Conditions, Cystitis, Cystitis, Interstitial Cystitis, Protocols

Probiotics for the Urinary Tract

Probiotics are ‘live microorganisms, which when administered in adequate amounts confer a health benefit on the host’ [1]. 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.

To Conclude

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?



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 Sources

  1. 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

16 Comments

  • Reply

    Sheryl Chan

    February 21, 2017

    Informative read and great research as usual. Interesting bit about gut health, somehow it never crossed my mind about that route for recurrent UTIs.

  • Reply

    chroncont

    February 26, 2017

    Great information! I wasn’t aware of this, so it’s good to know. Sharing 🙂

    • Reply

      Layla

      February 26, 2017

      Thanks so much 🙂

  • Reply

    Lori

    August 13, 2017

    I’ve had IC for bout 5yrs. I read all i find on it. I go to urologists and the bladder distention procedure burned and made it worse. I’ve tried many meds and the one that has helped this chronic condition is tramadol,

    • Reply

      Layla

      August 13, 2017

      Tramadol is a painkiller, right? I’m sorry nothing has helped you, I hope you can find relief soon.

    • Reply

      Ally

      September 30, 2017

      Have you tried asking your doctor to prescribe Elmiron?

  • Reply

    Jane

    March 4, 2018

    I used to eat yogurt daily. Last year I gave it up. In the last 12 months I’ve had two UTI and my interstitial cystitis has kicked in twice. After much research- I have gone back on yogurt with probiotics. I’ll keep up posted. I didn’t ever correlate the two.

  • Reply

    Sarah

    April 24, 2018

    Thanks for this information. Is it possible that a change in probiotics could aggravate or cause cystitis in someone who is already susceptible to it? Twice now I have developed cystitis after starting a strong course of probiotics (vsl and symprove). The idea was to strengthen my system but the reverse seems to happen.

    • Reply

      Layla

      April 24, 2018

      Yes, I believe this is possible and probably depends on whats already there. Vsl contains streptococci, these can be urinary pathogens. Symprove contains histamine forming bacteria, which could be an issue for some. Some types of Lactobacilli have also been implicated as potential urinary pathogens. On the other hand, introducing new bacteria can always lead to unfriendly bacteria dying off and releasing toxins, which could also lead to symptoms. It’s whether the symptoms then improve or not that tells you which is more likely.

  • Reply

    Erica Rohrer

    June 13, 2018

    You mentioned that introducing new bacteria could lead to unfriendly bacteria dying off and releasing toxins, therefore leading to symptoms. How long would it take for the symptoms to improve to know it’s helping? Days? Weeks? Or is everyone different?

    • Reply

      Layla

      June 15, 2018

      I would say it’s individual, depending on how many ‘unfriendly’ bugs are there and what types. Maybe a couple of weeks, but one should generally see gradual improvements – if it gets worse and worse then something is wrong…

  • Reply

    Erica Rohrer

    June 15, 2018

    Ok. Thanks so much. It got worse for a few days, then started improving. I’m hoping the longer I take them, the more my bladder heals!

    • Reply

      Layla

      June 15, 2018

      Good luck with it, hope you get better!

  • Reply

    Erica Rohrer

    July 15, 2018

    Hi Layla, I’ve been taking probiotics for over a month now. I’m also on oxybutynin. Throughout the course of a day, I have periods of relief where I don’t have any frequency/urgency, but then I can have several hours where I have both. I’ve only had pain down under my vagina a couple times. I’m of course seeing a urologist, and I have a CAT scan Monday…I’m guessing to rule out the major stuff. Would you recommend continuing the probiotics? I don’t want to take them if they are causing harm; I don’t know if they are or not. I’m nervous to change anything at this point because I do have some relief throughout the day. I have a 2 and 4 year old at home and I’m a full time mom. i drink the kefir probiotics. Any suggestions you can offer are greatly appreciated…I’m getting pretty desperate.

    • Reply

      Layla

      July 17, 2018

      Hi Erica, well if you are feeling better on the supplement then I wouldn’t think it is causing harm. You’ll need to see how you feel on it – generally if it’s making you more bloated long-term or causing other symptoms then I wouldn’t take it, if it brings relief then I don’t see why you can’t take it. Same goes for the kefir. To me personally the diagnosis ‘IC’ is more of a description of symptoms and whether you have it or not doesn’t tell you any more about the root cause.

  • Reply

    Erica Rohrer

    July 15, 2018

    I also want to mention I haven’t been diagnosed with IC, but I think I might be headed in that direction. 🙁

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