Urinary tract infection in women, prevention and treatment

Urinary tract infection (UTI) is the most common bacterial infectious disease in primary care. It is an invasion of the urothelium by a pathogen (germ, usually bacteria) that causes local inflammation, which can occur in the lower or upper urinary tract.

Urinary infection, also known as cystitis, is more common in women, occurring in 1 out of 3 women before the age of 24, and at least 50% of women will experience a UTI in their lifetime. Although the causes depend on many factors (age, sex, previous antibiotic use, etc.), the most common causal agent is bacterial, and among the bacteria that can cause a urinary tract infection, Escherichia Coli is the most frequent (60-90%). Other pathogens include Klebsiella pneumoniae, Proteus Mirabilis, or, in cases of certain predisposing factors or hospital assistance, Pseudomonas aeruginosa or Enterococcus.

What are the symptoms of a urinary infection?

The primary symptom is pain, specifically pain during urination, which we call dysuria in medicine, and it is usually accompanied by increased frequency and urgency of urination. This pain during urination is described in many ways, such as burning, stinging, etc., and characteristically appears at the end of urination. Other symptoms, such as hematuria, are less frequent. Hematuria is simply the visible presence of blood in the urine.

If we look at the urine, it is usually cloudier and has a strong odor. We should not confuse these characteristics with morning urine or urine after great exertion, as in these cases, the urine is darker (not cloudy) due to increased urine concentration.

There are some symptoms that should alert us to consult our doctor urgently, such as the presence of fever and pain in the kidney area or lumbar region.

How do we diagnose Urinary Tract Infections?

Initially, the diagnosis can be clinical; that is, if a woman comes to my office and tells me: "I have pain when I urinate, right at the end, it's like a stinging sensation, and I've also noticed that for the last 2-3 days my urine was cloudier and smelled very bad. Today, when I urinated, besides the stinging, I noticed some blood." In this situation, there are two possibilities: initiate treatment or perform a urine dipstick test in the office. Sometimes the urine dipstick test does not provide objective data for the infection, but this does not rule out the diagnosis of Urinary Tract Infection. Only the presence of these symptoms would justify medical intervention.

However, symptoms are not always so clear or they overlap with others. Often, a differential diagnosis must be made with a vaginal infection, or we might think that the pathogen could be resistant to the antibiotics of choice, or in recurrent infections. In a situation like those described above, we can request a urine sample collected first thing in the morning, for which we will request a systematic analysis (pH, nitrites, glucose, etc.), sediment analysis (presence of oxalates, etc.), and a urine culture to determine the bacteria and an antibiogram to know which antibiotics the bacteria in question are sensitive to.

Is it always necessary to take antibiotics?

Sometimes we prescribe antibiotic treatment, and the symptoms persist; in this case, it will be necessary to perform these studies to confirm the appropriate treatment. However, treating a patient with antibiotics who has no urinary symptoms, even if they have bacteria present in the culture, is not entirely correct. This is what we call asymptomatic bacteriuria.

Therefore, for the diagnosis of a Urinary Tract Infection, the presence of symptoms (dysuria, urinary urgency, etc.) is imperative, and the use of dipsticks or a urine culture will not always be necessary.

Early treatment is fundamental to resolving the situation. In sports, an infection significantly reduces our performance, not only in competitive events but also in daily training. Furthermore, complications such as pyelonephritis (kidney pain, fever, nausea, etc.) will be avoided.

What is the treatment? Can we prevent cystitis?

The treatment of choice is the use of oral antibiotics. Frequently, and according to clinical guidelines, the treatment for uncomplicated Urinary Tract Infection is a single dose of Fosfomycin for two days.

For some years now, American Cranberry has been used effectively when the infection is caused by Escherichia Coli (the most common bacterium). In recent years, many American Cranberry supplements have emerged, and not all of them meet the quality or concentration of active ingredients that give this fruit its efficacy.

Weider has developed a supplement that can be used for the prevention and/or treatment of Urinary Tract Infections, and its main components are D-Mannose and a patented American Cranberry concentrate called Pacran. These are the Cranberry gummies.

D-Mannose is a simple sugar or monosaccharide that is completely eliminated through the urinary tract. In these same urinary tracts, D-Mannose has a significant ability to adhere to bacteria, mainly E. Coli.

What cranberry extract supplement should I take?

American Cranberry (Pacran): First, it's a safe treatment that can even be used during pregnancy and lactation, and even with children. Pacran is more than just a cranberry extract; it is an American Cranberry concentrate that has achieved a high standardized level of Proanthocyanidins. But, as I said, the difference lies in it being a concentrate, meaning it utilizes all the components of the fruit, thereby achieving a synergistic effect of its components. Other components present include fatty acids, phenolic compounds, etc. (table-1).

In the use of medicinal plants (phytotherapy), it is common to use the whole plant to achieve that synergy of its components, but Pacran is unique in American Cranberry and is supported by several scientific studies, which is why it has been chosen for the Cranberry gummies. These published studies have been conducted to achieve the optimal concentration of its components to reach the desired efficacy in the treatment and prevention of urinary tract infection.

The primary activity of D-Mannose and American Cranberry is to prevent E. Coli from adhering to the urinary tract wall. The combination of both components, with Pacran being a concentrated American Cranberry and not just a PACs extract, gives this supplement unique characteristics.

Studies show that:

• Pacran has active compounds that bind to E. Coli, preventing it from adhering to the urinary tract wall and being eliminated through urine.
• Pacran has demonstrated a longer action time than PACs compounds. The action persists for more than 24 hours (Howell, 2009).
• Continuous use of a supplement with Pacran reduces E. Coli infection by 36%. This is a consequence of the continuous elimination of this bacteria through the urinary tract (Sengupta, 2011).
• Pacran reduces the recurrence of urinary tract infection episodes by 58% (Vostolova).
• It can be used in combination with the antibiotic of choice.

Taking 2 Cranberry gummies daily will help prevent urinary infections and even reduce their recurrence.