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Urinary tract infections (UTI’s) are one of the most common bacterial infections, and can result in a person feeling very unwell with substantial suffering if the infection is severe. The prevention of UTI’s is important for ostomates and non-ostomates alike to prevent damage and scarring to the kidneys. Poor management of and recurrent UTI’s can lead to chronic progressive renal damage, renal failure and the development of hypertension.
The urinary system is comprised of several muscles, organs, and nerves which collect, store, and release urine. The kidneys form urine by filtering waste and extra water from the bloodstream. The urine is carried through the ureters to the bladder, and the bladder stores urine until you are ready to empty it. The bladder opens into the urethra, the tube which allows urine to pass outside the body. Sphincter muscles, which are circular muscles at the end of the urethra, close tightly to keep urine from leaking inappropriately. When you are ready to urinate, the brain signals the sphincter muscles to relax and, at the same time, the brain signals the bladder muscles to tighten, squeezing urine out of the bladder and creating a strong urinary flow.
A UTI can occur when there is an excessive number of bacteria in the urine, usually more than 100,000 per ml. Infection arises from bacterial proliferation (growth), usually of E coli, within the otherwise sterile urinary tract. Not all bacteria in the urine will cause a UTI, and some people do not experience illness when they have bacteria in the urine. Most UTI’s have an ascending route of action, meaning that once the bacteria have established themselves in the urinary tract, they tend to travel in an upward route towards the kidneys, which places them at risk of infection, damage and scarring.
In the case of urostomates, the bladder has been removed and a segment of bowel tissue is used to create a conduit between the kidneys and the stoma on the skin. The muscles that assist in storing and releasing urine from the bladder are also removed. A lack of muscles that usually assist with urine flow means that urine output is not controlled and therefore constantly ‘dribbles’ through the conduit as it is produced by the kidneys. A strong urinary flow from the bladder usually assists in preventing UTI’s by washing away any bacteria. However this functionality is no longer available for urostomates which may create a greater opportunity for pathogenic bacteria to attach to the walls of the urinary tract. Bacteria is also commonly found in the urine of urostomates because bowel tissue that is populated with bacteria is used to create the conduit for the passage of urine.
A variety of antibiotics are commonly used for the prevention and treatment of UTI’s, however antibiotic resistance may develop and so it is important to look at other options to reduce the incidence.
Drinking additional fluids increases the amount of urine produced by the kidneys on a daily basis. With increased urine production, the urinary tract is flushed out more thoroughly. This can impede the adherence of pathogenic bacteria to the urinary tract walls and also flush out mucous that is produced by the intestinal tissue that was used to make the urinary conduit. Water, herbal teas and fresh vegetable juices are all appropriate fluids to consume. Aim to drink at least 30ml per kg of body weight each day, but check with your doctor if fluid balance is an issue or concern. Sugar can encourage habitation of the urinary system by undesirable bacteria, so soft drinks, alcohol and concentrated fruit juices and drinks should be reduced or avoided.
Urinary irritants such as caffeinated beverages (coffee, tea, Coke, cocoa), alcohol and spicy foods can also upset the harmony of the urinary system and should also be reduced or avoided. Signs and symptoms of inadequate fluid intake include thirst, dry mouth, dry lips and dry skin, as well as headaches, fatigue, irritability, poor concentration and constipation. Urine may also appear dark and cloudy in colour.
Refined carbohydrates found in white bread, white rice, and white flour products such as cakes, muffins, biscuits etc can have the effect of suppressing the function of the immune system, making it less able to fight infection. A diet that incorporates whole grains, complex carbohydrates, fibre, fruits, vegetables, garlic, onions, cold pressed oils, fermented dairy products (such as yoghurt and kefir) and good sources of protein is more supportive of a strong immune system.
Drinking cranberry juice has long been thought to prevent and treat UTI’s because it appears to prevent the adherence of bacteria (specifically E.coli) to the walls of the urinary tract. Cranberry has also been shown to inhibit binding of E.coli to intestinal mucosa. However, most forms of cranberry juice on the market contain one third cranberry juice mixed with sugar and water. As sugar is also detrimental to the immune system, the use of sweetened cranberry juice is not recommended.
The high sugar content of commercially prepared cranberry juice could also be problematic for diabetics. It is very important for diabetics to keep their blood sugar levels under control, as high levels of blood sugar can cause glucose to spill into the urine via the kidneys. This provides an excellent food source for any bacteria in the urinary tract and enables bacteria to rapidly multiply, which increases the risk of UTI’s. Chronically elevated blood sugar can also suppress the immune system and therefore additionally increase the risk of UTI.
Fresh cranberry juice (unsweetened or sweetened with apple or grape juice) is preferred. Another option is to purchase cranberry supplements in a concentrated pill form. Cranberry tablets have been proven to be clinically effective and economical with faster results.
Please note that cranberry may increase the INR in patients on Warfarin, so patients taking Warfarin and cranberry regularly should have their INR closely monitored.
Fermented milk products containing probiotic bacteria (such as kefir) have also been associated with a decreased risk of recurrent UTIs. To provide benefit the kefir must be consumed frequently.
Another strategy to combat UTI’s is to acidify the urine, therefore creating an unfriendly environment for bacteria to multiply and grow. Urinary pH usually varies between 4.0 and 8.0 depending on food intake and metabolic processes in the body. Foods that are considered to promote urinary acidity are meat, fish, cheese and grain products. However it should be noted that maintaining urine in an acidic state over long periods (at a pH of 5.5 or less in particular) may predispose the individual to either kidney stones or gout, due to high levels of uric acid. Generally speaking, urine that smells fruity is too alkaline.
Urinary acidification may also be achieved by means of Vitamin C supplementation; however very high doses are required which may loosen bowels and cause diarrhoea. Supplemental Vitamin C can also affect the results of numerous laboratory tests, including blood and urine tests, and should be stopped prior to any medical investigations.
It is common to experience fever and chills when a person has a UTI, however elderly people may not experience these symptoms and they cannot therefore be relied upon as an indicator of infection. Mental confusion may be evident instead. Urine that is dark and cloudy with a very strong odour may also indicate an infection.
To summarise, my dietary recommendations for reducing the occurrence of UTI’s are as follows:
- Drink ample hydrating fluids for your body weight to flush mucous and bacteria out of the conduit. Check with your doctor the appropriate amount if fluid balance is an issue for you.
- Avoid excessive intake of sugar and refined carbohydrates.
- Consume foods that boost the immune system.
- Consider unsweetened cranberry juice or tablets.
Overall it appears that drinking ample hydrating fluids to flush the urinary system and keeping the immune system strong with a healthy diet are the safest ways to prevent urinary tract infections.
Wishing you good health and happy days, – Margaret.