Bladder health supplements could play an important role in helping you treat and prevent urinary tract infections. In this post, I will review the most popular bladder health supplements 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 were just getting traction in 2019. 

Important Disclaimer: Always consult with your physician before starting a new supplement. Even though most supplements are safe, they can still 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. 1. Bladder health supplements that promote healing of bladder lining
   2. Bladder health supplements that alkalize the urine
   3. Bladder health supplements that help to decrease the number of harmful bacteria 
   4. Supplements that help to increase the number of beneficial bacteria. 

Promote healing of bladder lining: mucopolysaccharides

Healthy bladder urothelium (the 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. The GAG layer serves as a barrier layer on the inner surface of the bladder.

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

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

Chronic bladder inflammation could be one of the reasons why it is common for women with 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 from 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 the 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 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 like capsules might do the trick.

In fact, a 2018 clinical study used a combination of Hyaluronic Acid, Chondroitin Sulfate, Curcumin, and Quercetin orally and showed promising results in reducing the urgency and frequency of UTI after sex among women who took the supplements every day.

According to hundreds of reviews online, Hyaluronic acid in capsules helps sufferers worldwide 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):

• Hyaluronic acid by Bulk supplements ($)
• Hyaluronic acid by Amazing Formulas ($$)
• Hyaluronic acid by NOW ($$$)

Chondroitin sulfate

Similar to Hyaluronic acid, Chondroitin sulfate helps to restore the 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 the 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 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):

• BulkSupplements Pure Chondroitin Sulfate Powder ($)
• NOW Chondroitin Sulfate 
• Cystoprotek ($$)
• Cysto Renew ($$$) also includes Aloe Vera

Aloe Vera Juice

For ages, the Aloe vera plant has been known for its anti–inflammatory and wound-healing properties. To no surprise, many naturopathic doctors advise taking Aloe vera juice to help to heal the 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 therapy with juice or capsules taken daily. As with all supplements, do not look for 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):

• NOW Aloe Vera Gels ($), high potency per capsule
• George’s Aloe Vera Supplement juice

Quercetin

The bioflavonoid quercetin is a naturally occurring substance with anti-inflammatory and antioxidant 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 daily 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, which may enhance quercetin absorption. However, if you are trying to minimize the $ spent and maximize the effect, you can purchase bromelain or papaya enzymes separately.

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

• BulkSupplements Pure Quercetin Dihydrate Powder ($)
• NOW Quercetin with Bromelain ($$)
• Cysta Q ($$$)

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. 

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):

• Bulksupplements Pure Marshmallow Root Extract Powder ($)
• Nature’s Way Marshmallow Root ($$)

Alkalize the 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 a couple of things that happen when your diet includes a variety of veggies and greens:

First, you provide an ample supply of prebiotics for your good bacteria, creating a better environment for them to reproduce, and 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 a 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 its natural defenses.

If you want to eat your cake and 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 (the least expensive per serving first): 

• Hyperbiotics Organic Prebiotic Powder ($$)
• Genuine Health Greens+ Original ($$$)
• Vibrant Health – Green Vibrance, Plant-Based Daily Superfood + Probiotics and Digestive Enzymes ($$$)

Decrease the number of harmful bacteria

D-mannose

D-Mannose is a form of sugar that can be found in fruits and berries. Most 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 of 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 the 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 in eradicating them entirely. For this reason, new pharmacological approaches are desirable 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 the treatment of pregnant women) and, therefore, could be a great supplement to have in your toolkit.

NAC supplements:

• NOW Nac, 250 capsules 600 mg each
• BulkSupplements Pure NAC (N-Acetyl L-Cysteine) Capsules (300 Gelatin Capsules)
• Jarrow Formulas Nac Sustain 600mg, 100 Tablets (Pack of 2)

Garlic

E. coli bacteria that cause most urinary tract infections is known to form bacterial biofilms, a form of defense against the 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.

Read more about garlic dosage for UTI.

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

• BRI Nutrition Odorless Garlic ($)
• Nature’s Way Garlicin ($)
• NOW Garlic Oil ($$)

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.

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 a randomized clinical study, women with a history of recurrent UTI during the preceding year were assigned to take Uva Ursi supplements for a month versus a placebo (those girls got a sugar pill). These women were then followed for a year to establish UTI recurrence. In the 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)

• Bulksupplements Pure Bearberry Leaf Extract (Uva Ursi) ($)
• Nature’s Way Uva Ursi ($)

Berberine

Berberine is a plant alkaloid with a long history of medicinal use in 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 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):

• Bulksupplements Pure Berberine HCL Powder ($)
• Pure Berberine Complex ($$)

Salvia officinalis (aka Common Sage)

In an in vitro study, the 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):

• Sage Alcohol-FREE Liquid Extract, Organic Sage (Salvia officinalis) Dried Leaf Glycerite ($)
• Solaray Organically Grown Sage Supplement ($$)

Increase the number of beneficial bacteria

It should be no surprise that our bodies are equipped to protect us from harmful bacteria. However, due to many environmental factors, our own defense systems fail and sometimes require supplementation to restore and maintain them.

A healthy human microbiome (a collection of thousands of beneficial bacteria living on and in our body) is critical 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. 1. An 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 the urinary tract
   3. Healthy flora in your bladder helps you to fight pathogenic bacteria.

To understand how to choose the right probiotic strains that demonstrate clinical effectiveness in preventing urinary tract infections, check out Probiotics & UTI: what do you need to know?

Prebiotics

Prebiotics and a diet full of fiber could be the decisive factor are warding off pathogenic bacteria and suppressing the growth of virulent strains. In fact, with the right diet, you can even avoid the growth of antibiotic-resistant strains and promote a healthy gut microbiome.

Here is a post about prebiotics and a post that covers a super-spice Curcumin and how it works as a prebiotic!

What other supplements are you taking to prevent UTIs? Join our FB group to comment.