How to say goodbye to UTI’s

If you’ve ever experienced a urinary tract infection (UTI) you’ll know the horrible signs only too well: running to the loo every half-hour with what feels like a full bladder, only to squeeze out a pathetically small trickle — scalding its way out. It’s a truly miserable feeling and the sheer dread of a recurrence is enough to make you cry.

Simple UTIs do have a tendency to recur, unfortunately. It’s estimated that about 20 per cent of women who have one infection will have a recurrence. Of that group 30 per cent will have a third bout, and of that group 80 per cent will have further recurrences.

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These statistics refer to women because, well, it’s largely a woman’s problem. For the obvious reason, men have longer urethras and therefore suffer less from infections of the urinary tract, unless there are prostate problems, have conditions requiring catheterisation or are elderly. By contrast, more than half of all women will experience a UTI in the course of their lifetimes.

While anyone — including children — can develop a UTI, it’s most common in young women who have recently become sexually active (often known as “honeymoon cystitis”), in pregnant women and in peri- and post-menopausal women. See the box for specific risk factors.

Risk factors for UTIs

Being female
Being sexually active
Pregnancy
Dehydration
Vaginal dryness, such as with menopause
Urinary retention
Prostate enlargement in men
Catheterisation
Mobility limitations
Diabetes
Weakened immune system through age, illness or medication
Urinary tract obstruction

What causes UTIs?

Urine is produced by the kidneys and then travels through connecting tubes called ureters into the bladder. Once the bladder is full, you feel the urge to urinate. When you relax to pee, the bladder contracts to empty its contents through the urethra, the tube that runs from the bladder to the outside. Just like a plumbing system.

The usual way for urinary tract infections to occur is when bacteria gain access from outside, the most common offenders being Escherichia coli, which are responsible for around 90 per cent of UTIs. These are not the dangerous strains that have contaminated food and caused severe acute illness, but the normal E. coli found in our intestinal tracts.

The other 10 per cent of infections are most likely to be caused by other gut bacteria such as Proteus, Klebsiella, Enterococcus or staph organisms from skin. Catheterisation can also introduce Candida albicans, which can cause a fungal urinary infection.

Which particular micro-organism is the cause of an infection makes a difference to treatment, whether medical or natural. Pay much lower prices for rare products from ALDI Catalogue this week!

Symptoms of a UTI

While UTIs can sometimes be asymptomatic, particularly in children and elderly people, they are most often accompanied by a distressing set of signs, often striking in the evening when it’s not convenient to see a doctor. They can come on so quickly that by morning it’s practically unbearable. The most common symptoms are:

Sensation of burning or pain during urination
Urinary frequency
Urinary urgency
Despite the feeling of a full bladder, only passing a small amount of urine
Urine is cloudy or pink in colour and may have an unpleasant smell
Pain in the lower abdomen

Types of UTI

A bacterial infection can develop in the lower urinary tract and if not treated can make its way further up to become a more serious problem. While UTI is a blanket term, infections caused by the same bugs are also often referred to by their location:

Urethritis. An infection of the urethra, the tube through which urine goes from the bladder to the outside.
Cystitis. An infection of the bladder that usually has moved up from the urethra.
Pyelonephritis. An infection that has moved all the way to the kidneys, though sometimes is caused by an obstruction of the ureters that causes urine to backflow.
Interstitial cystitis. Not actually an infection, but chronic inflammation of the bladder, diagnosed when there’s no evidence of causes such as infection. The misery is just as acute as with an infection, and all the more so because it’s chronic.

For the purposes of this article, which focuses on using natural remedies and supplements, UTI refers to the first two, or infection of the lower urinary tract. This is often termed “a simple UTI”. Infection higher up, in the kidneys, is a serious condition that requires advice and treatment from a doctor and will need antibiotics to head off serious illness and permanent damage to the kidneys.

Treatment

The conventional treatment for urinary tract infections by doctors is antibiotics, which can effectively knock the infection on the head quite quickly if it’s the right antibiotic for the particular bug. The problem is, antibiotics are only a short-term fix and bring with them other, longer-term problems.

Some strains of the bacteria that cause UTIs are becoming antibiotic resistant as well. In addition, antibiotics don’t discriminate and will kill off the helpful bacteria in your body that work hard to keep the pathogenic organisms under control. So the medications literally sabotage one of your best defences against infection, which can ultimately trap you on a treadmill of recurring infections followed by more antibiotics.

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While it’s important not to let a simple UTI progress to something more serious, antibiotics should be the last resort. UTIs can be chronic or recurrent, so there is always potential for developing antibiotic resistance. Even doctors are acknowledging that the antibiotic treadmill is both dangerous and ineffective in the long term, even though the bad bugs take a temporary hit from them. Many healthcare practitioners are accepting that a natural approach to prevention and treatment may well be more desirable.

Bacteria that are particularly resistant to antibiotics and can therefore make life miserable are those that exist within a biofilm, a matrix that shields them from the efforts of both the immune system and antibiotics. Biofilm formation is an important virulence factor for many microbes that want to take up residence in the body, in particular mucosal areas. It’s the reason problems like gum disease, chronic sinus infections and recurrent UTIs are so persistent.

There are numerous alternatives to antibiotics, several backed up by research as well as clinical and anecdotal evidence. They range from botanically derived remedies and vitamins, to hormone treatment, pantry staples and essential oils. Some help symptoms, while others treat the acute infection; some are preventive and others are both. While many of them can be used and indeed are more effective in combination, it’s important to understand that some can be in conflict with one another.

D-mannose

Fast becoming considered the most effective of natural treatments, d-mannose is a simple sugar that your body metabolises like it does glucose, so it doesn’t have the problems associated with fructose and sucrose. It is not converted to glycogen and stored in the liver, so it has no effect on blood sugar regulation and doesn’t “feed” infection.

It’s important to realise that d-mannose only works on UTIs caused by E. coli, though, but as mentioned that is most infections. D-mannose doesn’t actually kill the bacteria; it just makes them unable to stick to the urinary tract and do their nasty work.

E. coli have sticky finger-like projections called fimbriae, which they use to hang on to the walls of the bladder so they can move in for the duration. Then they can also make their way upward, Spiderman-style, to wreak more serious havoc.

The fimbriae are tipped with lectin, which binds to the mannose produced by the body, which covers the lining of the urinary tract. The mannose is what allows them to stick like glue. But when a larger amount of mannose is introduced through supplementation, it’s mostly excreted in urine, so the lectin-tipped fimbriae bind to the mannose in the urine and exit with it into the porcelain.

In a recent study, 308 women with a history of recurrent UTIs were randomly divided into three groups: one group taking d-mannose daily for six months; the second group taking an antibiotic commonly used for UTIs; the third taking nothing. Overall, 98 of the women had recurrent UTIs: 15 were in the d-mannose group, 21 in the antibiotic group and 62 in the non-prophylaxis group. Not only did the d-mannose group do best in terms of infection but the women taking it had virtually no side-effects from the treatment, while some from the antibiotic group reported mild side-effects.

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American Dr Jonathan Wright, a pioneer of using d-mannose for two decades, has said that in his clinical experience of prescribing it to more than 200 patients it has been 85–90 per cent effective.

D-mannose is considered very safe, even for children and pregnant women, and works to stop an acute infection and also as a prophylaxis to prevent further bouts in those unfortunate enough to be prone to recurrent UTI. The main downside is it can be difficult to find, though some health shops and compounding pharmacies do stock it. It’s easy to buy online.

Cranberry (Vaccinium macrocarpon Ait.)

While cranberry has been used in folk medicine for centuries, a significant body of clinical and epidemiological studies — too numerous to detail here — have supported its use as a preventive for UTI. One meta-analysis summarised 10 cranberry trials: six using juice, three using tablets and one using both; the conclusion was that cranberry significantly reduced the incidence of UTI over a 12-month period, particularly in women prone to recurrent infections.

The A-type cranberry proanthocyanidins (AC-PACs) (a class of flavanoids) present in cranberries have been shown to have anti-biofilm properties against E. coli by preventing their adhesion in the bladder. In addition, d-mannose is present in cranberry and other berries, though not at the same levels as in the supplements.

This makes regular supplementation of cranberry capsules or consumption of sugar-free juice particularly useful for those who suffer relapsing or recurring infections (RUTI). (Juice containing added sugar is not recommended as sugar feeds micro-organisms.)

As a bonus, several studies have suggested benefits to oral health from the AC-PACs in cranberries. On the one hand, they’ve been shown to reduce the virulence of P. gingivalis by inhibiting biofilm formation, adhesion, proteinase activity and invasiveness. On the other, they have an anti-inflammatory effect on P. gingivalis-associated periodontal diseases.

Cranberry has a high safety rating, even for pregnant women. The supplement form is preferred to avoid fructose and there are some supplements available on the market combining cranberry with added d-mannose.

Uva ursi (Arctostaphylos uva-ursi)

Also known as bearberry or beargrape, along with a number of related plants (apparently because of wild bears’ liking for the fruit of these plants), uva ursi is a low-growing, trailing shrub native to many parts of the Northern Hemisphere that has several sub-species. The leaves, not the berries, are used in herbal medicine.

Uva ursi has a long history in traditional herbal medicine of treating conditions of the urinary tract and also chronic diarrhoea (due to its astringent tannins). In fact, before sulphur drugs and antibiotics it was the treatment of choice for UTI, pyelonephritis and kidney stones.

It has been approved for treating inflammation of the lower urinary tract by Commission E of the German Federal Institute for Drugs and Medical Devices, the governmental agency that evaluates herbal products for safety and effectiveness. The Commission E monograph lists its use as “for inflammatory disorders of the lower urinary tract”.

Uva ursi relieves symptoms quite quickly — sometimes in just a few hours. It contains a significant amount of arbutin, which is converted in the urine to hydroquinone, a urinary antiseptic. It also acts as a diuretic and has an anti-inflammatory action.

In clinical studies, human subjects were given either extracts of uva ursi or isolated arbutin and the urine of both groups was evaluated. The urine from the uva ursi group showed significant antimicrobial activity against E. coli, Proteus mirabilis, P. aeruginosa, S. aureus and 70 other urinary bacteria. Interestingly, one study demonstrated that arbutin taken alone was not as effective as the plant.

In the only clinical study on uva ursi as a preventive against UTI, it was shown to be statistically more effective than placebo in women with recurrent infections who took uva ursi or placebo for a month and were followed up for a year, with no recurrences in the treatment group. However, this result is academic because it is not considered safe to be taken for that long due to possible toxic effects on the liver.

In fact, expert advice is not to take uva ursi for longer than a week or more than five times a year, so it should never be used as a preventive. It also may conflict with cranberry and vitamin C, as these make the urine acidic and uva ursi needs the urine to be alkaline. Bicarb soda complements uva ursi, as it makes the urine alkaline. This is very important to understand as uva ursi and cranberry taken together may have the effect of cancelling each other out, so to speak.

Caution: Uva ursi is toxic in high doses. It should not be used in pregnancy or by anyone who has a kidney infection. It should not be given to children.
Berberine

Berberine has a long history of use in both Ayurvedic and traditional Chinese medicine. It is an alkaloid that’s present in many plants, including goldenseal (Hydrastis canadensis), goldenthread (Coptis chinensis), Oregon grape (Berberis aquifolium) barberry (Berberis vulgaris) and tree turmeric (Berberis aristata).

Berberine is extracted from the root, rhizome and stem bark of plants. The extract has shown significant antimicrobial activity against a variety of organisms, including bacteria, viruses, fungi, protozoans, helminths and chlamydia. While berberine can be consumed via herbs like goldenseal and Oregon grape, it’s usually taken in supplement form.

Like cranberry and d-mannose, berberine has been shown to prevent the adhesion of E. coli to the bladder wall. It does this by inhibiting the synthesis of fimbriae. In one in-vitro study, researchers cultured a strain of E. coli from patients with UTI. The E. coli cultured on their own were shown to be heavily covered with fimbriae but, when cultured in the presence of berberine sulfate, there were almost no fimbriae.

Berberine has also been shown in a Bangladeshi study to have a beneficial effect on E. coli-induced diarrhoea within eight hours of taking it. Other bonuses are that berberine has been shown to lower elevated blood glucose levels as well as total blood cholesterol levels, LDL and triglycerides. Plus, it appears to inhibit the growth of many types of tumour cells.

Caution: Berberine should not be taken during pregnancy as it can cause uterine contractions and lead to miscarriage.

Estriol cream

There is extensive, peer-reviewed data that supports the use of vaginal estriol cream for UTIs in peri- and post-menopausal women. While it requires a visit to your GP for a prescription and blood tests, bioidentical estriol is worth considering as another alternative to antibiotics. As mentioned, UTIs occur commonly around menopause and estriol cream can be used as a preventive for this problem, plus it delivers other health benefits at the same time.

Our bodies make three oestrogen hormones: estrone (E1), estradiol (E2) and estriol (E3). Estriol is considered the weakest of the three, but interestingly its weakness may be one of its strengths. While estriol acts as a weak oestrogen in the breast, endometrium and liver, at the same time it has full oestrogenic responses in the vaginal and bladder epithelium. This means a wealth of benefits without increasing the risk of hormone-dependent cancers.

Bioidentical estriol has been used by women in Europe for more than 60 years and is available over the counter in some countries, as it is in the UK and US, though not FDA approved. The cynical among us might wonder if the lack of FDA approval has anything to do with Big Pharma, as that’s who makes the big bucks from synthetic hormone replacement. While E3 is often prescribed in combination with E2 for hormone replacement therapy, you can talk to your GP about getting your levels checked with a view to having E3 alone.

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Estriol is used as a vaginal cream in a 0.5–1.0mg dose, usually daily for the first two weeks, then three times a week. Unlike oral estriol, which is not recommended, it does not accumulate and has shown consistent effects without any adverse impact on the levels of the other oestrogens in the body.

Vaginal estriol has been shown to consistently relieve urinary symptoms including stress incontinence, dysuria and urgency and, importantly, significantly reduces the incidence of UTIs. In a randomised, double-blind, placebo-controlled trial, women with recurrent UTIs were given either vaginal estriol cream (containing 0.5mg estriol) daily for two weeks, then twice-weekly for eight months, or placebo. The result was a dramatic drop in the incidence of UTI in the estriol group vs placebo: 0.5 vs 5.9 episodes a year.

Among its other benefits for peri-menopausal and menopausal women, it relieves vaginal dryness and normalises vaginal flora; relieves menopausal symptoms such as hot flushes and night sweating; helps to prevent bone loss and increase bone density (though not to the same extent as E2); and has a beneficial effect on the heart, decreasing LDL and increasing HDL cholesterol levels. It has even been shown to reduce brain lesions from multiple sclerosis.

Estriol has also been shown to normalise the proper pH of the vagina, which helps to prevent UTIs, and it helps the gut maintain the right environment for beneficial bacteria (Lactobacilli) to flourish.

On top of all these positives, large peer-reviewed trials have demonstrated that vaginal estriol does not increase breast cancer risk. In fact, in one study involving breast cancer survivors, there was a decrease in recurrence of the cancer among the estriol users vs non-users.

Probiotics

Probiotics help to populate the gut with healthy bacteria that keep the pathogenic bacteria in their place, which indirectly leads to a healthy urinary tract. The fewer unhealthy bacteria and yeasts in the digestive tract, the fewer there are ready to migrate to other areas.

A US study of 139 women from a uni student health centre and from the staff of a university hospital (mean age: 30.5 years) with a diagnosis of an acute UTI were compared with 185 age-matched women with no episodes of UTIs during the preceding five years. A questionnaire established the women’s dietary and other lifestyle habits to form a risk profile for UTI.

A decreased risk of UTI recurrence was seen in those who regularly consumed fresh juices, particularly berry juices, while even more protective were fermented milk products, though fresh milk products showed no such protective action. This led researchers to conclude that it was the probiotics in the fermented milk products that had the positive effect, not the milk itself.

A number of clinical studies have shown both probiotic vaginal suppositories and oral probiotic supplements containing certain Lactobacillus strains (casei, rhamnosus and crispatus) have decreased UTI rates significantly; in the case of suppositories containing Lactobacillus, growth factor rates of infections decreased by as much as 73 per cent.

Of course, the most powerful probiotics are those found in live fermented foods, such as sauerkraut, yoghurt, kefir, natto and kombucha, among many others.

Vitamin A

There has only been one study on this vitamin’s effect on UTI, where it was shown to be helpful for managing non-complicated recurring infection (RUTI) in children. In the study of 24 young patients, 12 received vitamin A in addition to antimicrobial therapy, while the other 12 received only antimicrobial therapy, for 10 days. The children were followed up for a year, with both groups continuing on the antibiotic prophylaxis. Serum levels of vitamin A and beta-carotene were measured periodically.

It was observed that after six months the children in the vitamin A group had a significantly lower rate of infection and, even a year later, their infection rates were still lower than those in the control group, whose infection rates remained steady over the year.

Vitamin C

Vitamin C comes up a lot in Forums, such as internet support groups etc. Many people swear by its effectiveness but there is also some science supporting its use for UTIs. It’s thought to inhibit the growth of some bacteria by acidifying the urine.

A 2007 study of 110 pregnant women was conducted to assess the effectiveness of vitamin C as a preventive for UTI during pregnancy. The women were divided into two groups. For a period of three months, one group was given a daily dose of 100mg of vitamin C while the other group was used as a control. Urine samples collected monthly from both groups revealed a significantly lower incidence of UTIs in the vitamin C group (12.7 per cent) than in the control group (29.1 per cent).

Some people take very high doses of vitamin C when a UTI hits, but caution is required as doses over 1000mg can cause diarrhoea and stomach upset. Don’t take vitamin C if you are taking uva ursi or berberine; as mentioned, both those remedies work when the urine is alkaline, not acidic. Vitamin C complements both cranberry and d-mannose.

A daily amount of 500-1000mg is considered an appropriate dose when infection is present.

Vitamin D

Low serum levels of vitamin D have been associated with greater incidence of RUTIs in pre-menopausal women. Over a period of three years, 93 women in their 40s with recurrent UTI were compared to 93 age-matched women with no history of recurrent UTI. It was found that the mean serum levels of vitamin D among the women with recurrent UTIs were significantly lower than those of the control group, leading to the conclusion that recurrent UTIs in pre-menopausal women are associated with vitamin D deficiency.

Essental oils

Among their many uses, essential oils have been shown to exert powerful antimicrobial actions. A number of essential oils have been very popular for treating UTI and there is a small amount of science supporting their use for bacterial and yeast infections.

Cinnamon oil has long been used for UTI and studies support its effectiveness on uropathogenic E coli. Trans-cinnamaldehyde, (TC), a major component of the oil, has been shown to limit the formation of biofilm bacteria on catheters. It is also known to reduce the adhesion and virulence of E. coli. The effectiveness of TC is attributed to multiple factors.

Essential oil extracted from Salvia officinablis (common sage) has been shown to inhibit several uropathogens obtained from the urine samples of adults with UTIs. Among the micro-organisms it inhibited were Klebsiella, Enterobacter species, E. coli, P. mirabilis and Morganella morganii.

Oregano oil, too, has been shown to be effective against E. coli, while clove bud oil and thyme oil have also been shown to have strong antimicrobial actions. One study found that a combination of thymol and eugenol, derived from thyme and clove essentials oils respectively, was as effective against bacterial vaginosis as standard antibiotic treatments.

Lemon oil is also well regarded by those who regularly use essential oils therapeutically, as are rosemary and bergamot oils. There are premixed blends of various essential oils available, such as K&B Tincture and Thieves, which are particularly favoured for combatting UTIs. Plus, a few drops of lemon oil in water in the morning is said to be more effective than the juice in water for alkalising urine.

How to use essential oils

Add 1–3 drops to a therapeutic drink such as unsweetened cranberry or water with d-mannose, or mix with a carrier oil to massage over the soles of the feet or abdomen for a transdermal dose. You can also add a few drops of essential oils to a carrier oil to fill capsules. Your preferred combination oils can be added to a warm compress or sitz bath, too. Bicarb soda or apple cider vinegar can be beneficial when added to the bath along with the oils.

Pantry remedies

There are numerous remedies straight from the pantry that have little or no science backing them up yet mountains of anecdotal support that make them worth mentioning, in our book. The following are particularly effective, especially if all three are taken over the course of the day, though not together at the same time.

Bicarb soda

What can’t this white powder do? Some of the things it can do include cleaning your home, making your baking rise and dealing with fungal infections; it can clean your teeth, stop insect bites from becoming infected, boost your laundry detergent, deodorise your fridge — in fact, deodorise everything from your shoes to the kitty litter tray and the kids’ lunchboxes. But how does it help with a UTI?

Oral administration of sodium bicarbonate tablets has been shown in tests to effectively alkalinise urine. This means the burning sensation on urination goes away, but it doesn’t mean the infection is gone. That will take a little time. Meanwhile, it quickly helps to make you feel better while your other chosen remedies start to take effect. Take a teaspoon in a glass of water three times a day until symptoms have subsided.

Citrate salts have also been shown to have a similar effect. One study showed that sodium citrate significantly improved symptoms in women with UTI by alkalising the urine. Potassium and sodium citrate have also been shown to be effective against urinary candidiasis, a fungal urinary infection often associated with catheterisation. In a clinical study of hospitalised patients, supplementation for a period of two days to a month resulted in a significant increase in urinary pH and the disappearance of candida in the urine.

Apple cider vinegar

Apple cider vinegar (ACV) is one of those cure-alls that no pantry should be without. The father of medicine himself, Hippocrates, prescribed vinegar mixed with honey for a variety of ills. The main substance in vinegar, acetic acid, has been shown to kill bacteria or prevent them from growing and multiplying. It has a history of use as a disinfectant and food preservative.

ACV is the preferred vinegar for maximum health benefits. It’s a probiotic food because it contains a living culture known as “The Mother”, consisting of strands of proteins, enzymes and beneficial bacteria. Make sure the vinegar you buy is unpasteurised and contains The Mother, one of the major contributors, along with acetic acid, to the health benefits gained from taking ACV.

Like any vinegar, apple cider vinegar is highly acidic so can be a threat to tooth enamel and the lining of your oesophagus if taken undiluted. Always dilute it in water, if you’re drinking it, or make a dressing with it for your mealtime salads. If you’re not fond of the taste, try mixing it with olive oil and pomegranate molasses for a delicious dressing. Take a tablespoon in water a couple of times a day when you feel the early symptoms of UTI.

While baths are not recommended when you have a UTI, a lukewarm bath with a cup of ACV added may be very helpful. Don’t make it hot, though, as too much heat can kill off the mother culture.

Coconut oil

Coconut oil has short-chain and medium-chain fatty acids, including lauric acid, caprylic acid and capric acid. These fats have anti-fungal, anti-bacterial, antiviral properties and give a good boost to the immune system.

Almost half of the fatty acids in coconut oil is lauric acid and, when coconut oil is digested, it forms a monoglyceride called monolaurin. Lauric acid and monolaurin together can kill pathogenic bacteria, fungi and viruses, including Staphylococcus aureus and Candida albicans.

In one study into the effect of oral oil pulling on biofilms, coconut oil was found to exhibit antibacterial activity against Streptococcus mutans and antifungal activity against Candida albicans present in the mouth. Another study by Irish researchers looked at the antibacterial activity of coconut oil modified by enzymes in a way similar to the effect of digestion, concluding that not only did it strongly inhibit the growth of most Streptococcus strains but that further work should be done on its effect on bacterial strains in the gut.

Take one to three tablespoons a day when you have symptoms. And don’t worry that it will make you put on weight: coconut oil has actually been shown to help weight loss. If you can’t stomach it straight off the spoon, try having it in a smoothie or even a teaspoon in coffee. A tablespoon a day even when no infection is present is a good health habit.

For good plumbing

Drink enough fluids — dehydration is a risk factor.
Go when you feel the need — don’t hold it in.
Take showers instead of baths (unless a therapeutic bath).
Clean the genital area before and after sex.
Wipe from front to back after going to the toilet.
Use unbleached loo paper and prefer cotton sanitary pads and tampons.
Don’t use ladies’ “hygiene” products, which may contain chemicals that irritate the urethra and genital area.

Avoid

Sugar. Sugar is the microbes’ friend, feeding them and helping them to grow. Avoid not only cane sugar but also keep your fruit intake minimal and reduce or eliminate grain carbs, especially anything made with processed flours.
Alcohol. Not only is it a sugar source but alcohol is known to irritate the bladder. It’s also dehydrating, so bad for UTI on all counts.
Caffeine. Caffeine is another bladder irritant you should avoid when you have UTI symptoms. Opt for water, coconut water and herbal drinks.

Embrace

Water. Of course, pure filtered water (not carbonated) is really your number-one aid in the battle against the buildup of bugs in your system. There’s no better time to adopt the eight-glasses-a-day regimen than when having urinary tract problems. Increased water intake means increased urination, which is essential to carry the bacteria to the outside, no matter what treatments you are using.
Herbal teas. Some herbal teas gently increase urine output. Dandelion is a good one, as are parsley and nettle. These teas have anti-inflammatory and immune-boosting properties, too, and the extra fluid helps to flush out the bacteria.
Daily doses of your choice of preventives. Use cranberry capsules, diluted apple cider vinegar and/or a daily dose of coconut oil as preventives and for their other health benefits. D-mannose can be an excellent preventive as well, though that can be expensive when taken year-round.