The Impact of Cranberry Juice Consumption on Bacteriuria
One of the common complications experienced by individuals with spinal cord injuries is urinary tract infections (UTIs). These infections, caused by various types of bacteria in the urine, can make treatment challenging. In these patients, due to antibiotic resistance, there is a need to find appropriate alternatives for treating these infections. Therefore, the aim of this study was to investigate the impact of cranberry juice consumption on bacteriuria and pyuria in patients with spinal cord injury and neurogenic bladder. The study was conducted with the goal of finding a suitable solution for treating urinary infections in spinal cord injury patients.
Spinal Cord Injuries
Spinal cord injuries can occur at any part of the spinal cord. Depending on the location and severity of the injury, it can lead to various neurological problems. For instance, damage to the cervical spinal cord may result in complete or partial paralysis from the neck down. Similarly, damage to the thoracic spinal cord can lead to respiratory issues, muscle weakness, and loss of sensation in the affected areas.
Types of Spinal Cord Injuries
Spinal cord injuries can be either temporary or permanent. The treatment varies based on the severity, location of the injury, and the duration since the injury occurred. Treatment may include physiotherapy, medication, and surgery.
Prevalence of Spinal Cord Injuries
The prevalence of spinal cord injuries varies from country to country. However, the global incidence of this condition is 40 cases per million population. Patients with spinal cord injuries live many years with severe disabilities. Most of these injuries are seen in individuals aged 34 and younger. Although life expectancy in individuals with spinal cord injuries has increased, these patients are at high risk of various diseases and secondary complications.
Common Complications
The most common complication leading to frequent hospitalizations for these patients is urinary tract infections. These infections, manifested as symptomatic urinary tract infections, cause significant pain and make it more difficult for these patients to tolerate their disabilities. These infections threaten their survival, have a long-term negative impact on their health, increase their dependency, and reduce their quality of life. Additionally, they impose a significant financial burden on both the patients and the healthcare system.
Urinary Tract Infection (UTI)
Urinary tract infection (UTI) refers to infections affecting any part of the urinary system, including the kidneys, bladder, urinary tract, and prostate (in men). UTIs are primarily caused by bacteria, although fungi and viruses can also cause these infections.
Causes and Risk Factors for UTIs
Most UTIs are caused by bacteria that move from the intestines to the urinary tract. Women are more prone to UTIs than men because their urinary tracts are shorter, making it easier for bacteria to travel to the bladder. Other risk factors for developing UTIs include pregnancy, old age, diabetes, urinary tract obstructions, and the use of urinary catheters.
Factors Contributing to UTIs in Spinal Cord Injury Patients
Several factors contribute to the occurrence of UTIs in spinal cord injury patients, including invasive procedures without antibiotic prophylaxis, cervical injuries, neurogenic bladder, urinary retention, the use of urinary catheters, increased bladder pressure, urinary and fecal incontinence, structural and functional urinary disorders, hydronephrosis, reflux, and urinary stones. These factors contribute to recurrent and chronic bacteriuria, resulting in symptomatic or asymptomatic urinary infections. In spinal cord injury patients, UTIs are often polymicrobial and resistant to treatment.
Treatment and Prevention of UTIs
UTIs are typically treated with antibiotics. To help prevent UTIs, patients are advised to drink plenty of water, empty their bladder when necessary, and avoid irritant chemicals in soaps and powders. If you experience UTI symptoms, it’s important to consult a healthcare professional, as untreated UTIs can lead to more severe infections and kidney damage.
Complications of Long-Term Antibiotic Prophylaxis
On the other hand, long-term antibiotic prophylaxis is not always very effective in these patients. The presence of multi-drug-resistant bacteria poses a life-threatening risk. Concerns about overuse of antibiotics in spinal cord injury patients highlight the need for alternative methods to treat recurrent UTIs. Studies have shown that spinal cord injury patients use cranberry supplements for their preventive effects and believe they are beneficial for urinary health.
Review of Studies Conducted
Numerous studies have been conducted to assess the effectiveness of cranberry in preventing UTIs in at-risk patients. In one study, consumption of cranberry juice three times a day reduced the microbial biofilm load in the bladder of 15 spinal cord injury patients. Another study confirmed the role of cranberry in preventing UTIs in women with recurrent UTIs. A study by Heitz and colleagues, aimed at evaluating the effect of cranberry capsules in preventing UTIs in children with neurogenic bladders due to myelomeningocele, showed the positive impact of this intervention.
Sterilizing the Urine
Maintaining sterile urine in spinal cord injury patients with functional or anatomical urinary system defects is more critical than in healthy individuals. Preventing the colonization of pathogenic microbes that cause UTIs, without antibiotic treatment, is extremely important and valuable in these patients.
Clinical Trial Results
This clinical trial, a double-blind, randomized, controlled study, was conducted on 60 spinal cord injury patients who were randomly assigned to control and test groups. Before the intervention, a complete urinalysis and urine culture were performed for patients in both groups. The test group consumed 250 to 300 ml of diluted 30% cranberry syrup for two weeks. The control group consumed the same volume of placebo syrup. After two weeks, urinalysis and urine culture were performed for both groups.
Results of the Current Study
The present study showed that cranberry juice consumption had no effect on urinary pH, contrary to previous assumptions that cranberry’s effect on UTI treatment was due to the presence of benzoic acid, which is excreted in urine as hippuric acid and prevents bacterial growth by acidifying the urine. In the current study, cranberry consumption had a greater effect in patients who did not have an indwelling urinary catheter or who used intermittent catheterization or condom catheters, compared to those with permanent urinary catheters or condom catheters. The most common complaints among spinal cord injury patients were urinary problems, urinary retention, and foul-smelling urine. The findings showed that cranberry juice was effective in reducing foul-smelling urine.
Conclusion
In conclusion, short-term cranberry juice consumption in spinal cord injury patients with normal filtration, especially in cases where they do not have an indwelling urinary catheter or a permanent urinary drainage system, reduces pyuria and bacteriuria and is effective in reducing the odor of urine. It also does not cause intolerable gastrointestinal or systemic side effects.
References Rajaei M, Hafize M, Noorian K. Evaluation of cranberry juice on bacteriuria and pyuria in spinal cord injured patients with neurogenic bladder. Armaghanj 2014; 19 (8): 662-674.