Non-prescription Treatment and Home Remedies for UTI

Helpful Highlights

• A urinary tract infection (UTI) is classified as uncomplicated or complicated.

• An existing UTI in the older adult will likely neither resolve on its own nor through the use of over-the-counter (OTC) products.

• OTC or home remedies that seem to work for young people do not work for older people.

• Urosepsis (sepsis arising from the urinary tract) is common among older adults and is the most common cause of sepsis in hospitals.

While about half of urinary tract infections will resolve without prescription treatment in young, healthy people, this is not likely among the older adult population. Likewise, while over-the-counter UTI products may appear to help younger, healthier people, they are unlikely to make a difference in older adults.

Uncomplicated versus complicated UTI

Younger, healthier people typically experience lower urinary tract infection, meaning it remains only in the urethra and/or bladder and does not climb the ureters to the kidneys. They also generally have uncomplicated UTIs, meaning they do not have risk factors that increase the likelihood and severity of infection, as well as increase the chances that treatment with antibiotics will fail. The exceptions are males, who by default have complicated UTIs, and pregnant women.

Uncomplicated (or simple)

• Female

• Healthy (no comorbidities or other health crises)

• Not pregnant

• Premenopausal

• Normal structure or function of the urinary tract

A complicated UTI means risk factors are present that increase the likelihood and severity of infection, complications from infection, repeat infections, and increased chances that treatment with antibiotics will fail. It is important to determine if the infection resulted from one of these risk factors and whether it can be cured with first-line antibiotics.

Males who have a UTI, by default of their anatomy, are considered to have complicated UTIs. Older adults are also more likely to have a complicated UTI.

Complicated

• Male

• Pregnant

• Postmenopausal

• Recurrent UTIs

• Abnormal structure or function of the urinary tract

• Foreign body in the urinary tract (catheter, stent)

• Kidney stones or other obstruction

• One or more comorbidities (chronic illnesses such as diabetes, kidney disease, immunocompromised)

• Atypical organisms causing UTI (not the usual bacteria)

• Organ transplant

• And other conditions

Over-the-counter (OTC) products

Some people (predominantly women) purchase OTC products without medical advice to treat a UTI.

PAIN RELIEVERS

There are no pain relievers capable of preventing or curing a UTI, prescription or non-prescription.

• Phenazopyridine (Azo). People may believe that this alone can cure the UTI. This is a common misconception, as the product only provides temporary relief of symptoms (e.g., burning, pain, urgency, frequency) but is not a cure. Upon relief of symptoms, a person may decide that the UTI is gone and that they do not need to see a provider. This is a mistake. Phenazopyridine does not kill bacteria, so any relief is from symptoms only and probably short-lived. The complicated UTI remains and will only get worse.

• Methanamine/sodium salicylate (Cystex). The brand even states: "Cystex Urinary Pain Relief Tablets are not meant to replace the care of a doctor, since there is no OTC remedy for urinary tract infections (UTIs) or self-treatment for UTIs. They require prescription medication to completely cure the infection."

• Pain relievers. Acetaminophen, ibuprofen, naproxen, aspirin, and those that are advertised specifically for UTIs - Cystex, Azo (as above) - are good for relief from pain, burning, and discomfort associated with UTIs, but they do not help to cure UTIs. Beware of mistaking pain relief for being rid of the UTI.

SUPPLEMENTS

Some supplements may be helpful in preventing UTIs, but there is no evidence to support their effectiveness in treating them.

• Cranberry. Cranberries contain proanthocyanidin (PAC), a chemical that - in high enough quantity - may prevent bacteria from sticking to soft tissue, like the wall of the bladder. However, PAC does not kill bacteria, and there is no evidence that cranberry supplements (extract, capsules, tablets, powders, etc.) are effective in preventing or treating UTIs.

• Uqora. This product is not a treatment for UTI, it is intended to prevent UTI. However, none of the ingredients are guaranteed to prevent UTI, nor do they target bacteria and hormones that make a person prone to UTI.

• Probiotics. While probiotics may support health in other ways, there is no evidence that probiotics are effective in treating complicated UTIs. However, studies are still being conducted testing their effectiveness in preventing, as well as combatting, UTIs.

• D-mannose powder. While early data on D-mannose powder effectiveness is promising, it has only been found in small-scale studies and only for the prevention of UTIs or the treatment of acute (not recurrent), uncomplicated, lower UTIs (urethra and bladder only). Therefore, it should be considered a complementary remedy at best and not a cure.

Home remedies

• Hygiene. Wiping front to back (for women) after toileting, peeing after sex, thoroughly washing the genital-anal area during bathing or when soiled, and avoiding any scented or powdered products in that area all seem like common sense, and they are likely to help, though believe it or not, these methods have never been proven through studies to prevent UTI and certainly will not cure them.

• Cranberry juice. As stated above (Supplements: Cranberry), when the research is compiled, cranberry juice has not been shown to prevent infection and does not fight bacteria that have already established an infection. If your loved one likes cranberry juice, certainly encourage them to drink it for its health benefits, but prevention or treatment of UTIs is not one of them.

• Vinegar drinks or washes (douches). Vinegar does awesome things outside the body - a detergent, a cleanser, a freshener, a cooking additive - and although it is an acid with antibacterial and antifungal properties, it has no effect in or on the body for UTI treatment. Drinking vinegar or washing with vinegar has no UTI-fighting benefits.

• Drinking lots of water. Unless restricted by a healthcare provider, we could all stand to drink more water - especially older adults and the elderly. There are many health benefits to greater water intake. Regular filling and flushing of the bladder can help keep bacterial presence and growth under control, aiding in UTI prevention. Studies have shown that drinking more water daily led to fewer episodes of recurrent lower UTI and less need for antibiotics for uncomplicated UTI. Increased water intake is not likely to cure many UTIs, but it may work in preventing them.

Urosepsis

UTIs are among the most common causes of sepsis in hospitals. Contrary to popular belief, sepsis is not a raging infection. Rather, it is the body's dysfunctional and dysregulated response to an infection. In other words, the body starts fighting itself rather than fighting the infection and destroys itself. Sepsis can happen quickly, requires immediate hospitalization and intense treatment, and can cause permanent organ injury or even death.

If you think that your loved one might have a UTI, promptly seek treatment, since an untreated infection in older adults could lead to permanent kidney damage, sepsis, or many other dangerous complications.