Urinary tract infections (UTI) after spinal cord injury (SCI) remains perhaps the most common medical complication and reason for admission to the hospital. After SCI many people develop a condition called neurogenic bladder (also called neurogenic lower urinary tract dysfunction). Damage to the nerves of the spine result in impaired or absent control of the muscles that allow the body to empty urine from the bladder. As a result many people suffer from issues with storing or emptying urine. In some cases the reflexes to void (aka pee) are present, but the brain cannot control when it occurs. In other cases the reflexes are gone or not working appropriately, resulting in urinary retention (aka not peeing or not emptying completely). In many cases the lack of coordination and urinary retention means high pressures in the bladder which can cause UTI’s, kidney stones or other kidney issues. In addition many people require catheters (indwelling or intermittent) to empty their bladder. Well catheters are the right treatment for many people they can learn too bacteria entering and living in the bladder. When this makes you sick, we call it a urinary tract infection (aka cystitis). If you’re not sick, it’s called colonization (aka asymptomatic bacteriuria).
Due to the frequency of infections, bacteria around the world are getting more and more resistant to antibiotics. Doctors resist giving unnecessary antibiotics whenever possible but some UTI’s need to be treated. Researchers, doctors and patients have long wanted ways to prevent UTI without antibiotics. Below are some examples of things we have tried and strategies you could consider.
Optimize your current strategy
For many people the number one cause of urinary complications is pressure in your bladder. This means drinking too much or missing your scheduled catheterization if you’re using straight caths; clogged catheters or forgetting to flush your catheter if you’re using an indwelling catheter; letting yourself reflex void (aka let your body leak or pee reflexively without controlling it). Minimizing these incidents we’re going a long way to preventing bladder wall ischemia, bladder hypertrophy, you ain’t backing up to your kidneys, etc.
Unclean technique is another main cause of UTIs. Clean doesn’t mean sterile but cleaning your hands and genitals with using soap and water before catching can make a big difference. Never reuse catheters without talking to your medical professional. If other people are inserting your catheter, make sure they are using sterile technique including sterile gloves and cleanser like betadine.
Other tests that may explain recurrent UTI can be ordered by your doctor. These include looking for kidney stones (X-ray, CT or ultrasound of your kidneys), checking your bladder for problems inside by cystoscopy (a small camera inserted by a urologist), or urodynamic testing to check the size and pressure in your bladder. These test results might mean other treatments or a change in your current bladder management.
Other non-antibiotic UTI prevention
Behavioral modifications
- Some studies suggest spermicide contraceptives can increase UTI’s after sex for women. In many cases the spermicidal portion of the contraceptive can be safely changed. Talk to your primary care or OBGYN provider before changing your birth control plan.
Hormone replacement
- A lack of estrogen in older women is another known risk factor for urinary tract infections due to the changes it causes in the vaginal environment. Estrogen treatments have been shown to reduce UTI recurrence.
Probiotics
- Like in the gut, probiotics may help “colonize” the bladder with good bacteria and prevent bad bacteria from causing a UTI. Studies of the benefit from probiotics in recurrent UTI’s are inconclusive but ongoing.
Cranberry
- Cranberry juice has long been thought to reduce UTI’s. The exact mechanism occurring is still not clear but cranberry is acidic and includes tannins (which may block bacteria from attaching to the bladder), both of which have been hypothesized in the past. Studies of the benefit from cranberry in UTI’s have been mixed.
D-mannose
- Similar to the tannins in cranberry, d-mannose is a special type of sugar that can bind to bacteria and block them from attaching to the bladder. D-mannose is safe with some small studies showing benefit but convincing evidence is lacking.
Methenamine hippurate
- Rather than an antibiotic, methenamine is an antiseptic. It is only activated in the acidic environment of the bladder it does not produce resistance like antibiotics. However, once again convincing the large scale research studies are lacking.
Chinese herbal medicine
- Some traditional Chinese medicinal herbs have demonstrated reduced inflammation or reduced bacterial attachment in the bladder (similar to D-mannose). However studies in the past have been small and maybe misleading.
Intravascular installations
- Rather than take a pill, treatment could be provided directly to the bladder by flushing liquid through a catheter. In addition to antibiotics some people have tried high concentration sterile salt water (hypertonic saline) or acetic acid (similar to vinegar). The best evidence suggests these treatments can prevent catheter clogging or stones in the bladder which can cause UTI’s. These treatments are safe and could be beneficial to the right person but again convincing evidence is still lacking.
Competitive inoculation, Immunostimulants or vaccines
- These potentially exciting no treatments are not yet available for routine use in the United states. Competitive inoculation (similar to probiotics) would involve clinicians instilling safe bacteria in the bladder using a catheter to crowd out the bad bacteria. Studies so far have been promising the larger studies are needed before widespread use. Vaccines and immunostimulants Help the immune system target bad bacteria similar to how they prevent the flu. Those treatments target only a subset of all possible bacteria enlarged human studies are still needed in most cases.
Overall, there was no single treatment or cure for every person to prevent UTI’s. Infection prevention plans should be customized to each individual and start with optimizing your bladder management plan with your physician. If you suffer from recurrent UTI’s please talked to an experienced provider to troubleshoot ways to improve your health. Many supplements lack large scale convincing evidence but are generally safe and maybe beneficial for specific people. Talk to your physician if you’re interested to learn more.
