5 basic principles of an alternative treatment for chronic UTI

“When it’s your 20th UTI, you start to look for an alternative treatment for chronic UTI rather than another round of antibiotics”, says Dr. Claire Graser. Her clinic often becomes “the last resort” for women who have been suffering from urinary tract infections for a long time.

Dr. Graser practices naturopathic medicine with expertise in women’s health, hormone balancing, holistic detoxification, weight loss, anxiety and stress management at San Francisco Natural Medicine clinic. I was thrilled to discuss UTI treatment strategies she uses with her clients.   

Alternative treatment for chronic UTI

Did your primary care doctor sit down with you to discuss your diet, stress level and everyday health challenges? Have your physician ordered anything besides a urine culture test? Perhaps, that’s why you are stuck in a recurrent UTI cycle. Or maybe you keep getting UTIs because your treatment plan is yet another round of antibiotics, that depletes your natural microbiome and leaves you even more vulnerable for the next infection?

According to Dr. Graser, too often primary care physicians keep prescribing antibiotics without verifying an active infection is present. Unfortunately for chronic UTI sufferers, their symptoms are not always a sign of bacterial overgrowth. In some cases, UTI-like symptoms are caused by chronic pelvic pain and painful bladder syndrome due to nerve damage and chronic inflammation.

“Chronic UTIs may eventually lead to chronic pelvic pain”, says Dr. Graser.

Natural treatment for the whole body

#1 Wholistic diagnosis

Dr. Graser’s fascination with natural medicine started at a young age: “My grandparents were involved in an international seed exchange and would often take me on the field trips to look for the seeds. I was excited to find wild flowers, berries, learn their names and properties and this was my first introduction to botany. I learned to appreciate plants and their practical use”.

Besides being well skilled with Eastern and Western herbs, Dr. Claire shares the naturopathic medicine philosophy to look at the whole person instead of an isolated organ or a symptom. Therefore, if you present with chronic urinary tract infection symptoms, these are tests that she might order for you:

    • A urine culture test to confirm the infection,
    • A blood panel test (including vitamin D3 levels, Thyroid panel and HemoglobinA1c)
    • A stool test to evaluate gastrointestinal health since your gut microbiome influences the vaginal flora,
    • An adrenal fatigue test to understand if current levels of stress are impacting your immune system.

After performing a thorough examination and looking at your test results, Dr. Graser will discuss your diet,  sleep habits and stress management to complete your health assessment and decide on a course for an alternative treatment for chronic UTI.

Natural UTI treatment options

#2 Herbs and supplements

If the tests confirm that an acute infection is present, patients may be advised to drink diluted unsweetened cranberry juice, D-Mannose, and take herbal formula for UTI that consists of soothing herbs like corn silk, antimicrobials like buchu, juniper, uva-ursi, and kava for pain relief.

Once acute symptoms subside, it will be important to take measures to support the immune system, improve daily hydration, promote healthy vaginal and gut flora with potent probiotics and better diet, as well as implement some lifestyle changes (no thongs, loose fitting cloth, better hygiene etc.).

#3 Stress reduction

Since stress causes hormonal imbalance and negatively affects human microbiome (the beneficial bacteria that inhibit your body and help prevent infections), it’ll be important to manage stress (plants like schizandra, lavender, chamomile, and lemon balm can be prescribed) on a daily basis.

#4 Healing your bladder

In addition, Dr. Graser also recommends adding aloe juice (2-3 times a day) to heal the bladder and to balance your immune system, especially after an acute infection. In a similar fashion, drinking a cold infusion of marshmallow root (at least a cup or two per day) can help heal the bladder lining.

#5 Combating bacterial biofilms

“When it comes to persistent, chronic infections it is important to destroy bacterial biofilms in order to eradicate the infection”, says Dr. Graser.

A “biofilm” is a complex ecosystem that allows bacteria to survive. Moreover, antibiotics are often ineffective because of their slow or incomplete penetration into the deepest layers of biofilms. The biofilm, due to its complex structure, constitutes an effective barrier to the antibiotics used in the treatment of urinary tract infections and therefore renders antibiotic treatment ineffective.

Read more about bacterial biofilms here.

Dr. Graser in her practice uses N-acetylcysteine (NAC), to aid the eradication of mature biofilms and to inhibit new biofilm production.

Health tips for holistic health from Dr. Claire

“Auto-immune problems, chronic pain, and allergies seem more common nowadays than they were a century ago. Stress and environmental toxic burden are probably the biggest contributors to modern illness & diseases. They impact the microbiome that is essential to optimal health and one of the most important factors that modifies your immune system response”, says Dr. Graser.

Here are some tips that you can implement today to live a healthier life:

  • It’s really helpful to go to bed early (10:30 pm) and get 8 hours of sleep. Don’t take pride in your sleep deprivation, it affects your cardiovascular health and leads to hormonal imbalances.
  • For 30 min before bed allow yourself no screen time to quiet down your adrenaline system. Cortisol should be dropping at night and melatonin should increase gradually to allow for a restful night.
  • Establish “sleepy time” routine: make some herbal tea, read a relaxing book. Winding down is important for the quality of sleep!
  • Use blackout curtains, noise cancelling ear plugs. 
  • Make sure to eat 20 grams of protein three times a day. Why? Protein rich breakfast helps to stabilize your blood sugar. In turn it helps you to decrease your anxiety and stress level throughout the day.
  • Choose healthy drinks. Coffee dehydrates you and depletes minerals that your body requires to function well. Get 64 ounces of water daily. Fatigue and constipation are two problems that are frequently stem from simple dehydration. Constipation is a known factor that contributes to chronic UTIs.

If you find yourself in a cycle of recurrent urinary tract infections, perhaps it’s time to try an alternative treatment for chronic UTI. Instead of spending five minutes with your primary care doctor to obtain a prescription for antibiotics, see if a holistic approach can work better. It’s okay if you have never thought about how the aspects of your stressful life could be contributing to your chronic disease; as many naturopathic professionals, Dr. Graser believes that a doctor is, first of all, a teacher. She loves to educate her patients and will spend time to help you connect the dots and to find the way to your optimal health.



  1. Hello Anastasia
    I live in Australia and I’m 62 years young and very fit but unfortunately have been cursed with recurrent UTIs for approx 20 years. My mother suffered the same and I believe it attributed to her death in 2001. She suffered badly from depression and her GP prescribed her long term use of Macrodantin which is an older type of antibiotic. After six months taking this medication she developed a cough and shortness of breath. Within 1 day of being admitted to hospital she was on life support but sadly after 1 month she lost her battle. The specialists could not determine her cause of death only that her lungs were badly affected and rock hard. My research found other cases where Macrodantin caused this type of lung failure. I’m am doing all I possibly can to try and find a cure once and for all as I no sooner stop antibiotics then it returns. I take cranberry and probiotics capsule at night and have just started taking D Mannose. Pathology always shows E. coli with last one being 2 different strains in one infection. Can you please offer any suggestions as to what else I can do. Can I possibly get the treatment that rebuilds the system DAC?? I sympathise with all who have contacted you regarding this as UTI’s ruin your wellbeing in every sense but I’ll never give up hope. With Thanks Christine

    • Hi Christine, so sorry about your mom, it’s unbelievable that these symptoms were not recognized early.

      Here something you could read up on estrogen, see if this makes sense and talk to your doctor if there are topical options available.
      Best wishes,

  2. Hi Anastasia, first up thank you for all the information you provide, you know a lot more than my doctor about uti treatment for sure!
    I believe I have a billion.
    I started a women’s probiotic yesterday and I take d mannose several times a day. I am going to try NAC as well. Do I need to add anything else and how long would I have to take the NAC for?


  3. My Mom is currently experiencing frequent UTI’s She eats lots of sugars and chocolates and doesn’t drink much water. Th e reason she doesn’t drink water is the fact that she’s urinating and not knowing she’s doing it especially at night.. Every morning she wakes up she is soaked. After reading this website I thought about trying D Mannose, Garlic Pills, Aloe and a probiotic. Is there a probiotic for her you would recommend. Also what would you suggestion be to help the UTI’s and frequent urinating.

  4. Hi,
    I just wanted to share my story… I went through a phase of chronic UTIs a few years ago, and eventually antibiotics weren’t touching it, perhaps because the strain of bacteria became antibiotic resistant; I’m not sure. All I know is I was suffering with severe pain for weeks.

    There is a medicine that is prescribed in Europe but not in the UK (which is where I live), manufactured by OM Pharma in Switzerland, called Uro-vaxom. It acts by stimulating the immune response of the urinary system, and each capsule contains “6 mg of lyophilized bacterial extract from 18 strain of E-coli” – in other words, freeze-dried versions of different kinds of e-coli, which as we probably know is one of the main types of infections causing UTIs. I suffered for several years before my doctor in Hungary prescribed this, and I took 3 doses and it never returned. (Except now, 5 years later, but I’m pregnant, so this is not unusual!) I can’t take it now because it hasn’t been proven safe for pregnancy, but you can rest assured that I would be returning to it after I give birth to sort out any further UTIs!
    It can be purchased in the states without prescription. Just make sure to leave at least an hour before eating anything – has to be taken on a completely empty stomach. I’ve heard that severe nausea and vomiting happens if you don’t stick to this.
    Obvs I would encourage continuing to support the vaginal and urinary microbiome with pre- and probiotics, though! But Uro-vaxom was a lifesaver during a truly miserable series of infections.

    • Hi Esther, thank you for sharing, yep Uro-vaxom is considered a vaccine and is not approved for sale in USA, unfortunately.

  5. I’m on my third treatment of antibiotics, the first course I started January 17, and I’m now starting my third course feb,2. My third UTI in about a 2 month period.before this I had went a full year UTI free so to be having this chronic UTI has really killed my dreams of being UTI free.I found your article and found the info on NAC and D mannos to be really interesting, I just rush ordered NAC and D Mannos and it should be here tomorrow I’m going to take both until I’m done with my 5 day treatment of antibiotics and I’m gonna continue to take them after, I plan to start a pro biotic soon too but until I can afford that I’m just gonna do yogurt and cut down my sugar consumption totally, I pray to god I see result and can keep another infection from starting in a week or two after this course(since that seems to be the pattern) if anyone has any helpful thoughts or comments I always love to hear!

    • Hello Tina, I would also suggest considering garlic if you have no other health issues and can tolerate it. It’s cheap and you can just consume raw garlic from a store, check with your doc to be sure. Best wishes and good luck,

  6. Hi, I’m glad I found your blog. I’m a chronic UTI sufferer myself and I needed an alternative to the neverending antibiotics rounds. I’ve been taking D- mannose and the other supplements you suggest and I’m feeling much better. I have to say that I believe in my case it all started with a kidney stone I dropped 2 years ago. Since then, I’ve been having several UTI’s , this year being the worst. I came to live in with my bf and we have intercourse often. He’s been tested for all STD’s and he’s clean. I’m clean too ( except i suffered from hpv some years ago, but i followed a strict treatment and leep and now my levels are undetectable).
    Anyways I kept getting UTI’s and it was driving me crazy! My question is, since I have tendency to produce kidney stones (it’s genetic, I eat super healthy and drink lots of water, cranberry juice, little salt, no sugar, fiber, etc) could that be my problem? I keep drinking herbal blends to help dissolve them and last xray came out fine with just few dust visible. Anyhow , I’m afraid they will come back (UTI’s). I stopped sex for now (which is not easy for us haha) because I’m trying to give my urinary and genital tracts a break to heal. Im also using vaginal probiotics suppositories to help all the most. What I’m wondering is, will I ever be able to stop on the supplements? Or is this something I’ll have to do for life? Is there any study stating anything about treatment’s times or is it something to do forever? I hope not! I mean I like the supplements and all but i wish someday I could just go back to normal! Thanks in advance for your help! Ps. Supplements (pills) I’m taking now are: d-mannose, probiotics+prebiotics, cranberry, nac, garlic oil. Plus the herbal blends i stated before.

    • Hi Tam,
      I’m happy to hear you are feeling better. Kidney stones are unfortunately a big risk factor for UTIs. If I were you I would just stick with the supplements, perhaps rotate the antimicrobials, but take them as regularly as vitamins. Many of them have wide range of benefits for overall health. Make sure to check with your MD that the supplements you are taking are ok to take with your condition.
      There is a two-case study (I think it is quoted here) that followed two women on a preventive regime of garlic pills; and unfortunately once one of them stopped the supplements she had a UTI recurrence. However, two case study is laughable and super unreliable, but at least one data point.

      I would be very careful with cranberries though, they may increase the risk for stones. On top of it, I personally think cranberry is bullshit 🙂
      Best of luck,

  7. Thank you once again,I am using kefir and juicing almost daily. Unfortunately my workload never lets me be in one place long enough to Center myself. I am using (or was poor husband) a product called “yes” but am now at your suggestion going to investigate other estrogen products.
    I will definitely follow your recommendations and let you know how I get on.
    It is good to know someone has got this under control .

    • Maria,
      Wholeheartedly wish you to break the cycle, and I’m sure you will. Just give yourself some time (couple weeks or so) to deploy all strategies focusing on restoring your vaginal flora and reducing number of bacteria in your bladder. Once you are ready to restart your sex life, stay away from cheap lube and go for water bases/ oil based ones. Best wishes,

    • Hi Corinna,
      NAC is taken mainly to eradicate existing bacterial biofilms and increase the effectiveness of antimicrobials and antibiotics. The literature has examples of clinical studies using anywhere 400 mg per day up to 600 mg twice a day of NAC.
      If somebody has a history of chronic UTIs, they could consider taking NACs to supplement their current antibiotic treatment or to take it with garlic pills (or other antimicrobial supplements) to fight bacterial biofilms.

  8. I am 67 years old female very into healthy lifestyle and the last 19mths the most time lapse between UTI is 6weeks.I take D-mannose ,oregano oil stopped having sex after a very active sex life as I fear the UTI . I have every strain of antibiotic ,even ciproflaxin for one month which has left me with Achilles heel…..help.
    I am glad I found your site it gives me HOPE.

    • Hi Maria, I’m so sorry to hear about your struggle with UTIs recently. What do you know about your lab results? Is it one type of bacteria that is causing your UTIs or several? How long have you been trying with D-Mannose and how often and in what concentration have you tried oregano oil?
      You know, I’m not a doctor, but from everything that I’ve heard and read so far I truly believe you can break the cycle.
      -Have you tried probiotics?
      -Topical estrogen?
      -Other natural antimicrobial supplements (such as garlic in combination with NACs) to help fight bacterial biofilms?
      -Diet (at least temporary while restoring your health) and supplements to heal bladder tissue?
      There is no harm in trying acupuncture and homeopathy to see if this helps.
      These are some thoughts to start the conversation. When UTIs become do frequent, you really need to attack the problem from all angles and don’t despair, it’s just a rough patch, you will be healthy.
      Best wishes,

      • Firstly thank you for your prompt reply.
        I will have another urine test to see if I have more than one bacteria,I travel lots to countries that are not always western sanitised so maybe I have picked up a rogue bug.I have had a cystoscopy and all was well,but obviously not as I am still suffering.
        I take strong probiotics and a prebiotic but will try your recommendation asap(I am at the moment in france and as far as I can tell not always up to speed with alternatives)Was really interested in NAC will purchase along with garlic.The oregano oil was really hard to track down and mine are capsules.I also take Rhodila ,ashwagandha,curcumin ,sometimes Uva Ursi and milk thistle to support all the herbs.
        I have been Hospitalised twice with bad urine bleeding also really low salt and told not to drink so much water ,(drink at least 1 1/2 litres a day)hence the UTI.I have always tried the alternative route ,seems to me STRESS and sex bring on the UTI ,of course at my age the vagina is well dry.Tried estrogen pesseries and they burnt like hell…but could try them again.On and off all through my life I have suffered the odd Uti and IC.I have to be in India and Thailand for 2mths from January and will seek out alternative help.
        I thank you for your support and certainty that it will get better, it means a lot to know there are other people battling with this and your comments and advice are purely as a friend would give another.
        Not sure what diet I should follow and should I have antibiotics whilst taking NAC?

        • Hi Maria,
          Your exotic travels probably have nothing to do with the type of bacteria 🙂 in your GU tract there are several types of bacteria that could cause a UTI besides E. coli: Klebsiella, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus saprophyticus, Enterococcus faecalis (group D streptococci) and Streptococcus agalactiae (group B streptococci). Statistically, chronic UTIs are caused by more than one bacteria. That’s why D-Mannose might not be enough.
          Type of prebiotic matters: look for very specific strains as described in the post.
          NACs are not necessary to be taken with antibiotics, you could take them with garlic pills as well if your stomach/liver tolerates garlic well. But if you are prescribed antibiotics, NACs could help further the effect.
          Are you using any lubricant during sex? If so, you might want to consider water based or natural oils.
          There is a variety of estrogen creams on the market, I can’t provide much feedback on that but perhaps your doc could advise something without the side-effects of burning. They can also order one for you in a compounding pharmacy.
          In terms of diet, here are couple posts to consider: Diet & UTI 1 & 2.
          Best of luck!


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