Eat foods high in fiber and vitamin C
    • Berries, apples, pears, oranges, kiwis, mango, pineapple, peppers, prunes, avocados, nuts, seeds, beans, lentils, whole grains, popcorn, leafy greens, broccoli, cauliflower, brussels sprouts
  • Include functional foods
    • Cranberry juice, blueberries, garlic, yogurt, miso, sauerkraut
  • Avoid bladder irritants
    • Caffeine, alcohol, carbonation, refined sugar, artificial sweeteners
  • Prevent constipation
    • Stay well hydrated, get adequate fiber, exercise regularly, and spend time on your feet as possible
  • Consider supplements for prevention and treatment
    • D-mannose for prevention and treatment of infections caused by E. coli.
    • Vitamin C- needs go up during an active infection
    • Probiotics, especially if taking antibiotics
  • Communicate with your healthcare team
    • If you have symptoms of a UTI, contact your healthcare provider
    • Let your healthcare providers know what supplements you take

Resources:

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  2. Beerepoot M, Riet G, Nys S, Williem V. Lactobacilli vs Antibiotics to Prevent Urinary Tract Infections. Arch Intern Med. 2012;172(9):704-712.
  3. Flores-Mireles A, Walker J, Caparon M. et al. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13(269–284).
  4. Gaby A. Urinary Tract Infection. Nutritional Medicine. 2011. (848-852)
  5. Hasler C. Functional Foods: Benefits, Concerns and Challenges—A Position Paper from the American Council on Science and Health. Journal of Nutrition. 2002. 
  6. Hess M, Hess P, Sullivan M, Nee M, and Yalla S. Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal cord injured patients with neurogenic bladder. Nature. 2008.
  7. Klebine P, Kirksey K. Urinary Tract Infection and Spinal Cord Injury. Model Systems Knowledge Translation Center. 2017. https://msktc.org/sci/factsheets/urinary-tract-infection.
  8. Kranjcec B, Papes D, Altarac S. D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World J Urol. 2014 Feb;32(1):79-84.
  9. Raguzzini A, Toti E, Sciarra T. Cranberry for Bacteriuria in Individuals with Spinal Cord Injury: A Systematic Review and Meta-Analysis. Oxidative Medicine and Cellular Longevity. 2020.  
  10. Monroy-Torres R, Medeina-Jimenez K. Cranberry Juice and Other Functional Foods in Urinary Tract Infections in Women: A Review of Actual Evidence and Main Challenges. Frontiers in Clinical Drug Research – Anti-Infectives. 2019.
  11. Santa Cruz J. Integrative Nutrition: Probiotics for UTIs. Today’s Dietitian. 2019;21(2):14.

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