Yes, Drinking More Water Helps Prevent UTIs

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A new JAMA Internal Medicine study offers women with recurrent urinary tract infections (UTIs) hope of a simple preventive strategy: Drink more water.
The randomized clinical trial, published online on Oct. 1, 2018, found that of 140 premenopausal women experiencing recurrent UTIs who said they drank less than 1.5 liters of fluid daily, UTIs became significantly less frequent in women who drank more water for 12 months.
The mean number of UTIs in the study participants for the previous year was 3.3. During the 12-month study period, the mean number of UTI episodes was 1.7 in the group who drank more water compared with 3.2 in the control group.
There were 327 UTI episodes, including 111 in the water group and 216 in the control group. The mean number of antimicrobial regimens used to treat UTIs was 1.9 in the water group and 3.6 in the control group. The mean time between UTIs was 142.8 days in the water group and 84.4 days in the control group.
“Premenopausal women with low fluid intake and recurrent urinary tract infections can halve the frequency of these infections by drinking an additional 2 cups (16 oz.) of water with each meal,” said Dr. Renée M. Ward, assistant professor of obstetrics and gynecology at Vanderbilt University Medical Center in Tennessee.
Forget the cranberry juice
Ward says that although many women drink cranberry juice at the first signs of a UTI, a better option is to increase water intake.
Multiple studies have evaluated whether consuming cranberry juice can prevent UTIs, she adds. While some of the initial studies suggested a benefit, there have since been multiple randomized trials showing no difference between cranberry juice and a placebo.
Ward says the acidity in cranberry juice may aggravate symptoms, and the juice often has a lot of sugar that doesn’t provide a health benefit.
“Interest in this topic remains in part because cranberry proanthocyanidins inhibit bacteria from adhering to the bladder lining. However, the appropriate dose and concentration of cranberry extract for a therapeutic benefit has not been determined,” she said.
“Currently, there are no high-quality data to support the use of cranberry products/extract for the prevention or treatment of urinary tract infections,” she added.
However, Dr. G. Thomas Ruiz, OB-GYN lead at MemorialCare Orange Coast Medical Center in California, says for healthy people who don’t have diabetes, cranberry juice or cranberry pills shouldn’t pose much of a problem and may help prevent UTIs. He says, of course, keeping hydrated is helpful.
“It is making a more dilute urine, so you’re having to pee more, so it’s causing you an increased urine output… it’s basically cleansing the bladder and the urethra,” he said. “The study is basically confirming something that we already knew from that standpoint.”
Dr. Jennifer Linehan, urologist and associate professor of urology and urologic oncology at the John Wayne Cancer Institute at Providence Saint John’s Health Center in California, says the study results were well-organized, but her one criticism is that studies where the participants control the modifying agent — in this case, water intake — can be hard to monitor. But the results weren’t a surprise.
“The study just confirms what we theoretically think is true, that dilution and purging of the bacteria ultimately treats the infection,” she said.
Linehan says she advises her patients to practice several preventive strategies, including taking 500 milligrams of vitamin C in the morning and at night, taking D-mannose, and staying hydrated with water. She says D-mannose works similarly to cranberry extract.
“There has been data both ways to support cranberry use and D-mannose use, as well as data that says it does not work,” she said. “The reason for that is that not everyone [has] the receptors that D-mannose and cranberry blocks, which prevents the bacteria from binding, so it doesn’t always work in everyone.”
Dr. Anne Narayan, OB-GYN at Hoag Hospital in California, said, “The beauty of the study is that its results reflect our prior commonly held, but not scientifically proven, beliefs about the association between hydration status and risk of recurrent UTI. The association is what I would have predicted anecdotally — about a 50 percent reduction in recurrence [of] UTI.”
She says those with a history of UTIs can be reassured that increased water intake is a safe, easy, and inexpensive strategy that can help prevent future UTI symptoms.
“Recurrent UTI is a common issue that causes decreased quality of life, contributes to high levels of antibiotic use, and can potentially have serious health risks, such as pyelonephritis [kidney infection],” Narayan said.
“Patients should develop strategies, such as setting water intake goals, use of smartphones to facilitate reminders, and carrying refillable water containers to help compliance with water intake, to help mitigate the consequences of recurrent UTI,” she added.