Urinary issues are responsible for over 10 million medical office visits per year, and roughly half of all women will have meaningful urinary health issues sometime in life, including recurring infections (UTIs), inflammatory conditions such as interstitial cystitis, pelvic pain or frequency and urgency (gotta go, gotta go!), even without infection.
Female urinary anatomy gets the short end
Women are more prone to urinary tract infections than men, primarily because the female urethra (the exit from the bladder) is five times shorter (4 cm vs 20 cm). This makes it easier for bacteria to backtrack into the bladder. Also, as 90% of the bacteria that cause urinary tract infections are from the E. coli family-a common colon bacteria, the shorter distance for colonic bacteria to get to the urethra in female anatomy is also a factor. And, while the cells in a healthy urethra sweep bacteria downstream, after menopause hormonal deficits atrophy this protective component and increase the frequency of urinary problems from midlife on. Additionally, as if to further prove that life is not fair, males have a bacterial growth inhibitor delivered directly into their urinary system by the prostate gland, which reduces their incidence of infection as compared to women.
The traditional approach
The most common medical treatment for urinary complaints is a course of antibiotics, or in some conditions low dose daily antibiotic therapy. While antibiotic therapy can be essential in clearing some infections, it does have potential side effects which include the alteration of healthy bowel flora and the potential for the emergence of resistant organisms in subsequent infections.
Is there a reasonable non-antibiotic option?
D-Mannose is by far the most effective non-prescription supplement for both treatment and prevention of UTIs. You may have heard that cranberry juice is helpful for urinary tract infections. The main reason for this is the high concentration of D-mannose found in cranberry extract. The high amount of fructose in cranberry juice is actually a compromising factor that should probably be best avoided. If you like cranberry for urinary prophylaxis, I’d favor using the extract over the juice.
D-mannose is a naturally occurring sugar. It is found in many fruits, including blueberries, cranberries and apples. Although it is similar in structure to glucose, D-mannose is not metabolized like other sugars, which means that it’s OK for diabetics and will not either raise your blood sugar or be stored as fat. It is equally safe in all age groups. Most of the D-mannose you absorb is directly filtered through the kidneys, and then concentrated in the urine.
How D-mannose works
The E. coli bacteria which cause most urinary infections have small fingerlike projections called fimbria, which allow them to stick to the walls of the bladder. This makes it difficult for urinary flow to rinse them downstream. The D-mannose works by attaching to the fimbria of the E. coli and not only prevents them from finding a foothold, but also causes them to stick to each other 1,2, and in the process they are cleared from the bladder when you urinate. It follows that hydrating well while using D-mannose to help flush out the bacteria will assist in the recovery process.
Clinical and anecdotal experience over the last 25 years suggests that D-mannose is highly effective for the majority of urinary infections, both acute and chronic. However, D-mannose has not been evaluated in clinical trials for acute infections, and the FDA has not approved it for clinical therapy. A recent clinical trial 3 did compare D-mannose to a common antibiotic (nitrofurantoin) and a non-treated control group in the prevention of urinary infections in an at risk group of 308 women over a six month period. The D-mannose group took 2 grams once daily, and the results were impressive. 32% of the control group had a re-infection, as did 20% of the antibiotic group, but only 15% of the D-mannose group had a reinfection during the six month period. The relatively low cost and side effect profile of D-mannose in comparison to antibiotics make it a very reasonable front line choice for many patients.
How to use D-mannose
Acute therapy: it works best if you start early in the process, before bladder wall inflammation becomes a part of the process. For those prone to infection, I often advise that they start at the very first indication of burning, urgent or frequent urination, and to take 500 mg every 2-3 hours for the first two days. If symptoms improve during this time-and most of the time improvement is noted in the first twenty-four hours, continue through five days. If not improving, especially if you have a fever, or see blood in the urine, get further testing with your health professional. Remember that this treatment only works reliably with E. coli, and as 10% of UTI organisms are not in this group, you may need additional treatment such as an antibiotic.
Preventative therapy: you can take D-mannose during the times where you feel you are most prone to UTIs, such as prior to intercourse, when dehydrated, or during prolonged antibiotic treatment. This is especially helpful for those who are prone to chronic or recurrent UTIs. As the study I referenced discussed, some people find that taking two grams per day every day is preferable to taking daily suppressive antibiotics for chronic or recurrent infections.
Typical D-Mannose products are formulated with pure, natural D-mannose and are available in both capsule and powder forms.
1 Effect of D-mannose and D-glucose on Escherichia coli bacteriuria in rats. Michaels EK, Chmiel JS, Plotkin BJ, Schaeffer AJ. Urol Res. 1983; 11 (2):97-102.
2 Bad bugs and beleaguered bladders: Interplay between uropathogenic Escherichia coli and innate host defenses. Matthew A. Mulvey, Joel D. Schilling, et.al. Proc Natl Acad Sci U S A. 2000 Aug 1; 97(16): 8829–8835.
3 Use of D-mannose in prophylaxis of recurrent urinary tract infections in women. Altarac, Silvio and Papeš, Dino BJU International Volume 113, Issue 1, published online Dec 13, 2013