Thursday, May 25, 2017

Waging the UTI War (Or: D-Mannose: The Sugar of Fate)

Note: I didn't receive any compensation for writing this post, but it does contain a couple of affiliate links to products that I found helpful. Thank you for supporting this site!

Okay, so, this is almost definitely going to veer into "TMI" territory, but bear with me.

I've been prone to recurring urinary tract infections since I was about fourteen. I've seen every type of doctor that exists for it, and nobody can really pin down why -- it's not a hygiene or habit problem, it's not due to a structural defect, it just happens. (A lot.) Unfortunately for me and others like me, sometimes that's just how it is. We get UTIs like it's our job, and nobody can really tell us why. You get handed yet another prescription for some Bactrim, and your doctor tells you to drink a lot of water and take a povidone iodine sitz bath.

Rewind to a couple of years ago, when I was still living in California. I developed a UTI to the surprise of probably no one, but, unlike the ones before that, it turned into pyelonephritis. I can't really adequately describe what having pyelonephritis feels like without being able to accurately type the onomatopoeia for tearing your hair out and screaming incoherently. I would need to develop a new branch of advanced mathematics just to be able to properly quantify how much it completely sucked.

I went to the ER, and, a couple of tests later, they handed be a prescription for Cipro. Cipro isn't great for you if you have intracranial hypertension -- as anyone with IH can tell you, the list of medications that either raise your intracranial pressure or just straight-up cause IH is stupidly long. Antibiotics, along with corticosteroids and hormonal birth control, are one of the most common culprits. That said, my round of Cipro was pretty uneventful and cleared everything up just fine. Great!

Flash forward to about three months after that, and my next UTI. (I wasn't kidding when I said I get them a lot.) Now deathly afraid of pyelonephritis, I motor to my doctor to get another prescription. He also prescribes me Cipro. Confident that this will handle everything just like last time, I head home and start taking it.

And nothing happens.

Panicked, I go back to the doctor. He orders a urine culture, and it comes back a few days later. Somehow, this UTI managed to be resistant to Cipro, Bactrim, and a host of other antibiotics I've never even taken. He prescribes nitrofurantoin, which makes me wheeze and feel sick as a dog. I can't finish the prescription, so I just kind of had to... live with this outrageous UTI and hope I didn't lose a kidney or two from it, more or less. I drank a lot of water and cranberry juice, and dealt with the urinary pain, stomach aches, and other symptoms. Some days were worse than others.

A couple of months ago, I spoke to my new doctor about it. Unable to isolate enough bacteria for a culture, she gave me a prescription for Bactrim. Nothing happened. We tried Cipro again. Nada. Now consigned to living with this UTI like some kind of awful room mate, I took matters into my own hands.

UTI Battle, Round 1: Uva Ursi

I tried using Nature's Answer uva ursi, which helped a lot. It's not good to take for long periods of time (it's not great for your liver), but it's very effective in very specific circumstances. I took it because I was already taking Diamox for my intracranial hypertension, and the combination of uva ursi and acetazolamide has specifically been shown to kill the bacteria responsible for UTIs (PDF). This mostly has to do with the active compounds in uva ursi -- the herb works best when your urine is alkaline, and, if there's one thing Diamox does well, it's alkalinize your urine. This is bad news normally, unless you're a fan of kidney stones and urinary tract infections, but helpful in this particular situation.

On the flip side, uva ursi can really irritate your stomach. It also shouldn't be used for long periods of time, or by pregnant or lactating women. It probably would have cleared up my issue entirely, but I have a pretty sensitive stomach and couldn't quite tough it out long enough to take care of everything.

UTI Battle, Round 2: A Whole Lot of Cranberry Juice

Do you know how hard it is to find real cranberry juice? I know, I know -- every guide to home remedies for UTIs says "Drink lots of cranberry juice!", but there are some things I don't think the writers really appreciate. To wit:

  1. Real cranberry juice is hard to find. Cranberry juice cocktail won't work, because it's really mostly apple, pear, or white grape juice with some cranberry added. Even "no sugar added" cranberry juice is mostly blends of other juices. The stuff that claims to be just cranberry usually isn't, because you have to add a ton of water and sugar to cranberry to make it remotely palatable. This is because:

  2. Real cranberry juice is disgusting. I'm talking about tartness that will taint everything you taste for the rest of the day. Astringency that will completely chap the inside of your mouth. Bitterness that will make you wonder what kind of depraved person ate a cranberry and decided it was a suitable food source, and not some kind of horrible practical joke.

  3. Real cranberry juice is hard to drink. I can get past something not tasting good, especially if it's healthy for me or has medicinal value. I had a much tougher time getting past the indigestion and heartburn it gave me.

  4. Real cranberry juice is expensive. Have you ever felt a cranberry? They're hard, kind of waxy. If you squeeze them, they feel like dense packing peanuts. There's not a lot of juice to them. It takes a lot of berries to make enough juice to be worth the effort. To treat a UTI, you have to drink about 6-8 ounces of cranberry juice three times a day. It cost us about eight bucks for enough cranberry juice for maybe two days.


This isn't to say that cranberry juice isn't effective. It contains naturally occurring compounds that inhibit bacteria from adhering to the walls of the bladder. This is super important, because a big part of the reason that UTIs aren't always easy to treat is that the bacteria form a biofilm within the body. Getting the little buggers to let go is part of the battle. Unfortunately, it wasn't that effective for me.


UTI Battle, Round 3: D-Mannose (Plus Some Other Stuff)

This brings us to the star of the show, and the whole reason I decided to write this post. After uva ursi, cranberry juice, and drinking so much water my back teeth were floating ("Keep your bladder flushed out!" the guides always say) I did some more Googling and picked up this stuff:

(I swear I'm not a Nature's Answer evangelist, the brand was a coincidence.)

D-mannose is a type of sugar, and I'm not sure exactly how it works. Some sources I've read suggest that it attracts bacteria off of the walls of the bladder, so, coupled with cranberry, gets rid of the biofilm. Most things say it's only for preventing UTIs, which I understand -- an ounce of prevention and all. With my options running out and wooed by the words "FAST ACTING," I decided to try this brand's three day regimen and see how it did.

As it turns out, it did really, really, weirdly well.

Each 4 ounce bottle contains enough for the three day regimen, or about two weeks of prevention. For the first day of the regimen, you take four tablespoons of the mixture spaced throughout the day. For the second and third, you cut back to two tablespoons. For prevention, you take a teaspoon once or twice a day. By the second day, I was pain-free. My stomach was a little upset, but I've accepted that that's par for the course for me and most herbal remedies at this point. In fact, I liked it so much, I picked up some lower dose capsules to take every day.


If you're struggling with UTIs like I do, or if you're stuck with one that's resistant to conventional treatment, ask your doctor about d-mannose. Seriously, it works. It's easy to take. The side effects are minimal. It's not too expensive. Bacteria won't become resistant to it. I can't say enough good things about it without sounding like some kind of weird MLM bot.

Do you have any home remedies or preventatives for UTI? Post a comment and tell me what you use!

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