Your Questions About UTI

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Hi there,

If I sent you a link to your question, scroll to find it here. I update this post regularly, starting with the most recent questions.

Remember, I’m just a UTI-nerd, not a doctor so take it with a grain of salt and always consult with your physician first before trying any new things to treat or prevent UTI.

To continue the conversation, please join our closed Facebook group.

Best wishes!

D-Mannose Products

Q: I have used Now Powder which cured my E-coli four years back. But have now come across D-MANNOSE & CRANBERRY WITH PROBIOTICS – 50G from New Roots of Canada. what do you think of this product? As prevention, I take daily two teaspoons of it with Cranberry Juice 100ml +Coconut & Pineapple Juice 250ml and Water 150ml. Do you think it is a good combination or should I mix it with a smaller quantity of this mixture? Also, I have bought Solaray, D-Mannose with CranActin, Urinary which you have placed as # 7. If I take above powder with juice then is one tablet a day enough for prevention?

Hi there and happy holidays! Looking at the ingredients of D-MANNOSE & CRANBERRY WITH PROBIOTICS – 50G from New Roots of Canada, I’d say you are better of buying D-Mannose in bulk. The product you are referencing contains cranberry (which is useless unless it’s something like TheraCran or Ellura, you can read about Ellura ). And the amount of probiotics per dose is laughable.  Pineapple Juice is normally pretty high on sugar, so check that, especially if taking regularly. Overall, your combo is not going to hurt you but it is also not particularly beneficial (unless it’s working for you, then keep it up, we should never underestimate placebo :)). In terms of what we know so far, cranberry juice and regular cranberry supplements are not that great. I’d imagine they have some benefit, but dozens of studies arrived at contradicting results. PAC is what makes it potent and it’s not regulated so supplements will vary in their potency even from batch to batch. If I were you and trying to supplement my UTI prevention efforts with a diet, I’d just add a variety of minimally processes veggies, greens, legumes, and a prebiotic blend to help restore your gut microbiome.

C-Section  & UTI

Q: I had my 5th Cesarean on July 18th of this year and 2 weeks later diagnosed with UTI, I was put on antibiotics that didn’t clear it, then put on another round that didn’t clear it, finally they cultured (E. coli) and did sensitivity and was put on a 3rd one which now has not cleared it again. I have also been taking D’Mannose and Raw Garlic and probiotics. They now have me on my 4th round (for 3 months) of Macrobid and I get a sonogram of my bladder and kidneys next week. I’m so worried we aren’t going to figure this out, I feel scared and helpless.

My non-medical answer:

Sorry, this must be tough, especially since you have to care for a baby.

Here are some facts: C-section is a traumatic event and can cause a variety of complications. Some researchers indicate that a woman has higher chances to develop a UTI after a C-Section, with some calculating that “The risk of postpartum infection seems to be nearly five-fold increased after CS compared with vaginal birth.” (here and here). Recent findings indicate that this could be due to the decreased number of good bacteria and imbalance of urinary microbiota. So I’d be surprised if your sonogram will be absolutely fine.

Now, why your infection won’t clear up, I’m not sure, especially if they did a sensitivity test first. It’s important, though, to differentiate UTI-like symptoms and acute infection. In any case, there are other, more powerful antibiotics they could try, but since you are probably breastfeeding they are trying to use conservative methods first.

Chronic UTI & Negative Culture

Q: I have been suffering from chronic recurring UTIs for the past 4 years. I have tried several various treatments. Right now, I am using D-Mannose daily, however just today I went to the doctor for UTI symptoms. My symptoms are odd – no burning, not a lot of frequency, but rather major bloating, headache, body aches, fatigue, and urgency. Whenever I go to the doctor, the initial “dip” test ALWAYS comes back negative, but the culture comes back positive for e.Coli a few days later. Have you heard from others that this happens to them? I have heard that this might mean the infection is residing higher up in my urethra and into my kidneys, rather than my bladder. I’d LOVE to hear your thoughts if you have heard anything similar. I’m really working on figuring this out myself after suffering from years of unsolved problems. 

My non-medical answer:

Well, t wouldn’t really matter where your infection “resides”. In fact, if infection (an overgrowth of pathogenic bacteria) is present, it is normally detectable by culture tests, and if you’d have a kidney infection there would be a whole bouquet of other systemic symptoms. However, there are issues with culture tests as well as dip stick tests: both could be a false positive or false negative. I would recommend these posts for you that could help explain symptoms and culture test results:

  1. UTI-like symptoms after antibiotics
  2. IC or UTI
  3. Culture test issues
  4. Bacterial biofilms
  5. Best UTI treatment

Supplements for UTI

Q: Have read D-Mannose is helpful in the possible prevention of UTI caused by E. coli bacteria. Is there any supplement that has a ‘good track record’ to prevent UTI caused by serratia fonticolla bacteria?

My non-medical answer: This is a pretty rare bacteria to cause UTI, there are only couple reports available on cases when this bacteria was linked to a UTI and mostly it teamed up together with other pathogenic organisms. I’d say, addressing the underlying dysbiosis that allowed this to happen in the first place, would be a strategy to consider.

Q: Is it safe for me to take D mannose powder morning and night as a preventative for chronic UTI’s? It seems to be working and I’ve been taking it for months now.

My non-medical answer: There is no data showing otherwise, Dr. Wright who has been using D-Mannose extensively in his practice since the 80s also mentioned that D-Mannose a safe preventive supplement.


Q: … only 10 minutes ago I was curled up on my bedroom floor crying my eyes out uncontrollably because I have yet another UTI for the Xth time this year. I get them every month or two months for the past SEVEN years. I thought it was because of sex (because that’s when it would trigger) so my husband went through a number of tests, and it’s not him. We haven’t had sex for 4 months now because of how scared we are of getting another UTI but lo and behold- I got another UTI right after what felt and looked like a yeast infection or BV. Took pessary antibiotics for my yeast infection/BV and a few weeks later I’m positive with a UTI too once my vagina clears up. What is this?!? Which one is causing which? UTI the BV or the other way around? Thirdly, as grateful as I am for your website I am also so overwhelmed by it. I don’t know where to start or what to do first. I got up to step 3 on your homepage where I need to clean out my bladder that could be lined with bacteria and then stopped there. How do I do clean it out? It’ll take 200 days? Can I do it at home? Can I ever have sex again? How long did yours take to calm down? Help.

My non-medical answer:

So sorry for all your struggles! I know that you feel overwhelmed and seems like nothing is working, plus there is a ton of information here. I actually put together an actionable guide (shared in our closed Facebook group, see files) for folks who are looking for specific steps, since I realize it’s too much theory here. However, I have to be upfront: the guide and none of these posts that I have will not answer your questions. After all, it is impossible to know why you keep having UTIs based on the conversation online. Besides, I’m not a medical professional and I can’t consult you. What I can tell you is the areas where to look, how to find a physician, how to order better tests, how to discuss your treatment options and can offer some sample plans for a review with your doctor, you can either find most of this info on my blog for free or get the guide that has it set up in an actionable manner. From what you described, I bet your BV is a culprit, but why it happens and what else is going on, only a doctor can tell after doing a physician and medical history review. Don’t fall for “one size fits all” UTI protocols, every woman is different and the only thing I hope this blog can achieve is your appreciation of how complex and multi-faucet a chronic problem is. So it’s normal to feel overwhelmed, but I don’t think you should try to become your own doctor, rather a well- educated patient 🙂

UTI Symptoms

Q: I had all the symptoms bloody urine pain it lasted 2 days. It went away with cranberry and lots of water. Now it’s coming back just pain when urination and little blood what should I so now. Why back so soon confused and frustrated
My non-medical answer: Well, to be honest, you probably just slowed down the progression of your infection, but cranberry juice is not really a treatment.  Honestly, either work with a naturopathic doctor to try things like garlic, uva–ursi, d-mannose, oil of oregano or even SSKI or ask for a urine culture and get a narrow-spectrum antibiotic.

IC since Childhood

Q: I have celiac disease since 14 years ago and recently diagnosed with IC. I live in Monterrey Mexico, do you have any specific recommendations for my case?

My non-medical answer:

I’d suggest to check out the resource for more info on IC, I’m not well versed in this topic. However, I just got off the phone with Aperiomics, and we spoke extensively about misdiagnosed IC patients. According to their CEO, Dr. Icenhour, Aperiomics’ technology is able to identify viruses in 25% of samples from IC patients and if the virus could be suppressed, patients report a significant or complete resolution of symptoms. In the rest of the cases, they are able to identify bacteria that could be targeted to reduce IC symptoms. This is a pretty unique way to look at the problem and we should probably wait till Aperiomics publishes their findings for the rest of medical community to analyze, but it also points out at the limitations of culture tests. I’d think that if you were diagnosed on a base of a negative culture, you can try DNA-based testing to see if something else comes up.

UTI Vaccines

Q: Recently I have seen that several vaccines are in testing for the treatment/prevention of UTIs. But I have not seen any update on how soon they might be available. Have you heard anything on this?

My non-medical answer: If you are in Europe, it’s already available. As to the USA, I would not bet on it anytime soon. Last time I checked, the University of Washington folks had troubles finding an investor for a UTI vaccine.

Bladder Feels Uncomfortable

Q: I’ve had 9 UTIs over the last two years. I have one now. This is my 9th. I am about to start taking oregano oil because after reading your article, I am sure by now I must have biofilms building up. I take D-mannose probiotic powder on a daily basis, morning and night. I also take cranberry, bladder (uva-ursi, marshmallow root mix), vitamin D, vitamin C, and probiotic morning and night. I always have a stash of antibiotic on me too (which I am taking right now along with all of my vitamins). I would consider this last UTI a “mild” one because I caught it early and upped my vitamin intake before it got completely HORRIBLE. Aside from oregano oil, any other suggestions? I may also try NAC after reading your article. My bladder usually just feels uncomfortable. I feel like I’m always on the brink of a UTI in daily life. I just want to go back to feeling normal and balanced. Typically, I get a UTI every three months. I stay super clean and eat a very healthy diet.

My non-medical answer:

Ouch! You know, given that your bladder is feeling uncomfortable I’d do a more thorough diagnostic test. Perhaps, your culture tests missed some pathogens and by self-prescribing antibiotics without monitoring sensitivity, you might be breeding drug-resistant bacteria. Nowadays there is even a theory that certain IC patients could be cured with prolonged antibiotic therapy if pathogens are correctly identified. I’m more of a fan of working with a naturopath to set up a plan to use antibiofilm enzymes together with a range of natural antimicrobials. Bottom line, you need help and it’s time to find a good doctor 🙂

Lubricants & UTI

Q:  I’ve been suffering UTIs for many years. When I was pregnant my OBGYN told me that it looked like my urethra was shorter than average and thus bacteria can more easily reach my bladder. I have always relied upon antibiotics and I contract UTIs frequently. I am now 50 and sex with my husband is painful and 80% of the time I get a UTI. I don’t want to have to give up intimate pleasure but am starting to feel a bit hopeless. I have vaginal dryness but am worried about lubricants being safe. 

My non-medical answer:

There are many lubricants that are better for those who are UTI prone I have a list of what to look for in a lubricant here, but I’d highly recommend talking to your OBGYN about topical estrogen. And, of course, since you have been taking antibiotics a lot, make sure to include in your diet a good probiotic and a prebiotic. These are good first steps. However, after menopause, there are a couple more tests that could be beneficial for you to make sure there are no new developments so I’d advise checking in with a urologist if topical estrogen won’t fix the issue.

Symptoms Linger After Treatment

Q: …I’ve had UTI symptoms for a month now. They found Strep B in my culture, but after treatment frequent urges to urine continued. All of the symptoms subsided (pain etc.) I got tested again and my urine was clear. Then tried another antibiotic, but seem to be again left with urinary frequency. Have you heard of other women having a lingering frequent need to urinate after a UTI is cleared? Did this resolve by itself? Thank you!

My non-medical answer: Actually, I wrote about this in detail, so I’m going to just give you a link to the post: Lingering symptoms after UTI treatment with an antibiotic.

Recurrent UTI In a Child

Q: … My daughter is 8 and has suffered from recurrent (monthly) UTI’s since she was 4. She has been treated with a radical amount of antibiotics (was on an adult dose, a full course for 6 months) and numerous single courses at each new infection. The GP and pediatrician are at all loss. ( we live in a small town in New Zealand so access to specialists is tricky)She is now resistant to most of the routine antibiotics for UTI’s which terrifies me. We have paid to see a private pediatric urologist who focused mainly on constipation. This hasn’t been a problem now for 18months but the UTI’s persist. They don’t cause her pain or discomfort but do cause daytime wetting when she has an infection. Whilst she is on the antibiotics she is dry. She takes Clinicians D mannose (has done for about 2 years) and I alternate between a Clinician Flora Restore and a Clinician Multiflora digest probiotic daily. I feel we are not winning and am very keen to try some pre and different probiotics. There are so many on your site I don’t know where to start. Any specific recommendations would be wonderful ( also need to check that an 8-year-old can take them). 

My non-medical answer:

Hi there. So sorry to hear, poor girl 🙁 Well, She has consumed a lot of antibiotics in the age critical for developing a healthy microbiome. Especially if she was delivered via C-section she might be lacking essential bacteria that she would otherwise inherit from you that she needs to stay healthy. I’m very happy that your physician suggested focusing on fixing constipation. Does your strategy include stool softeners or have you been enriching her diet with veggies and leafy greens, limiting sugar and simple carbohydrates? Did the physician consider taking a sample for vaginal culture? If her vaginal cavity is colonized with pathogens perhaps your physician can prescribe a topical medicine for that. The probiotic products you mentioned seem to have useful strains, I do not think you need to switch but you need to make sure her diet has a variety of fiber so the good bacteria have more chances to survive. Ask your MD if 10 billion CFUs is the right dose for her (it is for adults) because if you are giving her one capsule per day it is 1/2 of the dose. Something you can ask your physician (and research if you have any trial with this treatment approach) is fecal microbiome transplant (here is another study).

How Long To Take Probiotics?

Q: …I have just started to take D-Mannose. After reading your articles I understood that probiotics, NAC, and hyaluronic acid + chondroitin sulfate are also important in order to support the immune system and prevent UTI. Could you tell me please is it ok to take all these supplements at the same time? Or should I take it one after another course? How long should I take these supplements? Is one package enough? Should I also use suppository with lactobacteria in order to reinforce the effect? 

My non-medical answer:

Unfortunately, whether if it’s ok to take a combo or any one of the listed supplements would depend on so many things: your medical history (allergies, chronic problems etc..), prescription meds and even, sometimes, diet. As much as I wish I could give you a straightforward answer, I can’t. As a rule of thumb, it’s always a good idea to consult with a doctor and introduce supplements one by one, so in case if you have an adverse reaction, you know what’s causes it. In terms of how long, I honestly don’t know. Bladder GAG layer takes time to regenerate and your progress will depend on other things you do (smoking, exercise, diet included). Probiotics are always among my favorite supplements (but again, I’m not a physician and clinical studies arrived at conflicting conclusions when testing probiotics for UTI prevention) and if tolerate them well, it’s good to keep them as a part of your routine supplementation (see a reply below to a similar question). Sorry, I can’t be any more precise 🙁

Actionable Guide for UTI

Q: …I find myself a bit confused with so many posts, so I wanted to check if there is anything that summarises everything. I haven’t tried probiotics yet and I think it’s what I should do next. In a nutshell, what is the winning combination that kept yourself away from UTIs? Do you have any post summarising that? I really want UTIs to disappear from my life forever. Many thanks for your help and the great blog you have! You can’t imagine how helpful it is. P.d. if there is any product specific to Europe, I would appreciate if you can point at it as I am writing from this side of the Atlantic.

My non-medical answer:

Yep, here is the post that summarizes my thoughts on UTI prevention strategies. As to my personal experience, I describe it here. Here are probiotic recommendations (links lead to Amazon and if you do not see a specific product, it will suggest a closest similar option). And here are general guidelines on how to choose a probiotic. Hope this helps!

D-Mannose & Yeast Infections

Q: Does, d Mannose help with yeast infections? I’ve tried the recommended probiotics and they helped for a while but not any longer. Thank you!

My non-medical answer:

Oh no, unfortunately, D-Mannose is not meant for UTI infections. There are plenty of natural options some find useful for a yeast infection. As to the probiotics comment, I’d suggest approaching the issue of UTI holistically, you might need more than just probiotics, especially if you keep having a yeast infection.

Constipation & UTI

Q: Hi For the first time ever, I’ve had a UTI, to be exact a Staph UTI. And I never ever want to experience it again so I’m trying to come up with some answers as to why it happened in the first place and how I can start a prevention plan. First off, I do have sex (oral, vaginal). But this isn’t new for me, for the last year or so my partner and l have been active. So I don’t understand why it’s all of a sudden a problem now. It’s the same person and not much has changed in our routine. The only thing that might have contributed to it was that right before I got my UTI we had vaginal sex a lot more than usual in a short span of time. And we weren’t too good about making sure there wasn’t friction and we used a lube that maybe wasn’t vagina friendly? Secondly, all my life I’ve had BAD constipation, bad. I have IBS and I’ve dealt with it all my life. Thirdly, I also don’t drink as much water as I should. That’s changed now that I have a UTI lol. I’m confused and upset, I hate taking antibiotics and the antibiotics I took for my UTI gave me pretty bad side effects. Any ideas?

My non-medical answer:

Hello! There is a lag time between how soon changes in one part or system of your body affect other organs or systems, but at the end of the day, everything is connected (a very, very slo-mo dominos effect). If you are constipated, then it’s known culprit for UTIs, you probably read why. I’d suggest talking to a naturopathic doctor who could address IBS and UTI together. If you have no access to one, start with asking your OBGYN to perform a vaginal culture test, see what it shows. Here is an overview of the main areas where you can look (25 main UTI causes) and a review of a holistic approach to UTI prevention. Hope this helps!

UTI won’t go away

Q: I have had my UTI for 3 months and it will not go away I got treated at a minute clinic they said it was a small number of bacteria the gave me medication and it just came right back please help what can I do to get rid of this fast.

My non-medical answer:

What you really need is to see a urologist or, at least, a family doctor. Unfortunately, minute clinics and emergency rooms are ill-equipped to deal with recurrent chronic problems.  A primary care physician or a specialist will be able to analyze your symptoms as well as previous medical history to make a conclusion about the appropriate course of actions. I find that folks often think about acute UTI symptoms as a one-off problem, which could be true if, indeed, the infection doesn’t come back. However, if you are dealing with recurrent UTIs or symptoms that won’t go away, you have to dig deeper and think about in a more systemic way.

I’d suggest looking for a urologist or naturopathic doctor, or even scheduling an appointment with your primary care or OBGYN if you can’t afford specialists.

Here are my thoughts on why UTI is often a systemic problem.

Ellura and D-Mannose

Q: Can you take Ellura and d-mannose together or should you take one or the other?

My non-medical answer:

Ellura is a pretty strong cranberry supplement, the active ingredient is PAC (36 mg per tablet). D-Mannose is a naturally occurring sugar, that is sourced in high concentration to create D-Mannose supplements. While the method of action against pathogenic E.coli could be similar (both are focused on decreasing the ability of bacteria to stick to the bladder walls) these are still two different supplements. When thinking about starting or combining supplements it’s always better to chat with a doctor who could consider your overall health and knows about how supplements are metabolized by a body and if they could produce an undesired effect if combined. Since both supplements have their own side-effects, I’d also consider that if you combine them, it’ll be harder to tell what’s causing side-effects if they appear. My vote always goes for a gradual introduction of supplements to see how your body reacts to them. All these being said, I have not seen any contradictions but I also don’t think this combo has been clinically tested as of yet.

Amoxicillin Is Not Working

Q: I have suffered for a week now with a painful bacterial UTI. Amoxicillin isn’t working and I’m allergic to all the rest. They just called in Trimethoprim, hope it works! My question is if I start a probiotic, how long do I take them?

My non-medical answer:

Well, probiotics are still a new area for the health practitioners to learn about. There is a lot of research on what is an optimal microbiome. The things are even more complex when you consider that everybody has a unique combination of bacteria. Here is an excerpt from my interview with Dr. Mike Hsieh on this topic:

“Most oral probiotics don’t colonize the long term which I think is fine. … FDA grants probiotics the GRAS status (generally recognized as safe)… But you know sometimes people do have adverse reactions to probiotics and if you happened to be in that unfortunate category I think the last thing you want is a probiotic that stays in your system after a single dose…I think there are some studies suggesting that particular probiotic strains only stay for a matter of days or two weeks at most so your body washes it out,” he adds “I don’t think these probiotics necessarily exert an immediate effect”.

In fact, if patients tolerate probiotics well, Dr. Mike Hsieh suggests that they take it long-term as a preventive measure.


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