Women's Bodies, Women's Wisdom (69 page)

Many women, however, experience recurrent bladder infections, which are treated with repeated courses of antibiotics. This is a different story, and requires a different approach. Chronic use of antibiotics to treat recurrent UTIs doesn’t address the underlying imbalance in the body that is leading to the infections, and antibiotics can also kill off helpful vaginal flora, resulting in yeast infections, diarrhea, and—unfortunately—recurrent urinary tract infection.

Treatment

Nutritional Aspects

Start taking a good probiotic. Many are on the market, and most require refrigeration to keep the bacteria alive. PB 8 is a brand that doesn’t require refrigeration; it is available at natural food stores. Another way to help restore your vaginal flora if you’ve had repeated UTIs and multiple courses of antibiotics is to dip a stiff tampon (for example, OB is a good brand) in plain, organic yogurt and put it in your vagina. Change “yogurt tampons” every three or four hours. This will replenish the vaginal flora and decrease the risk of repeated infections associated with the yeast problem. You can also douche with yogurt or put a probiotic capsule directly in your vagina each night for a few nights.

Coffee, even decaf, can also have markedly adverse effects on your urinary tract and act as a bladder irritant, so if you currently drink it, stop.

Many women with UTIs are also helped by using cranberries, which contain an ingredient that helps keep bacteria from adhering to the walls of the bladder, thus helping prevent infection.
⁸²
Cranberry juice also acidifies the urine, making it harder for bacteria to grow. Long a popular home remedy, drinking cranberry juice has been confirmed by scientific studies to eliminate bladder infections in a majority of the women tested.
⁸³
Sugar-sweetened cranberry juice partially nulli fies the benefits, so use the unsweetened variety. You can buy unsweet ened cranberry juice concentrate and use 16 ounces of reconstituted juice daily to treat an infection. (Add a small amount of the herb stevia if you want to avoid saccharin or aspartame. Stevia has been used for decades as a noncaloric sweetener in many countries and is widely available in powder or liquid form in health food stores.) Use 8 ounces per day for prevention. Or you can look for cranberry juice in pill form; Cranactin is a popular brand.

The herb uva ursi contains a substance known as arbutin, which is a natural antibiotic that relieves bladder infection.
⁸⁴
You can take the powdered solid extract (20 percent arbutin) as capsules, two capsules three times per day. Or take the tincture, one dropperful in a cup of water three times per day. Continue this treatment until symptoms disappear. Both capsules and tincture are available in health food stores.

Vitamin C can be very helpful in preventing reinfection. Take at least 1,000 to 2,000 mg every day, and if your infections are associated with sexual activity, take 1,000 mg before and 1,000 mg after sex. Drink plenty of fluids as well, and make sure you get up to urinate within one hour of having sex. Women who do this do not get as many infections after sex as those who wait for an hour or longer, probably because drinking fluid and then urinating prevents bacteria from adhering to the tissues and starting an infection.

Hormones

Menopausal and perimenopausal women often have thinning of the outer urethra from lack of estrogen in that area of the body, which results in burning with urination. This can be mistaken for a UTI. The condition can be treated well by putting an estrogen-based cream in the upper part of the vagina, right along the urethral ridge. I recommend estriol 0.5 mg vaginal cream. The usual dose is 1 gram (one-quarter teaspoon) once daily for one week, then twice or three times per week or as needed thereafter. This will restore your vaginal tissue to its normal thickness and the burning will stop.
⁸⁵
Other forms of vaginal estrogen also work well, including Estrace and Vagifem. The small amount needed to reestrogenize the urethra does not raise levels in the blood significantly and is considered safe by most doctors.

Sexual Activity

UTIs are often associated with frequent or traumatic sex (sex that involves injury to the vaginal and vulvar tissues). For example, in couples who travel separately or live apart during the week, frequent intercourse during a weekend visit can irritate vaginal and urethral tissue. Treatment for this involves making the necessary ad justments in your sex life to decrease trauma. This may mean using a lubricant if you suffer from vaginal dryness. It may also mean rethinking any aspects of the relationship that are less than satisfactory.

Repeated bouts of infection and/or burning on urination can also be related to a woman’s contraceptive method. If your diaphragm is too large, it can irritate your urethra during intercourse, causing bacteria to enter the urethral opening and migrate up to the bladder area. Also, the use of condoms or contraceptive creams that contain nonoxynol-9, a spermicide, can cause urethral irritation and burning on urination. It will go away when you stop using the offending agent.

Other Treatments

Don’t introduce bacteria into your urethral area. After using the toilet, make sure you wipe yourself from front to back, not the other way around.

Castor oil packs applied to your lower abdomen two or three times a week can work wonders in preventing UTIs, because they appear to improve immune system functioning. Acupuncture can also be very helpful.

Psychological Aspects

As I’ve already stated, there are some very spe cific stresses that affect the bladder and urinary system that are often related to unacknowledged anger at someone or blaming someone—often of the opposite sex. So as you’re drinking your cranberry juice, taking your uva ursi, or lying down with your castor oil pack, try the following affirmation: “I flow easily with my life. I easily release and let go of old concepts and ideas. They flow out of me easily and joyously. I am at peace with my thoughts and emotions.”

Women’s Stories

Chrissa: Recurrent UTIs

Chrissa was thirty-two when she first came to see me for an annual exam. She was in relatively good health but had menstrual cramps, intermittent bouts of pelvic pain, and also recurrent UTIs, for which she’d been on repeated courses of antibiotics. She told me that every time she went on a short trip or vacation she worried that she might get a UTI and be unable to get an antibiotic prescription filled. She was also tired of the yeast infections she developed when taking antibiotics.

When I asked Chrissa what was going on in her life, she told me that her husband had a job that kept him on the road for about two weeks out of every four. His irregular schedule made her life difficult to plan. When I asked about her sex life, she said, “It’s full speed ahead when he’s home, and I use a diaphragm and vaginal gel alternating with condoms.” I asked if she tended to get a UTI after sex with her husband. She thought about it and realized that if she was going to get one, it was usually a day or two following sex.

I checked her diaphragm to make sure that it fit her properly, and it did. I knew that Chrissa needed a strategy to prevent UTIs, so I sug gested that she follow the nutritional and supplement program I’ve already outlined:

Decrease the refined sugar and flour products in her diet and switch to a whole-food approach.

Drink cranberry juice regularly or take a cranberry supplement.

Start taking a good multivitamin-mineral supplement.

Take 1 to 2 grams (1,000–2,000 mg) of vitamin C as soon after intercourse as possible. Take the same dose the next day.

Take a good probiotic the day before, the day of, and the day after intercourse.

I also asked her to observe her emotional triggers. Specifically, was she angry with her husband about any unspoken matters between them—such as whether or not to get pregnant or who should be paying the bills?

Chrissa came back for a checkup three months later. She had had the beginning symptoms of a UTI only once, and they had gone away very quickly with the cranberry juice and vitamin C. She told me, “I realized that the key factor in whether or not my body actually got a UTI was my emotions. As soon as I found myself feeling ‘pissy’ toward my husband, I forced myself to talk over my concerns with him so that my body wouldn’t have to do the talking for me. I also made sure that I never had sex with him when I was feeling angry. I realized that was a setup for an infection. I’m thrilled that I finally know that my body is not betraying me with these infections. There’s a lot I can do to prevent them, or at least nip them in the bud.”

STRESS URINARY INCONTINENCE

Though many women find it difficult to talk about, even to their doctors, fully 30 to 50 percent of us will experience urinary inconti nence (the involuntary loss of urine) from time to time. Ten percent of these women are under the age of forty. And many have never had children, evidence that there’s more to urinary incontinence than bladder damage from childbirth. In most, it’s just an occasional problem that occurs when coughing or sneezing or laughing really hard. But about one in six women between the ages of forty and sixty-five has a significant problem that interferes with her lifestyle. The problem is also common after age sixty-five, but not necessarily more common.