Can Probiotics Help With UTIs? The Science Behind the Hype

The urge to pee every five minutes. The rush to the toilet only to find out your bladder is actually completely empty. And the burn, oh, the burn!

If this sounds familiar, you might already know we’re talking about urinary tract infections (UTIs). They are extremely common in people assigned as female at birth (AFABs) — in fact, more than half will have at least one episode of UTI in their lives, with about 4 in 10 experiencing a recurrence in six months.

Regardless of their prevalence, UTIs are serious, can cause significant discomfort, and tend to recur. While they’re typically effectively managed with antibiotics, researchers are looking into whether probiotics — also called the ‘good bacteria’ — could help avoid repeated UTIs.

In this article, we tell you the most important things to know about urinary tract infections and answer the question: do probiotics have the potential for helping with recurring UTIs?

What are urinary tract infections?

UTIs can happen anywhere in the urinary tract — including the urethra, the bladder, ureters, and the kidneys.

Most often, they happen because the bacteria from your skin or anus enter the urinary tract through the urethra (the pipe out of which the urine comes out from) and cause infection, most commonly affecting the bladder. Infection of the bladder is called cystitis. If left untreated, it may spread to the kidneys, causing kidney infection (also known as pyelonephritis).

It’s been shown that women get UTIs up to thirty times more often than men do. Women and other AFABs are at a higher risk of getting UTIs because their urethras are shorter than in people with penises, making it easier for harmful bacteria to travel into the urinary tract.

Symptoms of urinary tract infections

People with UTIs might experience:

If you notice these signs and symptoms, seek medical attention. The latter four symptoms are associated with a kidney infection, or pyelonephritis, which has to be treated promptly: back pain, fever, and vomiting all call for emergency medical care.

Men, older people, or children may show slightly different signs of UTIs, which may be more difficult to spot or tell apart from other diseases. This article mainly focuses on UTIs in women and other adult AFABs.

UTI risk factors

Some people have a higher chance of getting UTIs. These risk factors include:

• Sexual activity. Having intercourse makes it easier for harmful bacteria to enter the urethra in AFABs.
• Pregnancy. Hormonal changes and trouble emptying the bladder properly due to the baby pressing down on the bladder put pregnant people at a higher risk for UTIs.
• Certain methods of birth control. It’s been suggested that those who use spermicides (gels, foams, or creams that are intended to kill sperm) and contraceptive diaphragms may be at a higher risk of developing UTIs.
• Menopause. Lower levels of the hormone estrogen may lead to vaginal dryness, which makes it easier for the bacteria to multiply and cause a UTI.
• Having diabetes or other diseases and conditions that impair the normal function of the immune system.
• Experiencing medical problems with the urinary tract, including kidney stones, that can block the urine flow and raise the risk of infections.
• Recently having had a bladder catheter or undergoing a urinary procedure, which may make it easier for bacteria to enter the urethra.

If you're pregnant and are thinking you might have a UTI, contact your healthcare provider right away — untreated infections may cause problems both to you and your baby.

How are UTIs managed?

Typically, UTI treatment involves antibiotics, which are prescribed by a healthcare provider according to a person’s health history and the type of bacteria that has caused the infection in the urinary system. Painkillers may be recommended for quick symptom relief.

While most cases of UTI are effectively managed in an outpatient setting, more severe infections (e.g., in the case of pyelonephritis) may require administering intravenous (IV) antibiotic treatment at a hospital.

Around 20–30% of women who’ve had UTIs experience a repeated episode. UTIs are considered recurrent when a person gets more than three UTIs in a year or two or more UTIs in six months. In these cases, doctors may recommend:

• Antibiotic prophylaxis (taking low-dose antibiotics for a prolonged period of time).
• If UTIs seem to be associated with sexual activity, they may recommend taking a single dose of antibiotic each time after intercourse.
• For people post-menopause, vaginal estrogen creams or tablets may be suggested.

What’s the place for probiotics in urinary health?

We’ve already learned today that UTIs are incredibly common, and often, they tend to recur. Both one-time UTIs and recurrences are generally managed with antibiotics and may be used for the prevention of repeated episodes.

However, researchers have noticed that over time, bacteria have become more resistant to antibiotics — or, in other words, these kinds of infections may eventually become less responsive to traditional treatment.

And while antibiotic treatment is currently irreplaceable in managing bacterial infections, it means that in the future, they may become more and more difficult to treat.

This is one of the main reasons why scientists are looking for non-antibiotic alternatives for preventing UTI recurrences, and it’s being hypothesized whether probiotics could be used for helping people avoid repeated episodes.

What exactly are probiotics, and what do they have to do with UTIs?

Probiotics are live microorganisms that, when taken in recommended amounts, are believed to positively affect the health of the individual taking them. They are naturally found in fermented foods, such as yogurt, kimchi, or kombucha, or come in the form of dietary supplements.

You might wonder: how can they possibly help with UTIs?

Normally, millions of bacteria live in the healthy human vagina. Lactobacillus — also called the ‘good’ bacteria — produce various compounds, including lactic acid, to fight the harmful bacteria and other potentially dangerous microorganisms to protect and maintain vaginal health.

These ‘good’ bacteria also help protect against the microorganisms linked to UTIs, whereas it’s been suggested that the loss of lactobacilli may be associated with increased rates of UTI-causing microorganisms.

Lactobacilli levels also seem to become lower after intercourse, when using spermicides, or in menopause. To add, researchers have also found that repeated antibiotic use may negatively affect vaginal lactobacilli levels.

Naturally, it has come to the attention of researchers to explore whether restoring the balance of ‘the good bacteria’ in the vagina could help reduce the risk of UTIs and maintain urinary health.

What do we currently know?

Both as a doctor and a person who’s had a bunch of UTI episodes in their life, I was incredibly curious to go over the current scientific evidence and see if probiotics could actually play a role in helping people experience recurrent episodes less often.

So, should you use probiotics for UTIs? Unfortunately, we don’t have a straightforward answer yet. The findings from currently available studies have been inconsistent.

A clinical trial recently published in Clinical Infectious Diseases has shown that prophylactically inserted vaginal probiotics — alone or in combination with those taken by mouth — may potentially be effective in helping avoid recurrent episodes of UTI in women before menopause.

Similarly, a few other studies have suggested that probiotics taken by mouth or inserted vaginally could help restore the healthy balance of vaginal microorganisms and potentially reduce UTI recurrence rates.

However, a 2021 systematic review and meta-analysis published in Cureus has concluded that probiotics are ineffective in helping avoid the recurrence of UTIs — but more studies are needed to draw more definite conclusions.

Which probiotic strains are linked to urinary tract health?

Even though the evidence on the effectiveness of probiotics in managing repeated UTIs is contradictory, many people still try to reduce the number of episodes they experience by taking probiotic supplements.

It’s been suggested that specific strains, including Lactobacillus acidophilus, Bifidobacterium lactis, Lactobacillus reuteri, and Lactobacillus rhamnosus GR-1, have more evidence of benefit for helping avoid recurrent infections in the urinary tract.

If you’re struggling with repeated infections in the urinary tract, talk to your healthcare provider and discuss whether probiotics could potentially be worth giving a shot in your individual case.

Are probiotics safe?

Commonly used probiotics, such as Bifidobacterium and Lactobacillus strains, are considered to be generally safe to use in healthy people. Side effects are generally mild and self-limited. They might include:

• Bloating and gas
• Temporary indigestion
• Nausea

However, some people, including those with compromised immune systems or terminally or severely ill individuals, shouldn’t consider probiotics for UTIs due to a higher risk of serious adverse health effects.

To add, most probiotics are considered dietary supplements by the FDA, which means that they haven't been evaluated for safety and efficacy.

Though advertised as ‘the good bacteria,’ some probiotic supplements may contain potentially dangerous microorganisms that are not listed on the label, therefore, it may be safer to choose a reputable and trustworthy supplement brand that tests its products in a third-party lab.

Look for products labeled as cGMP-certified (meaning that the manufacturer adheres to current good manufacturing processes enforced by the FDA), as well as free of allergens, sugar, artificial color, and flavor.

Ultimately, it's important to consult a healthcare provider before starting any new supplement.

Ways to support urinary health

The American Urology Association (AUA) recommends the following measures in order to lower your chance of getting a UTI:

The U.S. Office on Women's Health suggests that urinating before and after sex, washing your genital area daily, avoiding douching and using perfumed feminine hygiene products, taking showers instead of long baths, and wearing cotton panties could also help prevent urinary tract infections in women.

To lower your risk of recurrent UTIs, make sure to closely follow the treatment plan recommended by your healthcare provider and take the full course of antibiotics, even if you start feeling better sooner.

What about cranberry juice?

There’s a good chance you’ve heard that drinking cranberry juice or taking cranberry supplements may help avoid UTIs. The rationale behind it is that substances found in cranberries might help prevent harmful bacteria from attaching to cells of the bladder lining in the urinary tract and causing infection.

Some evidence does suggest that drinking natural and unsweetened cranberry juice or taking cranberry pills might be effective in reducing UTI episodes in women with a history of recurring UTIs. However, the exact doses and regimen remain unclear — more studies are needed.

Probiotics for UTIs: the takeaway

UTIs are very common in women and other AFABs, and many people experience recurrent episodes. Antibiotics are currently irreplaceable for managing bacterial UTIs.

However, the concerning research results on antibiotic resistance have led scientists to look into whether probiotics could be used to help people avoid recurrent episodes, which could potentially lessen antibiotic use in the future.

For now, the role of probiotics in managing repeated UTIs remains unclear. The currently available scientific evidence is inconsistent, with some studies showing a positive potential effect and others failing to demonstrate such a benefit.