Recurrent Urinary Tract Infection Care

Integrating Complementary and Alternative Medicine

Feng Feng; Jane Hokanson Hawks; Jeanine Kernen; Eric Kyle


Urol Nurs. 2018;38(5):231-235. 

In This Article

Manual Healing


Acupuncture originates from ancient China and has been used to manage various clinical disorders for thousands of years. This Chinese medical practice uses thin needles to stimulate specific points in the body, thereby regulating the flow of qi along the meridians in the body. Acupuncture has been widely accepted by U.S. medical providers and patients. Many clinical conditions can be treated or prevented by acupuncture, such as postoperative and chemotherapy-associated nausea and vomiting, fibromyalgia, low back pain, and asthma (Micozzi, 2015). A systematic review indicates that acupuncture may have a potential therapeutic effect in decreasing post-void residual urine volume for chronic urinary retention, which may lead to decreased rUTIs (Wang et al., 2016). Early research indicates there is a significant reduction in the incidence of rUTI compared to no treatment in women undergoing real acupuncture and sham acupuncture (Beerepoot & Geerlings, 2016).

Five main acupoints are used for patients with urinary diseases and qi/yang deficiency. Stimulating these points on women with UTI was correlated with far fewer episodes of rUTI than for women who did not receive this treatment (Alraek, Baerheim, & Birch, 2016). Acupuncture also provides analgesic action that could relieve the pain/discomfort caused by rUTI without complications and adverse effects (Leong, 2014; Verghese, Riordain, Champanrtis 2016). The mechanism is thought to be a rebalance of energy flow, increased endorphin secretion, and pain ablation by stimulating A delta sensory fibers, which inhibit C fibers. The percutaneous nerve stimulation of acupuncture was related to decreased frequency and urgency of perineal pain or suprapubic pain with fewer complications (Atchley, Shaw, & Whitmore, 2015).

Massage and Touch Therapies

Massage and touch therapies include a wide variety of approaches that use the practitioner's hands, elbows, forearms, and even feet to directly apply techniques to the patient's body for enhancing health and well-being. Massage and touch therapies do not directly benefit rUTI. However, massage and touch therapies may increase lymphatic drainage and decrease the incidence of muscle contractions (Pang & Ali, 2015). Transvaginal massage can relieve pain symptoms, and whole-body massage may down-regulate the influence of stress and negative control of the body, thereby benefitting patients with rUTI. Myofascial physical therapy has been introduced to patients with bladder pain syndrome. Providers massage connective tissue over the trunk, thighs, and buttocks, resulting in a significant reduction in pain, urgency, and frequency (Pang & Ali, 2015; Verghese et al., 2016). Unfortunately, there is not enough evidence to support the effectiveness of these approaches on rUTI, and transvaginal massage may increase infective risks. Therefore, additional research is needed to determine the efficacy of these techniques.


Yoga, which originates from India, often has less emphasis on spiritual union and more emphasis on simply performing physical postures, and perhaps meditation, for physical and emotional well-being in the Western society (Micozzi, 2015). The practice of yoga in the United States increased from approximately 5.1% of adults in 2002 to over 9.5% in 2012 (Clarke, Black, Stussman, Barnes, & Nahin, 2015). The most common therapeutic uses of yoga are for back pain, stress, and arthritis (Cramer et al, 2016). There is good evidence to support the use of yoga breathing, relaxation, and muscle control techniques, which may assist in strengthening the pelvic floor (Huang, Jenny, Chesney, Schembri, & Subak, 2014; Kim, Kim, Shin, Choo, & Kim, 2015; Tenfelde & Janusek, 2014). Yoga also promotes mindfulness and non-judgmental acceptance of feelings and thoughts related to psychological stress. Yoga practice has demonstrated a reduction of stress-induced rUTI urge symptoms. Yoga also reduces inflammation and promotes sympatho-vagal balance, which can benefit rUTI long-term management (Patil, Nagaratha, Garner, Raghuram, & Chisan, 2012; Tenfelde & Janusek, 2014).


Reflexology is based on the premise that there are zones and reflexes in various parts of the body that correspond to all parts, glands, and organs of the entire body. Manipulating specific reflexes removes stress by activating a parasympathetic response that seems to break up deposits that may interfere with the body's electrical energy in the nervous system (Micozzi, 2015). With stress removed and circulation enhanced, the body can return to a normal state of homeostasis (Micozzi, 2015). The explanation for the effect mechanisms of reflexology is based on the gate control theory, neural impulse theory, lactic acid theory, and endorphins theory (Gozuyesil & Baser, 2016). The abdominal area includes the kidney and adrenal glands, and is connected to the arch of the feet. The reflexology method would massage these areas of the feet, from medial to lateral. Massaging these areas can lead to increased blood flow to the kidneys to maintain filtration with increased urine flow (Rollinson, Jones, Scott, Megson, & Leslie, 2016). Self-administered foot reflexology provides stimulation of the urinary reflex associated with the ureter, bladder, fallopian tube, deferent duct, uterus, urethra, and vagina (Song et al., 2015). It could have the potential to manage rUTI without adverse effects. Reflexology can provide significant improvement in urinary symptoms (Aydin, Aslan, & Yalcin, 2016), which may increase the quality of life for patients with rUTIs. However, most reflexology studies used a small sample size, and results are limited and may negatively affect true effects. Larger research studies should be implemented to further assess the impact of reflexology.