For BLADDER INFECTIONS, CYSTITIS, oral probiotics support whole-body systemic immunity, and helpful strains can attach to the bladder walls to prevent colonization by pathogens. During a UTI, gut bacteria like E. coli take up residence in the urethra and bladder. If women receive antibiotics to combat the infection, the medication destroys many of the body’s helpful bacteria, and sets the stage for harmful bacteria to grow back, risking recurrent UTI’s and cystitis. Probiotics help to restore the natural bacterial environment to make it hard for bad bacteria to cause another infection. Since lactobacilli dominate the urogenital flora of healthy premenopausal women, it has been suggested that restoration of the urogenital flora with lactobacilli may protect against UTIs. In addition, vaginal douching with probiotics helps restore healthy pelvic flora which further protects against urinary tract infections, especially after antibiotics.
A 2011 randomized, placebo-controlled study found that out of fifty women, only seven who received a probiotic to restore the naturally occurring bacteria experienced a recurrence of UTIs over a 10-week period, compared with 13 who received a placebo.1 A 2015 review included nine separate studies of 735 people and sought to determine if probiotics provided a therapeutic advantage when used to prevent UTI in susceptible patient populations. Because there were so many different probiotic formulations used, different dosages, and varying lengths of time, researchers drew varied conclusions.2 In our clinic, we have seen very good short and long benefits for cystitis with Lactobacillus acidophilus, Bifidobacterium lactis, Lactobacillus plantarum, Lactobacillus rhamnosus, Bifidobacterium breve, Lactobacillus salivarius, and other related species. Patients prone to UTIs have notably fewer bladder infections over time; and high-dose probiotics can help to halt an early urinary tract infection if symptoms start.
Many in vitro studies, animal experiments, microbiological studies in healthy women, and clinical trials in women with UTIs have been carried out to assess the effectiveness and safety of probiotics for prophylaxis against uropathogens, microbes that attack the urinary tract. Most of them had encouraging findings for some specific strains of lactobacilli. The evidence from the available studies indicates that probiotics can be beneficial for preventing recurrent UTIs in women; they also have an excellent safety profile.5
Beneficial bacteria in the intestinal tract may account for as much as 80% of our immune system’s activity, and a well-balanced profile of gut bacteria helps to prevent urinary tract infections. Taking probiotics helps immune function in several ways. Helpful bacteria lining the intestine form a living barrier against microorganisms that arrive with food or invading pathogens. Some varieties of probiotics are capable of directly killing thousands of species of pathogenic bacteria, viruses, fungi, parasites, and yeast. Acidophilus species can release powerful antimicrobial compounds in the gut such as acidolin-1, acidophilin and lactocidin which kill unwanted bugs. Friendly bacteria can also produce a number of immune-boosting mediators such as transfer factor and lactoferrin, as well as B-vitamins that provide nutritional support for the immune system. It is now thought that about 70% of the body’s immune system cells occur in the colon within a layer of lymphoid tissue just below the epithelial cells lining the gut. Probiotics may restore levels of secretory IgA, the antibody that naturally lines and protects mucous membranes. Probiotics can stimulate the immune system’s gut-associated lymphoid tissue, or GALT. Acidophilus species can boost immune cytokines which kill unwanted cells, improving phagocytic activity and antibody production, as well as phagocytosis of Salmonella. Helpful intestinal flora communicate with lymph nodes, part of the immune system, to help them recognize “normal” cells, and focus on attacking potentially harmful cells within the body or invaders.
In addition to oral use, vaginal douching with probiotics helps restore healthy pelvic flora. This further protects the bladder against urinary tract infections, especially after antibiotics. To make a douche, one capsule of 20 to 40 or more billion probiotic is opened and mixed into about 30ml of cool water. This is gently introduced into the vaginal canal with a syringe or just a teaspoon, to relieve odor, itching and burning. Lactobacillus acidophilus is the dominant species in vaginal flora, and its natural production of lactic acid maintains the naturally low vaginal pH of 3.5 to 4.5 which inhibits growth of yeast and pathogens; probiotics also help to crowd them out. Lactobacilli release hydrogen peroxide that research finds makes the environment inhospitable to microbial overgrowth including Gardnerella and trichomonas; and bacteriocins that kill or inhibit growth of microbes and yeast. Probiotics attach to the vaginal lining, blocking out other bacteria, and make bio-surfactants that prevent invading bacteria from adhering. Clinical trials show that oral and vaginal probiotic treatment can reestablish normal vaginal flora, and prevent future yeast overgrowth or bacterial imbalance.
In our clinic we look for an ultra-high potency, time-tested formula that has a demonstrated track record for helping with UTIs. We want one that meets our specifications in nine important ways: 1, one capsule provides 50 or more billion good bacteria, a huge number so there is an ample dose of live bacteria at the time of taking it; 2, these species are very stable at room temperature with a long shelf-life, further ensuring that plenty of bacteria are still viable when taken; 3, a special gum capsule that can withstand stomach acid, protecting the probiotics so they can pass through the stomach and be delivered intact and viable into the intestinal tract; 4, good bacteria must be evenly distributed throughout the lengthy intestinal tract, which a formula must allow; 5, the species must be able to effectively attach to the intestinal lining and reproduce; 6, the correct strains should be ones known in clinical studies to be highly effective for infections and UTIs, including Lactobacillus acidophilus, Bifidobacterium lactis, Lactobacillus plantarum, Lactobacillus rhamnosus, Bifidobacterium breve, Lactobacillus salivarius, and other related species; 7, a formula containing the key probiotic strains for immune boosting, with which our patients have ongoing excellent responses with long- and short-term use for preventing and treating urinary and other gynecological infections; 8, a room temperature-stable probiotic that is easy to remember and easy for travel because it does not need refrigeration; 9, probiotic bacteria that can help to maintain a healthy level of oxalates in the gut.
Please note: We recommend taking probiotics after antibiotic therapy to replace the good microbes killed as antibiotics do their job. There is little point in using probiotics along with antibiotic drugs which will indiscriminately destroy bacteria, both good and bad.
Recommendation: A minimum of 50 billion beneficial bacteria in a slow-release vegetarian capsule including some or all of the following species, which have particularly good resistance to digestion, adherence to intestinal cells and stability: Lactobacillus acidophilus, Bifidobacterium lactis, Lactobacillus plantarum, L paracasei, L. casei, L. brevis, Lactobacillus rhamnosus, L. gasseri, Bifidobacterium breve, Lactobacillus salivarius, Bifidobacterium bifidum, B. longum, and other related species; or as directed by your healthcare provider. The probiotic can be taken between meals or with cold food such as salad, fruit, smoothie, sandwich, yogurt, or apple sauce.
- 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.” Clinical infectious diseases 52.10 (2011): 1212-1217.
- Schwenger, Erin M., Aaron M. Tejani, and Peter S. Loewen. “Probiotics for preventing urinary tract infections in adults and children.” The Cochrane Library (2015).
- Stamm, Walter E., et al. “Urinary tract infections: from pathogenesis to treatment.” The Journal of infectious diseases 159.3 (1989): 400-406.
- Stapleton, Ann, and Walter E. Stamm. “Prevention of urinary tract infection.” Infectious disease clinics of North America 11.3 (1997): 719-733.
- Falagas, Matthew E., et al. “Probiotics for prevention of recurrent urinary tract infections in women.” Drugs 66.9 (2006): 1253-1261.
- Morelli L, Zonenenschain D, Del Piano M, et al. Utilization of the intestinal tract as a delivery system for urogenital probiotics. J Clin Gastroenterol 2004; 38: S107–10.