Urinary tract infections (UTIs) are caused by bacteria and are 10 times more common among women than men. About 30 percent of UTIs go away and do not recur. When UTIs do recur, it is often because the treatments used to suppress bacteria seem to work at first, but do not produce a lasting cure. UTIs can also recur when a woman is infected again by a different kind of bacterium.

• Pain or burning when urinating
• The need to urinate more often than usual
• A feeling of urgency when you urinate
• Blood or pus in the urine
• Cramps or pain in the lower abdomen
• Chills or fever (fever may be the only symptom in infants and children)
• Strong-smelling urine
• Pain during sexual intercourse

Some risk factors include the following.

• A new sex partner or multiple partners
• More frequent or intense intercourse
• Diabetes
• Pregnancy
• Use of irritating products such as harsh skin cleansers
• Use of irritating contraceptives such as diaphragms and spermicides
• Use of birth control pills
• Heavy use of antibiotics
• A blockage in the urinary tract (benign masses or tumors)
• A history of UTIs, especially if the infections were less than six months apart

Your health care provider will feel your abdomen and kidneys for changes and use laboratory tests, such as a urine culture, to find out if you have a UTI. If the usual treatments do not work, your provider will explore the possibility that you have some other condition. Other illnesses can cause symptoms that mimic a UTI, such as sexually transmitted diseases.

Several antibiotics and other drugs are used to treat UTIs. The most effective antibiotics are usually taken for 7 to 10 days. Shorter courses of treatment are available, and your health care provider may prescribe an antibiotic that you take for 1 to 3 days.

• Drink a lot of fluids, such as herbal teas and water. Avoid sweetened fruit juices and other sweetened drinks.
• Eliminate refined foods, fruit juices, caffeine, alcohol, and sugar.
• Cranberries and blueberries contain substances that inhibit the binding of bacteria to bladder tissue. Drinking unsweetened cranberry juice regularly seems to help lower the risk of UTIs and can help cure one if you drink it when you first feel symptoms.
• Vitamin C (250 to 500 mg two times per day) makes urine acidic, which inhibits bacterial growth.
• Beta-carotene (25,000 to 50,000 IU per day) is necessary for immune function and mucous membrane integrity.
• Zinc (30 to 50 mg per day) supports immune function.

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots.

Start herbal therapy at the first sign of symptoms and continue for three days after you start feeling better. Teas work best for treating UTIs because the additional fluid intake helps the "flushing action." Combine two herbs from each of the following categories and drink 4 to 6 cups per day.

• Urinary antiseptics are antimicrobial: uva ursi (Arctostaphylos uva ursi), buchu (Agathosma betulina), thyme leaf (Thymus vulgaris), pipissewa (Chimaphila umbellata)
• Urinary astringents tone and heal the urinary tract: horsetail (Equisetum arvense), plantain (Plantago major)
• Urinary demulcents soothe the inflamed urinary tract: corn silk (Zea mays), couch grass (Agropyron repens)

Marshmallow root (Althaea officinalis) is best used alone in a cold infusion. Soak 1 heaping tbsp. of marshmallow root in 1 qt. of cold water overnight. Strain and drink during the day in addition to any other urinary tea.

For advanced or recurrent infections prepare a tincture of equal parts of goldenseal (Hydrastis canadensis) and coneflower (Echinacea purpurea). Take 30 drops four to six times per day.

There have been few studies examining the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for UTI based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Apis mellifica — for stinging or burning pains that tend to worsen at night and from warmth; individuals for whom this remedy is appropriate feel an intense urge to urinate, yet can only do so in drops
• Aconitum — for early symptoms of UTI, particularly with extremely painful urination that is often described as a hot sensation
• Berberis — for UTIs with burning or shooting pain during urination that may radiate to the pelvis and/or back; when not urinating, an aching sensation is present in the bladder that worsens with movement; pains may also extend to legs and abdomen
• Cantharis — this is the most common and considered the most effective homeopathic remedy for UTI; this remedy is most appropriate for individuals who are restless, experience a burning sensation and decreased urine flow (despite a strong desire to urinate), and have increased sexual desire despite symptoms
• Mercurius — for burning urination and a strong urge to urinate; symptoms worsen at night and tend to be accompanied by chills and sweating; urine is dark and only small amounts pass; burning sensation is often worse when the individual is not urinating
• Nux vomica — for individuals who have a constant urge to urinate; pain is described as needle-like; urge to have a bowel movement may accompany urinary urgency; mild, temporary relief may be experienced from urination and warm baths; symptoms may begin following ingestion of alcohol, coffee, drugs or overeating
• Pulsatilla — for bladder inflammation that begins after an individual develops a sudden chill in hot weather; this remedy is most appropriate for individuals with an urgent desire to urinate who may be emotional, crave attention, and dribble urine after laughing, coughing, sneezing, or being surprised
• Sarsaparilla — for women who experience severe pain at the end of urination and who, occasionally, may feel compelled to stand to urinate
• Staphysagria — for UTIs usually associated with sexual intercourse or following extreme embarrassment or humiliation, particularly from sexual abuse; this remedy is most appropriate for those who have an urgent desire to urinate and have the sensation that a single drop of urine is still present even following urination

Preventive measures you can follow:

• Urinate both before and after intercourse.
• Have your health care provider recheck the fit of your diaphragm if you use one.
• Avoid sex while you are being treated for a UTI.

If you are pregnant, you are more at risk for developing a UTI.

Avorn J, Monane M, Gurwitz JH, Glynn RJ, Choodnovskiy I, Lipsitz LA. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. JAMA. 1994;271:751-754.

Berkow R, ed. The Merck Manual. 16th ed. Rahway, NJ: Merck and Company Inc; 1992.

Blumenthal M, ed. The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:432.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3^rd ed. New York, NY: Penguin Putnam; 1997: 193-195.

Engel JD, Schaeffer AJ. Evaluation of and antimicrobial therapy for recurrent urinary tract infections in women. Urol Clin North Am. 1998;25:685-701.

Goodman-Gilman A, Rall T, Nies A, Palmer T. The Pharmacological Basis of Therapeutics. 8th ed. New York, NY: Pergamon Press; 1990.

Howell A, Vorsa N, Der Marderosian A, Foo Lai Yeap. Inhibition of the adherence of P-fimbriated Escherichia coli to uroepithelial-cell surfaces by proanthocyanidin extracts from cranberries. N Engl J Med. 1998;339:1085-1086. Letter.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 188.

Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:98-102.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Murray M, Pizzorno J. Encyclopedia of Natural Medicine. 2nd ed. Rocklin, Calif: Prima Publishing; 1998.

Ofek I, Goldhar J, Zafriri D, Lis H, Adar R, Sharon N. Anti-Escherichia coli adhesion activity of cranberry and blueberry juices. N Engl J Med. 1991;324:1599. Letter.

Schmidt DR, Sobota AE. An examination of the anti-adherence activity of cranberry juice on urinary and nonurinary bacterial isolates. Microbios. 1988;55:173-181.

Schulz V, Hänsel R, Tyler VE. Rational Phytotherapy: A Physicians' Guide to Herbal Medicine. New York, NY: Springer; 1997.

Sobel JD. Pathogenesis of urinary tract infection: role of host defenses. Infect Dis Clin of North Am. 1997;11:531-549.

Sobota AE. Inhibition of bacterial adherence by cranberry juice: potential use for the treatment of urinary tract infections. J Urol. 1984;131:1013-1016.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 52-53.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 191-192.

Werbach M, Murray M. Botanical Influences on Illness: A Sourcebook of Clinical Research. Tarzania, Calif: Third Line Press; 1994.

Zafriri D, Ofek I, Adar R, Pocino M, Sharon N. Inhibitory activity of cranberry juice on adherence of type 1 and type P fimbriated Escherichia coli to eucaryotic cells. Antimicrob Agents Chemother. 1989;33:92-98.