A bladder infection is a common type of UTI, especially among women. This bacterial infection can be painful, stubborn, and distressing. The good news is that it is simple enough to treat in most cases, while certain lifestyle changes may help prevent it from coming back. Learn what your doctor may prescribe and which home natural remedies can help.
Conventional Bladder Infection Treatment
Antibiotics
Antibiotics are the mainstay treatment for bladder infections. Simple cases usually require a short course of antibiotics.
For a long time, the first choice was the combination drug trimethoprim/sulfamethoxazole, more commonly known by its brand names Bactrim or Septra.
According to multiple studies, Bactrim is on par with other strong antibiotics. It also has fewer side effects. In clinical trials, the cure rate of Bactrim was about 80-100% [1, 2, 3, 4].
The main drawback of Bactrim is that bacterial resistance is steadily increasing. One study found that its cure rate dropped to 42% when treating resistant strains of bacteria. Many clinicians now recommend only using Bactrim in specific cases (when the local resistance rate is less than 20%) [5, 6, 7].
Another commonly used antibiotic is nitrofurantoin, also called Macrobid or Macrodantin. Studies show that nitrofurantoin has a similar cure rate to Bactrim, averaging about 90%. The benefit of nitrofurantoin is that bacterial resistance is still low [4, 8, 7].
On the downside, it may have negative effects on the kidneys. Nitrofurantoin must be used cautiously in those with kidney disease and in the elderly [9].
Other antibiotics may be used for severe infections or highly-resistant bacteria. Stronger antibiotics come with more side effects and can be more expensive. Other factors that affect antibiotic choices include drug availability, allergies, and drug interactions [10, 7]
Pain Medications
Pain-relief medications are sometimes used to reduce symptoms of pain and burning when urinating. However, painkillers only temporarily ease the discomfort and do not treat the underlying infection.
A popular pain-relief medication is phenazopyridine, which is available over-the-counter. Common brand names include Azo, Uristat, and Pyridium. This drug is able to concentrate in the urine to provide localized pain relief [11].
Phenazopyridine has been used in bladder infections for nearly a century, but research on its use is limited. One large study found that it improved symptoms in 61% of about 1500 women [12].
Other painkillers, like NSAIDs and opioids, are sometimes used. According to research, opioids improve symptoms in 65.5% of women and their short-term use causes fewer side effects than Pyridium. However, opioids are strong painkillers that should be reserved for severe pain. Tolerance develops quickly and the risk of abuse is high [12].
Non-prescription NSAIDs are also a popular choice, as they reduce both pain and inflammation. Multiple studies have even explored the idea of using ibuprofen without antibiotics. They found that about 50 – 66% of women were able to recover while only taking ibuprofen. However, these women also experienced more serious infection complications [13, 14].
Potential Home Remedies for Bladder Infection
Various natural remedies have been researched and traditionally used for helping prevent UTIs, reduce rates of recurrence, or ease mild symptoms. However, few large-scale clinical studies have been carried out.
Never use these strategies in place of something your doctor recommends or prescribes.
Insufficient Evidence For:
The following substances have shown promise against bladder infections in limited, low-quality clinical studies; there is currently insufficient evidence to support their use in this context, and they should never replace what your doctor prescribes.
Remember to talk to your doctor before starting any new supplement or making significant changes to your diet.
1) Cranberries
Many believe that cranberries are a safe and effective way to prevent UTIs. Despite numerous studies, the scientific community has not reached a clear verdict.
In clinical trials, cranberries reduced the recurrence of bladder infections. One clinical trial of 150 women found that cranberries reduced the rate of infection by 20% [15, 16, 17].
However, not all research supports their effectiveness. A comprehensive review of 24 studies and over 4,000 people concluded that strong evidence to recommend their use is lacking [18].
Cell-based studies have found that cranberries contain compounds that prevent bacteria from attaching to the bladder [19].
Recommendations are further complicated by the fact that different strengths and forms of cranberry supplements are used. Cranberry products can be taken as a juice, powder, or in pill form. It is unclear whether one form is more beneficial than another [20].
Ultimately, cranberries remain a popular natural remedy due to their low cost and minimal side effects, but their actual effectiveness is unknown [20, 17].
2) Vitamin C
Based on limited research, vitamin C may help prevent bladder infections. In one observational study of 468 women, vitamin C was weakly linked to lower infection risk. According to a different study, pregnant women who took daily vitamin C had fewer bladder infections [21, 22].
Cell-based studies show that vitamin C may make the urine more acidic, turning it into a less hospitable environment for the bacteria [23, 24].
You usually don’t need to take supplements to get enough vitamin C. Its content in food can vary, but eating vitamin C-dense foods will usually supply a decent amount of this vitamin. The best sources include camu camu, citruses, acerola cherries, wild strawberries, and rose hips.
3) D-Mannose
D-mannose is a type of sugar that naturally occurs in the human body. Its chemical structure is very similar to glucose. Research on D-mannose is limited. One clinical trial of 308 people suggests that it is just as effective as nitrofurantoin, an antibiotic, and has significantly fewer side effects [25].
Similar to cranberries, cell studies show that D-mannose prevents bacteria from sticking to the walls of the bladder. Theoretically, this allows for bacteria to be flushed out when urinating [26, 27].
D-mannose is available as a nutritional supplement, in powder or capsule form.
4) Probiotics
Probiotics have become a popular and safe natural remedy for preventing infections. Research uncovered that probiotics can help with various types of infections. However, their benefit for bladder infections specifically is somewhat unclear.
A review of 9 studies concluded that there was not enough scientific evidence to say probiotics have a benefit: the difference between probiotics and placebo in reducing recurrent infections was minimal [28].
However, one particular probiotic does show promise. L. crispatus is a beneficial bacteria species that is commonly found in the vagina. A specific probiotic strain called CTV-05 is available as suppository capsules for vaginal use.
In one clinical trial, 100 women with recurrent bladder infections were given antibiotics plus L. crispatus or placebo. About 15% of women who took L. crispatus had an infection, compared to 27% of placebo users. A safety study confirmed that this strain is safe and has minimal side effects [29, 30].
5) Garlic
Compounds in garlic can fight bacteria, fungus, and viruses. Specifically, the compound called allicin seems to be responsible for the health benefits. Allicin is also anti-inflammatory properties, which may help reduce symptoms like pain and discomfort [31, 32, 33, 34].
Garlic may have a potential benefit for bladder infections. In two young women who failed multiple antibiotics, garlic reduced the frequency of infections and the severity of symptoms [35].
However, these women also received other natural remedies aside from garlic, including cranberries, probiotics, parsley, magnesium, evening primrose oil, and L-arginine. Because so many supplements were used, it is difficult to determine exactly what had the most beneficial effect [35].
6) Acupuncture
Curiously, studies have examined the potential effectiveness of acupuncture in bladder infections.
Two small clinical trials were performed in Norway. The first study lasted for 6 months and included 67 women with a history of recurrent bladder infections. Of the women that received acupuncture, 85% were infection-free by the end, compared to only 36% of women who didn’t undergo the treatment [36].
A second study included 98 women and also lasted 6 months. This time, 73% of women who received acupuncture did not have a bladder infection by the end of the study period. Of the other women, 52% were infection free [37].
Larger clinical trials are needed to confirm these findings. Acupuncture is generally very safe when performed by a qualified practitioner, and may also help reduce pain and balance your stress response.
Lacking Evidence For:
No clinical evidence supports the approaches listed below to combat bladder infections. Below is a summary of the existing animal and cell-based research, which should guide further investigational efforts. However, the studies listed below should not be interpreted as supportive of any health benefit.
7) L-Arginine
L-Arginine is an amino acid that is used by the body to create proteins. L-arginine is typically found in foods such as red meat, fish, chicken, and dairy products.
L-arginine may play a role in fighting infections. One cell study shows that it activates cells in the immune system to attack bacteria. In an animal study, it improved circulation and metabolism in pigs with severe blood infections [38, 39].
The only evidence for L-arginine use in bladder infections comes from case reports. These used a combination of natural remedies (mentioned above), making it hard to judge the effectiveness of l-arginine alone [35].
8) Berberine
Berberine is a plant compound used in traditional Chinese medicine. Several plants contain berberine including barberry, Indian barberry (“chutro”), and goldenseal.
One cell study shows that berberine prevents bacteria from attaching to the urinary tract surface, which would help detach bacteria in bladder infections. However, no clinical trials have been performed and its efficacy is unknown. Berberine supplements are safe and only rarely cause mild side effects [40].
Possibly Ineffective:
9) Uva Ursi (Bearberry)
Uva ursi is a species of plant that has been traditionally used to remedy bladder infections, but clinical studies have not produced positive results.
A compound called arbutin is the main active component. There is some concern that arbutin metabolizes into compounds that are toxic to the liver, but initial cell and animal studies propose that uva ursi is generally safe [41, 42].
Clinical research on uva ursi is limited. One clinical trial of 382 women found that uva ursi does not have an effect on the frequency of bladder infections or the severity of symptoms. Other larger trials are in progress [43].
Strategies for Bladder Infection Prevention
Lifestyle Changes
Despite the mainstream consensus, studies show that some popular methods of prevention may have no effect in women with recurrent infections. Behaviors like post-sex urination, wiping patterns, and tampon use are not strongly linked to recurrent infection risk [44, 20].
Some experts recommend urinating after sex and wiping front to back. More broadly, good intimate hygiene maintains vaginal flora balance and supports reproductive health. Although they may not have a direct effect on recurrent bladder infections, using soaps and douches can change the vaginal pH and increase the risk of vaginal infections [44, 20, 45].
Sexual Activity & Birth Control Methods
Research shows that sexual activity is the strongest risk factor for bladder infections. Infections may still develop in the absence of sexual activity, however [46, 20].
The use of spermicides as birth control is also strongly linked to infection. Intrauterine devices (IUDs) may also increase the risk and can lead to more complicated infections. Women with recurrent bladder infections should consider using a different form of birth control [46, 20, 47].
Drink Plenty of Water
Successfully preventing bladder infections may be as simple as drinking enough water. Increasing water intake may help flush out bacteria and maintain an optimal urine acidity level [48].
Observational studies show that low water intake and urine output are linked to bladder infections. One small study of 17 women found that women who tracked their hydration and water intake experienced fewer bladder infections [49, 50, 51].
No clinical trials have tested the effect of hydration on bladder infections. There is also no consensus on the optimal amount of water to drink. Despite this, adequate hydration remains a popular recommendation due to the many benefits and very few drawbacks of drinking enough water [52].
Medications
If you struggle with recurrent, severe bladder infections or UTIs, your doctor may prescribe certain medications to reduce the risk of the infection coming back and causing serious complications.
Do not take antibiotics unless they are prescribed to you. If your doctor writes you a prescription, be sure to finish the whole prescription to prevent the development of bacterial resistance.
Antibiotics
Women who experience frequent bladder infections may be prescribed antibiotics as a preventive measure. The same antibiotics are usually prescribed both for prevention and treatment, but the strategies can differ. Do not take antibiotics unless prescribed by a doctor.
One strategy is to take antibiotics every day to prevent bladder infection. A large review of 19 studies found that continuous antibiotic use for 6-12 months reduces recurrent infection. However, daily antibiotics also increase the risk of side effects and antibiotic resistance [53].
Alternatively, antibiotics can be taken on a weekly or monthly basis. One study of 361 women found that weekly antibiotics were more effective than monthly doses [54].
Another approach is to take a single dose of antibiotics after sex. Several studies show that a post-sex dose of an antibiotic reduces bladder infections [55, 56, 57].
According to long-term research, antibiotics after sex are just as effective as taking daily antibiotics. This strategy reduces the quantity of antibiotics taken compared to daily use, which lowers side effects and bacterial resistance [53, 55, 56, 57].
The last strategy is to start antibiotic therapy at the first sign of infection. For this self-start method, women are taught how to self-diagnose and treat their bladder infection. Multiple clinical trials show this approach is effective and safe. According to one study, about 90% of women were able to accurately self-diagnose a bladder infection [58, 59, 60, 61].
However, self-start therapy is not as effective as daily antibiotics. One small study found that women who self-treated had 2.2 infections per year, compared to 0.2 infections per year with daily antibiotics [60].
Methenamine
Methenamine, also called Hiprex or Urex, is sometimes used to prevent bladder infections. Methenamine metabolizes to formaldehyde in the urine, which acts as an antibacterial. This drug is more effective when the urine is acidic. Increasing urine acidity by taking vitamin C or limiting milk products can be beneficial [62].
In one large review of 13 studies and 2,000 people, methenamine prevented the majority of bladder infections. However, it did not work for people with abnormalities of the urinary tract. The rate of side effects was low, based on limited data [63].
Estrogen
Estrogen is an important hormone for maintaining vaginal health. It promotes the growth of good bacteria, which in turn blocks the overgrowth of harmful bacteria. Postmenopausal women produce less estrogen, which increases their risk of bladder infections [64].
A large review of 9 clinical trials including over 3k women reported that estrogen taken by mouth is not effective. Estrogen applied vaginally did reduce the frequency of infections. However, there was not enough evidence to support the use of one vaginal estrogen form over another (cream or vaginal ring) [65].
Vaccines
A vaccine that prevents bladder infection is an appealing prospect to some. However, the clinical effectiveness of newly developed vaccines is limited. In the U.S. there are currently no approved vaccines available for bladder infections [61].
The vaccine Uro-Vaxom (also called OM-89), is an oral vaccine available in Europe. It contains 18 different types of inactivated bacteria. An analysis of 10 clinical trials found that Uro-Vaxom reduces the frequency of infections more than any other vaccine. However, the quality of the studies was weak and the researchers could not make a definite recommendation [66].
A second vaccine called Solco-Urovac has also been developed in Europe. It comes as a suppository that is placed directly into the vagina. Research reviews show that Solco-Urovac also reduces the frequency of bladder infections. It requires a cycle of booster immunizations to be effective [66, 67].
Bladder Infection & Genetic Predispositions
Summary of Associated Genetic Variants
Some researchers believe that genetic differences may, in part, explain why some people are more susceptible to bladder infections. The research on this front is in its early stages.
One area of focus is on Toll-like receptors (TLRs). These are a group of proteins that help the immune system identify bacteria. Studies have linked genetic variations that reduce TLRs to an increase in recurrent bladder infections, as they reduce the body’s ability to recognize invading bacteria and host immune response [68].
Certain variants in the following TLR genes were linked to bladder infections [69]:
Research also suggests that genetic variations of interleukin receptors may play a role. Interleukins are a large group of signaling proteins that play a variety of roles in the immune system. Certain genetic variations can interfere with interleukin binding, which may increase the risk of bladder infections.
Variants in the following interleukin receptor genes have been linked to bladder infections [69]:
Limitations and Caveats
Limited Research
A great deal of research is available about bladder infections and strategies to treat or prevent them. Antibiotic treatment is one example. However, scientific evidence is lacking in some areas, especially for natural home remedies. More investigation is required before many of the natural products can be confidently recommended.
Different Types of Infection
The focus of the information presented here is on simple cases of bladder infections. Complicated bladder infections and kidney infections often require different treatments and precautions.
Takeaway
Bladder infections are among the most common bacterial infections in the world. Typical infections are usually simple enough to treat and don’t cause long-term complications. Treatment usually involves a short course of antibiotics, sometimes along with symptom-relieving painkillers.
Sufficient hydration is linked to reduced rates of infection. Spermicides and IUDs are linked to increased rates of infection. Some research supports the use of supplements for prevention, including cranberries, vitamin C, D-mannose, probiotics, and garlic.
