Complementary and alternative medicines (CAMs) are treatments that fall outside of mainstream healthcare. The prevalence of CAM use in some developed nations varied between 30 and 90%, with large scale surveys suggesting an increasing popularity of CAM use in Europe in recent decades(1) and studies have demonstrated that patients were using CAM with only limited information about the therapies and their effects (2). Up to 60% of patients who used CAM did not disclose this to the doctors with the most cited reason being that their doctors did not ask them(2). These findings highlight the lack of awareness of CAM usage among health care professionals. 
The primary aim of this study was to elicit women’s perception, knowledge and experience of CAMs to prevent and treat urinary tract infections (UTIs).

In this qualitative study we interviewed 24 women all of whom have had at least one experience of a UTI. The women were recruited from three different out-patient settings (GP practice (n=7), general gynaecology clinics (n=6), urogynaecology clinics (n=6)) and online via social media groups (n=4). The one-to-one telephone interviews had a semi-structured design to explore the women’s perception, knowledge and experience of CAMs. We analysed the data using Braun and Clarkes Thematic Analysis approach to identify codes and themes.

All women had tried to self-manage their UTIs using a range of CAMs and/or changes in behaviour, such as increasing their fluid intake to try and “flush it out”. Cranberry based products were shown to be the most known about with 96% (22) of women mentioning cranberry based products as an alternative therapy. 48% (11) had heard about CAMs via word of mouth with only 17% (4) of them hearing about them from healthcare professionals. 

The main reasons for trying CAMs were inability to attain an appointment with a healthcare professional, wanting to avoid antibiotic use, thinking it would help and desperation. 83% (19) had no concerns taking CAMs, primarily because they were perceived as being “natural”, “safe” and “worth a try”. Despite having no concerns, 70% (16) were unsure on the dosage they should take. 70% (16) attributed the dosage down to the individual’s ideas such as “guess work”, the more the better and as much as tolerated. 35% (8) followed instructions that came with the product with 88% (7) of them finding the instructions easy to follow. 9% (2) used google/online support groups to determine the dose. 22% (5) of women did not disclose their use of CAMs to a healthcare professional.

Women with recurrent UTIs 15 (63%) had more knowledge and experience with CAMs with 3 (75%) of the women in the social media group sourcing expensive products from non-readily available sources such as international suppliers.

78% (18) experienced no side effects but 39% (9) described an unpleasant taste with cranberry juice. While 70% (16) did not think or were unsure that alternatives were effective, with 83% (13) subsequently needed antibiotics, only 2 (9%) were unwilling to try CAMs again in the future.

Women are keen to self-manage their symptoms of UTIs with a majority having no concerns with taking CAMs despite being unsure if they work. A large number of them are also unsure of the dosage and use a variety of platforms to increase their knowledge of these medications. 

Cranberry based products were the most known and tried across all groups. A relative minority discussed this with their healthcare practitioners and did not disclose their use of CAMs to them for UTIs. The group of women with recurrent UTIs had the most knowledge and experience using CAMs.

A significant number of women have tried and will continue to try CAMs as a management option for UTIs despite a majority of health care practitioners not discussing this with them. This remains an appealing option to many women because they may be considered “natural” remedies rather than pharmaceutical agents. 

Although previously tested with varying degrees of statistically significant effects, it remains that these remedies for prevention and self-treatment could alleviate symptoms and reduce discomfort for women prone to UTIs (3). It is important to better articulate the knowledge of complementary and alternative medicine in UTIs, since the strategies, advice and remedies that some women find useful may also be beneficial for others.

Overall, this demonstrates a need for further research into the use of CAMs for the prevention, treatment and relief of UTI symptoms in women.

Adams J, Sibbritt D, Broom A, Loxton D, Pirotta M. A comparison of complementary and alternative medicine users and use across geographical areas: A national survey of 1,427 women. BMC Complementary and Alternative Medicine. 2011;11(85)
Hyodo I, Amano N, Eguchi K, Narabayashi M, Imanishi J, Hirai M, et al. Nationwide survey on complementary and alternative medicine in cancer patients in Japan. Journal of Clinical Oncology. 2005;23:2645–54.
Litherland A. Urinary tract infection: diabetic women’s strategies for prevention. British Journal of Nursing. 2011;20(13):791–6.