Ultimate Review of Bladder Health Supplements, 2018 (updated)

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Bladder health supplements could play an important role in helping you treat and prevent urinary tract infections. In this post, I will review most popular bladder health supplements that you can use if you suffer from chronic urinary tract infections. Many have been available on the market for a while and some new ones are just getting traction in 2018. 

Important disclaimer: Always consult with your physician before starting on a new supplement. Even though most supplements are safe, they still can interfere with your other meds or provoke an allergic reaction. Also, remember, that clinical research cited in this review was performed on otherwise healthy, not pregnant adults. Supplements by definition are not intended to prevent or treat any diseases, however, they can boost your existing prevention or treatment strategy.

In this review, I divide bladder health supplements for chronic UTI into four main categories:

  1. Bladder health supplements that promote healing of bladder lining
  2. Bladder health supplements that alkalize urine 
  3. Bladder health supplements that help to decrease amount of harmful bacteria in your urinary tract
  4. Supplements that help to increase amount of beneficial bacteria 

Bladder health supplements that promote healing of bladder lining: mucopolysaccharides

Healthy bladder urothelium (first layer of bladder lining) has a high density of glycosaminoglycans, which are present in the form of proteoglycans, and form the so-called ‘GAG layer’. GAG layer serves as a barrier layer on the inner surface of the bladder.

Urinary tract infections cause inflammation of bladder lining. After multiple UTIs, your bladder lining is much different than the one of a healthy person who never had a UTI. Bladder urothelium of a chronic UTI sufferer could be eroded, thinner than normal, and ulcerated.

Damaged GAG layer fails to protect you from pathogenic bacteria that are able to hide in deeper layers of the bladder lining. Moreover, toxic substances contained in urine can irritate and cause further inflammation of the bladder wall when it is not shielded by healthy urothelium. 

Aloe - Natural Bladder Health Supplements
Aloe – Natural Bladder Health Supplement

Chronic bladder inflammation could be one of the reasons why it is common for women who have no acute infection to still experience bladder discomfort, often aggravated by bladder filling and relieved with voiding. Many chronic UTI sufferers report bladder pain or pressure, urgency and frequency even though their tests are absent of acute infection.

Therefore, if you suffer from chronic bladder pains you might benefit from using supplements that contain glycosaminoglycans (GAGs). These supplements could potentially benefit an inflamed bladder by replenishing the defective GAG layer.

Naturally occurring mucopolysaccharides are hyaluronic acid, chondroitin sulfate, bioflavinoid quercitin, and aloe vera.

Hyaluronic acid

Using Hyaluronic acid to replenish GAG layer is a newer promising strategy proposed for patients with chronic bladder inflammation. I came across hundreds of studies that demonstrate the effectiveness of Hyaluronic acid for a variety of bladder-related diagnoses.

However, all clinical tests that have been performed using Hyaluronic acid were done via direct bladder installations, meaning cocktails with Hyaluronic acid were put directly into the bladder. If you are not planning to put a needle or a catheter in your bladder, supplements in a form of capsules might do the trick.

According to hundreds of reviews online, the Hyaluronic acid in capsules helps sufferers around the world to improve the condition of their joints and skin. One could hope that in a similar fashion it could help to rebuild healthy bladder lining and elevate symptoms of those who suffer from chronic UTIs and Interstitial cystitis (IC) (which is basically chronic inflammatory bladder)

Bladder health supplements containing Hyaluronic acid (least expensive per serving first):

Chondroitin sulfate

Similar to Hyaluronic acid, Chondroitin sulfate helps to restore bladder’s epithelium and promote healing from bladder inflammation. Chondroitin sulfate is the main ingredient in bladder health supplements such as in Cystoprotek and Cysto renew capsules known in IC community.

However, similar to Hyaluronic acid, in the few studies that showed the effectiveness of Chondroitin sulfate, the drug administration was done intravesically (straight into the bladder). It is unclear if Chondroitin sulfate will work well when taken orally but I think there is no harm in trying. You can go with pure Chondroitin sulfate or choose to try one of the formulas packed with additional health-boosting elements, such as Aloe vera. 

Bladder health supplements containing Chondroitin sulfate (least expensive per serving first):

Aloe Vera Juice

For ages, Aloe vera plant has been known for it’s antiinflammatory and wound healing properties. To no surprise, many naturopathic doctors advise taking Aloe vera juice to help to heal bladder lining and reduce inflammation, especially after acute infections.

Some patients diagnosed with interstitial cystitis (IC) report significant relief in symptoms within 2-3 weeks after starting a therapy with juice or capsules taken on a daily basis. As with all supplements, do not look for an immediate relief and make sure to adjust your diet to promote the health of your bladder. 

You can choose to drink Aloe vera juice or take capsules. Capsules have more potency and definitely easier to manage during the weeks of therapy.

Bladder health supplements containing Aloe vera (least expensive per serving first):

Quercetin

The bioflavonoid quercetin is a naturally occurring substance that has anti-inflammatory and anti-oxidant properties. It is present in seeds, citrus fruits, olive oil, tea, and red wine.

A quercetin-containing compound (called Cysta Q) was studied in 22 IC patients given 500 mg twice a day for 4 weeks. Two patients dropped out of the study. Of the remaining 20 patients, 57% had a significant decrease in symptoms. A randomized, placebo-controlled trial is needed to further determine the efficacy of quercetin in treating chronic bladder inflammation but it seems promising.

Some quercetin supplements come with bromelain derived from pineapples that may enhance quercetin absorption. However, if you are trying to minimize $$ spent and maximize the effect, you can purchase bromelain or papaya enzymes separately.

Bladder health supplements containing quercetin (least expensive per serving first):

Marshmallow Root

In the same way, marshmallow soothes sore throats, marshmallow appears to ease swelling in mucous membranes that line the colon and the urinary tract. 

Marshmallow root is great for your bladder
Marshmallow root powder is great for your bladder. But not the candied one!

Moreover, Marshmallow root has been identified as having one of the highest levels of glucuronoxylan, a potent antioxidant. Glucuronoxylan protects cells from free radical damage, promoting healthy cell regeneration. It also demonstrates mild antibacterial properties.

Remember that Marshmallow root possesses diuretic properties, encouraging urine flow (you will pee more often) so be mindful of this effect.

Bladder health supplements containing Marshmallow root (least expensive per serving first):

Bladder health supplements that alkalize urine

New research demonstrates that alkaline urine can promote better bladder health by suppressing the growth of pathogenic bacteria. It is important to highlight that high urine pH is also a symptom of a healthy diet that is rich in greens, vegetables, and berries. There are couple things that happen when you diet includes a variety of veggies and greens:

Plant based prebiotics- Natural Bladder Health Supplements
Eat or drink your veggies regularly to maintain healthy urine pH

First, you provide ample supply of prebiotics for your good bacteria, creating a better environment for them to reproduce, thrive and help you to stay healthy. Especially if you are taking probiotics, it is crucial that you help your newly obtained beneficial bacteria with better diet and/or probiotics.

Second, you introduce various bioactive elements that help to fight pathogenic bacteria.

Therefore, alkaline urine is a side effect of a balanced diet. Your task is to provide your body with the right fuel so it can maintain it’s natural defenses.

If you want to eat your cake and to get all the benefits of a healthy diet, research shows that plant-based supplements can help if you are unwilling to drastically change your diet and rather spend some money and drink your veggies. 

Plant-based bladder health supplements are (least expensive per serving first): 

Bladder health supplements that help to decrease amount of harmful bacteria

D-mannose

D-Mannose is a form of sugar that could be found in fruits and berries. Most of commercially produced D-Mannose is made of corn or birch tree juice.

D-Mannose can help you to reduce the number of E. coli bacteria in a safe, natural way almost without any side effects. E. coli binds to the molecules of D-Mannose and could be easily washed away with urine.

Check out this review of D-Mannose supplements.

NAC (N-acetylcysteine)

NAC is one the most important supplements in fighting chronic infections. For several years now NAC supplements have been investigated for their effectiveness both in inhibiting biofilm formation and in destroying developed biofilms.

As per article titled “N-acetylcysteine as a powerful molecule to destroy bacterial biofilms. A systematic review”: “Biofilm is a sophisticated network of pathogens living within protective extracellular polymeric substances. Bacterial resistance and survival are greatly augmented in biofilm, so that both chemical (antibiotics, disinfectants) and biological (viruses, protists) antimicrobial agents may be ineffective to eradicate them entirely. For this reason, new pharmacological approaches are desirable, in order to prevent biofilm formation, eradicate mature pre-formed biofilms and increase the permeability of antibiotics, so overcoming the resistance phenomenon.”

NAC is often consumed together with an antibiotic or an antibacterial supplement but could be also taken on its own.

600 mg twice a day is a sufficient dose to provide help in destroying bacterial biofilms and therefore helping to get rid of stubborn infections.

The jury is still out, but encouraging study results provide hope. NACs have no known side effects or contraindications (one of the studies successfully used it for treatment of pregnant women) and therefore could be a great supplement to have in your toolkit.

NAC supplements:

Garlic

E. coli bacteria that causes most of the urinary tract infections is known to form bacterial biofilms, a form of defense against immune system and antibiotics, that’s why it is so hard to eradicate. 

Garlic has a wide range of pharmacological activities and a broad antibacterial spectrum. Moreover, allicin, isolated from garlic essential oil, has demonstrated potency against bacterial biofilms.

Use of garlic softgel tablets (serving size 2 softgels: garlic oil 4.6 mg, 500: 1 concentrate equal to 2300 mg fresh garlic), 2-4 tablets per day, together with other supplements, could be an alternative option to prevent chronic UTI and improve IC symptoms as demonstrated in a two case study.

Bladder health supplements containing garlic (least expensive per serving first):

Uva Ursi (aka Bearberry)

Uva ursi is one of the most commonly used antimicrobial botanicals for UTIs. The antimicrobial component is believed to be the aglycone hydroquinone of arbutin, which is released in alkaline urine. For optimum results, the urine pH (you can test it with urine pH strips) should be at least 8.

Increased urine alkalinity can often be achieved by a high vegetable diet; however, in some cases consumption of 6-8 g sodium bicarbonate in water daily or taking Uva ursi with calcium citrate.

Uva Ursi natural bladder health supplement
Uva Ursi is a very well known natural bladder health supplement

Although uva ursi is commonly used successfully for UTI treatment, no studies have been conducted to confirm its efficacy. However, one clinical study indicates its effectiveness for UTI prevention. In randomized clinical study women with a history of recurrent UTI during the preceding year were assigned to take Uva ours supplements for a month a placebo. These women were then followed for a year to establish UTI recurrence. In placebo group 5 of 27 women experienced a UTI, while among the women who took Uva ours for one month, none had a recurrence in the following year.

Uva ursi is best used at the first sign of an infection or for short-term prophylaxis. Note in the above study the women took Uva ursi for only one month, despite the fact they were followed for one year.

Bladder health supplements with Uva Uris (least expensive per serving first)

Berberine

Berberine is a plant alkaloid with a long history of medicinal use in both Ayurvedic and Chinese medicine. It is present in many plants, including Hydrastis Canadensis (goldenseal), Coptis Chinensis (Coptis or goldenthread), Berberis aquifolium (Oregon grape; Mahonia aquifolium), Berberis vulgaris (barberry), and Berberis aristata (tree turmeric). Berberine is found in the root, rhizome, and stem bark of the plants. Berberine extracted from Berberis aquifolium demonstrates growth inhibition of several bacteria, including both sensitive and resistant E. coli.

Do not take berberine during pregnancy.

Bladder health supplements with berberine (least expensive per serving first):

Salvia officinalis (aka Common Sage)

In an in vitro study oil of common sage inhibited several urinary pathogens extracted from urine samples provided by individuals with UTIs.

Salvia demonstrated 100-percent inhibition of Klebsiella and Enterobacter species, 96-percent inhibition of E. coli.

It is a known fact, that recurrent UTIs are caused by a combination of pathogens, therefore a supplement that can inhibit the growth of two bacteria that together cause 99% of all UTIs is critical in the prevention of recurrent infections.

Bladder health supplements with Common Sage (least expensive per serving first):

Supplements that help to increase amount of beneficial bacteria

It should come to no surprise that our bodies came equipped to protect us from harmful bacteria. However, due to many environmental factors, our own defense systems fail and sometimes requires supplementation to restore and maintain it.

Healthy human microbiome (a collection of thousands of beneficial bacteria living on and in our body) is of the critical factors in our natural defense against disease. Taking probiotics helps to restore the balance of good bacteria.

Probiotics

There are several strains that have been studied for their effectiveness against recurrent UTIs.

Probiotics work in three main ways when it comes to UTI prevention:

  1. Increased number of good bacteria in your gut allows for better nutrient and vitamin production, that in return improves how our body functions and resists infection
  2. Healthy vaginal flora helps to prevent pathogenic bacteria from reaching urinary tract
  3. Healthy flora in your bladder helps you to fight pathogenic bacteria.

To understand how to choose right probiotic strains that demonstrated clinical effectiveness in prevention of urinary tract infections, check out Probiotics & UTI: what do you need to know.

What other supplements are you taking to prevent UTIs? Leave me a comment!

24 COMMENTS

  1. Thank you for this great website. It has a lot of details that have been helpful. I have had 3 UTI’s in the last 9 months. I’m 53 and NEVER had one until 9 months ago (I understand the bladder lining is weakened as you age so UTI’s can be common then). 1st one I went to a Dr and got an antibiotic. 2nd one I tried Uva Ursi but don’t think I took a strong enough version, or just not enough, so very slowly the infection got worse. So went to the Dr again and got antibiotics. 2 months later 3rd UTI. Took Uva Ursi from the beginning, but was scared to increase the dose from what was on the label. After some research, I determined more would be OK, so increased the dose a little, the next day it was a little better. But I was nervous of it getting worse so went to see a Naturopathic Doctor. She gave me some great information and put me on the following: Cranstat Extra (Vitanica), this has a bit of something from each of the above 1st 3 categories in addition to a few more. She recommended D-Mannose, and Vitamin C. I won’t say exact doses because I think it is important for a person to see a professional, I will say the doses are definitely more than what is on the labels. Anyway, it appears my UTI is gone (i’m a little paranoid as any discomfort I experience might mean it hasn’t completely dissipated), but I think it is really gone. So I thought your readers may like the idea of the Cranstat Extra as a single supplement, rather than having several different ones, I get tired of taking so many different things.
    I noticed you didn’t mention the value of Apple Cider Vinegar (ACV) (Organic with “the mother” in it). It appears this is suggested as a great preventative method and for some it gets rid of early onset of UTI. It does taste nasty though, diluted or straight. My Dr. didn’t have any information on it. But she did say it is harmless, but I do believe it acidizes the urine which my Dr. mentioned e-coli doesn’t like. So I’ve been trying to take it hours after or before I take other supplements. As I think those work best in a more Alkaline environment. I get much mixed info on that so I’m not sure what is best in that case.
    Have you researched the value of ACV and it’s interaction with the above supplements you mention as well.

    • Hi DW,
      Thank you for sharing and taking time to write a comment. Check out this post if you haven’t yet, this is specific to UTI in men. Being paranoid is normal at the beginning, I offer you to start focusing on positive things. For example, when you pee (and I know it sounds kind of silly) take a moment to acknowledge that everything is working fine, you feel healthy and tap into that feeling of gratitude for being healthy 🙂 Sometimes when we focus on something we can start feeling unhealthy even if you are healed.
      Cranstat Extra seems like a nice product looks like they packed in a lot of supplements per capsule. My only hesitation with this approach is if your body has a conflict with one of the ingredients, it’s harder to deduce which one is causing a problem. My preferred method is to get approval from your doctor on a set of supplements, give it a try for 2-3 months, then add or subtract based on personal results. I’m glad it’s working for you. As to the vinegar, a post is long overdue 🙂 Apple Cider Vinegar will actually make your urine more alkaline. You can read this post about diet and urine pH here. I don’t think though you should worry about the interference of ACV and pills. The pills work by first being digested and then filtered through kidneys to reach your bladder in urine. Same goes for ACV. By the time it is digested its effect is actually alkalizing not acidifying. It’s a common misconception to think that acidic foods acidify the urine, in many cases it’s quite opposite when we talk about natural products.
      Best of luck 🙂

  2. Hi Anastasia, thank you so much for sharing all the information on your website with us. I have learned a lot from you and following your advice tried D-Mannose in treating my e.coli. It has helped a lot so far although I know it is not over yet! Thinking longer term now and have ordered Forskolin, but noticed the info about it is missing from your list of supplements. This worried me slightly and I will investigate further but would you be able to tell me why is it not on your updated list? I wish you all the best, Marija

    • Hello Marija, you are welcome! I try to stay on top of anything UTI-related but I’m not in anyway an expert, just sharing what I was able to learn so far. There is no reason to be alerted if you know about something that is working for UTI but I haven’t mentioned it.
      Thank you for bringing up Forskolin. I have found less info about this supplement than the research I was able to find for NAC that is used for the same purpose. Ultimately, Forskolin seems to be working by bringing bacteria up from intracellular pockets to the “surface” and making them more susceptible to your immune system and antimicrobials and I would imagine needs to be take either with D-Mannose, antibiotics or natural antimicrobials and probably not good for folks with any immune issues (if to speculate on how mechanism of action is going to unfold in your body). But again, not enough research that I was able to find. Where you able to find a source that recommends it for UTIs? If you share here, I’ll look into it as well as other readers.
      Best wishes,

      • Hi Anastasia, thank you so much for taking the time to reply. I have to apologise now: I assumed forskolin was mentioned in your list right after NAC and thought you have removed it recently (hence my worry). While researching for natural alternatives to antibiotics I have made a list of things to look into more details, forskolin included. Beacause my list was very similar to yours by the time I got to read your text I happily concluded I was on the right track and decided to try D-Mannose combined with forskolin. You’ve already done this amazing work of organising lots of information much better than I have done so far. I have just gone through some of my saved links but can only find this related to forskolin: https://www.researchgate.net/blog/post/alternative-to-antibiotics-for-treating-utis-uses-bodys-own-cell-defense-mechanism.
        I’ve had problems with UTIs (always caused by e.coli) for over 10 years. I found that fresh parsley tea alleviates the symptoms. Uva ursi tea helpes too. So far the cure in the end was always antibiotic of some sort. A few people I know swear by wild oregano oil. I did try taking drops of Wild Oregano Oil, but it made me anaemic after a week of taking it (1-3 drops diluted in a teaspoon of olive oil, 3 times a day after the meal).
        Once this episode is over I will share my experience with D-Mannose and forskolin here.
        Again, thank you so much for sharing and caring! Best wishes, Marija

  3. Hi Anastasia,

    Thanks so much for this great website. This is the best resource on UTI prevention I have come across online. I wanted to ask a question, which no doctor seems to answer. Can low dose combination birth control pills cause UTIs?

    Thank you!
    Yagna

    • Thank you, Yagna, for your kind words.
      The jury is still out. We need more studies that research a link between vaginal microbiota and oral contraceptives. Every case is different, as well as OCs are different and vaginal microbiota is unique for each woman before she starts OC. So I don’t think there has been a study to compare apples to apples, so to speak. It would be nice to know the bacterial composition of women prior starting OC, and then follow them for an extensive period of time to see if there were any changes. And, unfortunately, the longer the study, the harder it is to account for differences in lifestyle, other contraceptives used, and other factors that could influence vaginal microbiota besides OC. I’m not aware of any studies that done this.

      However, here are couple links that could hint to the positive connection between OC & UTI.
      1) Increased E.coli count in vagina due to oral contraceptives (research paper #1)
      2) “In the British prospective studies of high-dose oral contraceptives, urinary tract infections were increased in users of oral contraception by 20%, and a correlation was noted with estrogen dose” (page 379).
      Are you taking special probiotics? Do you have any other health issues?
      Best wishes and happy New Year!

  4. This is a great blog and is very helpful.
    Has anyone had success using MMS as a curative agent for reoccurring bladder infections or IC?
    What can you tell me about that?

  5. From your list of good supplements….You said that “low urine ph is a symptom of a healthy diet” but low urine ph is ACID and high ph is alkaline. Just saying so people do not get confused. Anyway I am still confused about which is best to have. I suppose it depends upon the germ. Some bacteria like it a bit more acid and others alkaline. Thanks.

    FROM YOUR ARTICLE:
    “Bladder health supplements that alkalize urine
    New research demonstrates that alkaline urine can promote better bladder health by suppressing the growth of pathogenic bacteria. It is important to highlight that low urine pH is also a symptom of a healthy diet that is rich in greens, vegetables, and berries. There are couple things that happen when you diet includes a variety of veggies and greens:”

    • Hi Gideon, thank you so much for catching this, just fixed. Yes, you want alkaline urine as some recent research indicates, but also high urine pH as I mentioned is a side-effect of a diet rich in veggies and fruits so it’s unclear if pH on its own or the microelements from veggies, help to fight the bacteria.
      Thanks so much for taking the time to point this out,

  6. Hi Anastasia, your site has truly been a lifesaver these past few months as I’ve been struggling with recurring UTIs! Now that I’ve incorporated a number of supplements into my diet (including pre and probiotics, d-mannose, camu camu powder, NAC, biofilm defense, Aloe Vera capsules, cranberry tablets, and occasional oregano oil), do you happen to know about any possible interactions with birth control pills? Do any of the supplements listed here lower the effectiveness of BC? Thanks for your help!

    • Hi Rose, glad to hear! Unfortunately, as with many supplements, information about drug interactions is rarely available. I would advise asking your physician just to be sure, but I did not come across any mentions about any interactions.
      Best wishes,

  7. Hi, nice work!. Some years ago in Germany I visited a scientific conference; two students from a German university had a poster; they researched the folia uva ursi thing; they discovered this saying about that your urine should be alkaline is a myth. In fact the splitting of arbutin is done in the liver, not in the bladder. In Germany uva ursi is considered an effective regular medicine. Sorry cannot find their publication. But see this http://medherb.com/Materia_Medica/Arctostaphylos_-_Uva_ursi_and_alkaline_urine.htm

    • Hi, Antonella,
      Thank you, this is a valuable piece of info.
      Alkaline urine, in general, is a side-effect of a healthy diet and besides the pH effect, a healthy diet introduces a variety of active substances that are the product of metabolizing vegetables and fruits and could potentially have anti-microbial properties. I quote a study about alkaline urine and UTI here.

  8. Thank you! This is fantastic information. Would you recommend taking all of these simultaneously? I may have missed this in your blog but should they be taken for a certain amount of time and then stopped?

    • Hi Mon, glad to hear it is helpful. Best answer is to consult with an MD. My personal opinion, depending on what is the reason for your UTIs. If this is, for example, due to catheter, then take it while you have it in. If trying heal after years of chronic UTI, I would stick with a supplement that works for at least a year. In some cases you can take supplements after a trigger event (after sex, or after eating aggravating food) etc..
      I would not recommend taking all of them simultaneously, but would suggest to consider taking a supplement from each category till you figure what protocol works for you.
      Best of luck,

  9. Good article, and I love what you’re doing with your blog. I think it has help me immensely with a reoccurring UTI.

    If I may offer one piece of constructive criticism. A marshmallow (as you depict roasting over an open flame), and marshmallow root, are two very different things. I hope no one sees the image you posted and thinks they can get the same health benefits from eating a bag of sugary treats (marshmallows), as they would from taking marshmallow root supplements.

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