Probiotics are ‘live microorganisms, which when administered in adequate amounts confer a health benefit on the host’ . Historically, probiotics have lacked credibility in the orthodox medical community but with recent scientific advances in the field of the human microbiome the therapeutic potential of different probiotic strains has been recognized.
In my last two posts I have looked into the urinary microbiome and how an imbalance of microbes in the bladder can predispose us to bladder conditions such as urinary tract infections, interstitial cystitis, overactive bladder and chronic pelvic pain.
Today I would like to take a look at several probiotic strains that have been studied for bladder- and genital health.
The Vaginal and Gut Microbiota Matter, Too
Both the bladder and the vagina seem to be dominated by different strains of Lactobacillus. It seems to be the type of Lactobacillus that makes a difference as certain strains can also cause problems.
The health of the bladder does not only depend on the urinary microbiota. The vaginal flora/microbiota is also protective for the bladder.
Most pathogens migrate from the gut (via the anus) to the bladder. If the vaginal flora is healthy, it can act as a first line of defence for pathogens getting to the urethra and into the bladder.
On the other hand, a healthy gut shouldn’t harbour a lot of pathogens. Therefore, working on a healthy gut microbiota may decrease the risk of catching an UTI further. The less pathogens are in the gut, the less pathogens can get to the bladder.
Probiotics for the Vagina
A healthy vagina is dominated by Lactobacilli.
If the vagina becomes populated with yeasts or coli forms, problems such as thrush or bacterial vaginosis can arise.
Populating the vagina with probiotic strains has been shown to help prevent thrush, bacterial vaginosis and ultimately UTIs.
Both oral and suppository preparations seem to be effective.
Although the exact mechanism of the therapeutic effects of these probiotics is not fully known, it has to do with out-crowding pathogens and interacting with the mucosal lining to improve the immune response against pathogens, plus optimizing vaginal pH.
The following strains have been found to be effective for vaginal health and in turn bladder health:
- L rhamnosus GR-1
- L fermentum RC-14 and B-54
- Lactobacillus crispatus
These strains have been shown to reduce the recurrence of UTIs, thrush and bacterial vaginosis.
Probiotics for the Urinary Tract
Apart from modulating the vaginal flora to protect the vagina and bladder, certain strains have been studied specifically for urinary health:
- rhamnosus GR-1: has been found to enhance the activation of immune responses in the bladder, helping the process of fighting pathogens.
- L rhamnosus GG: has shown potential for reducing UTI recurrence.
- L casei Shirota: may have potential for reducing the recurrence of bladder cancer.
- Oxalobacter formigenes: has potential for reducing the occurrence of kidney stones by degrading oxalates (an acid found in plant foods that can form into crystals) in the intestine.
- plantarum 299: has been found to reduce infection in patients undergoing surgery.
Reducing Pathogen Load in the Gut
Most UTIs are caused by pathogens migrating to the bladder from the gut. The most common pathogen is E. Coli.
Reducing the pathogen load in the gut may be the best way to reduce the chances of urinary tract infections.
As this is to big a topic to discuss in this post, I’m going to outline just a few options below.
Modulating the gut microbiota is a big task and doesn’t usually happen quickly. Long term solutions include:
- A diet high in fibre, especially probiotic fibre such as inulin and oligo-fructosaccharides
- Probiotic foods that are naturally fermented with live bacteria such as kefir, kombucha, sauerkraut and kvass
- Bone broth as nourishment for the gut wall
- Probiotic supplements
- A fecal transplant – using the stool of a healthy person to modulate an imbalanced microbiota
- Helminthic therapy – helminths are higher beings that used to be part of our intestinal microbiota. They include certain types of beneficial hookworms and whipwhorms
- Avoidance of antibiotics, chemicals, GMOs, artificial sweeteners and processed foods – all these can negatively affect the microbiome
The simplest step to take if recurrent infections are caused by E. Coli would be to reduce the E. Coli in the gut.
This can be achieved by taking the beneficial strain E. coli strain Nissle 1917. Not all types of E. Coli are bad. This strain is available as the probiotic Mutaflor manufactured in Germany.
Whilst most other probiotics are transient (they don’t take up residence in the body) this strain actually takes up residence in the body and can disrupt the formation of biofilms by pathogenic E. Coli strains.
It could therefore have great potential for preventing urinary infections caused by pathogenic E. Coli.
Probiotics are not a magic bullet and should be considered as an additional step towards bladder health.
Friendly bacteria can’t thrive in an unfriendly environment and therefore diet and lifestyle should always be considered first.
Not all of these preparations are commercially available yet but it may be worth experimenting with the ones available to see if they make a difference.
Now I’d like to hear from you: Are you taking probiotics? Have they helped with urinary tract infections? Have they maybe helped with interstitial cystitis?
Pin it for later:
- Reid G, Burton J, Devillard E. The Rationale for Probiotics in Female Urogenital Healthcare. Medscape General Medicine. 2004;6(1):49.
Reid G, Burton J, Devillard E. The Rationale for Probiotics in Female Urogenital Healthcare. Medscape General Medicine. 2004;6(1):49. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1140735/
Karlsson M, Scherbak N, Reid G, Jass J. Lactobacillus rhamnosus GR-1 enhances NF-kappaB activation in Escherichia coli-stimulated urinary bladder cells through TLR4. BMC Microbiology. 2012;12:15. doi:10.1186/1471-2180-12-15. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305351/
Amdekar S, Singh V, Singh DD Probiotic therapy: immunomodulating approach toward urinary tract infection. Curr Microbiol. 2011 Nov;63(5):484-90. Available at: https://www.ncbi.nlm.nih.gov/pubmed/21901556
Bruce AW, Reid G. Probiotics and the urologist. Can J Urol. 2003 Apr;10(2):1785-9. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12773227
Reid, Gregor et al Oral probiotics can resolve urogenital infections Pathogens and Disease Volume 30, Issue 1, February 2001 , Pages 49–52 available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1574-695X.2001.tb01549.x/abstract;jsessionid=73A7B5C805D405FC4D35A7BCBACE2D70.f04t02
Stapleton, Ann E. et al Randomized, Placebo-Controlled Phase 2 Trial of a Lactobacillus crispatus Probiotic Given Intravaginally for Prevention of Recurrent Urinary Tract Infection Clin Infect Dis (2011) 52 (10): 1212-1217. Available at: https://academic.oup.com/cid/article/52/10/1212/478332/Randomized-Placebo-Controlled-Phase-2-Trial-of-a?linkType=FULL&ck=nck&resid=52/10/1212&journalCode=cid
Hancock, Victoria et al Probiotic Escherichia coli strain Nissle 1917 outcompetes intestinal pathogens during biofilm formation 01 April 2010, Journal of Medical Microbiology 59: 392-399. Available at: http://jmm.microbiologyresearch.org/content/journal/jmm/10.1099/jmm.0.008672-0