Prevent or control recurring urinary tract infections with Hiprex

Dr. Ashley Girard: Hi Michelle. Thank you for having me to speak about Hiprex and about my practice. I’ve been working with the Kitchener Waterloo IC/BPS support group, which was before The Happy Pelvis. I think a number of people that follow you may, may already know my name, but my practice is Holistic Bladder Care and my website is bladdercare.ca.

It is pretty bare bones, but it’s got the important stuff. I specialize in this area because it’s very underserved and there’s a lot of benefit that comes with using alternative therapies for many of these conditions. I think some of the research shows that people with pelvic conditions over 50% are using alternative therapies. So, there’s a there’s a lot of things out there that can help patients.

And that’s essentially what I specialize in. I came to this field because I, like many, had similar complaints of recurrent urinary tract infections and then got a really bad one and no cultures were coming back positive. And then I was told I had IC and oh what fun, fun times.

The only the only thing that I can look back on and say I was lucky at the time was I was in school for becoming an NP. I was in my second year and that, that meant I had lots of resources and I was able to pick many brains. And despite being in chronic pain, I mean, I was worried that I wouldn’t be able to continue, but I started implementing lots of things and made lots of changes and then I slowly got better and I came out of it and I’m no longer in chronic pain. I feel very lucky and grateful. I like to say I’m in remission because there’s still some bumps along the road. Right? Having children shakes up your whole pelvis and your hormones. So, there has been little bumps there, too. But overall, things are really, really well managed for my particular case. And when I started practicing out of school in 2015, I did mostly general practice for many years.

It’s been in the last couple of years that this (bladder care) has become my entire practice focus. And I love it. Like there are so many women (those assigned female at birth) are struggling with these problems and not getting help. And it’s wonderful to bring this information and educate and help women find figure out what’s going wrong with them in their particular bodies, because it is so complicated.

And that’s why the conventional stream isn’t as good figuring this out, this chronic condition, because it’s too many little it’s too many different areas, infection, hormones, like how our stress that plays into it, lifestyle factors, dietary life factors, immune system. There’s just a lot that comes together to predispose genetics that predispose women to these conditions. So it’s kind of looking at all those different things and figuring out what the right treatment plan is for a particular patient.

So I don’t have protocol. Everybody pretty much gets a different approach and it just takes that really careful, careful history taking to figure out what’s going on and asking the right questions, you know, vaginal infections and intercourse triggers and the list goes on.

That is my practice. And I primarily do all virtual. So I see people all over the place and that works very, very well. And in Ontario, I’m able to do all the regular lab work that I need to do. I do the fancy functional medicine tests and I prescribe hormones. Yeah, I can’t do antibiotics, but that may change eventually for some, for in the future, for not so. And then lots of herbs and things like that.

Michelle, The Happy Pelvis: Thank you so much for dedicating your career to helping people and the fact that you know firsthand the pain and where your patients are at. I think that’s a huge, huge win for a patient to know that your practitioner has been in your shoes at some point and the fact that you have overcome it, even though despite you say you have bumps, everybody has ups and downs. But the fact that you’ve gotten over that provides a lot of people with hope.

Dr. Ashley Girard: Thank you! I liked one of your posts about the path to healing and it was a little graph and it’s like, do a circle here, back down here and up here. And it’s just not linear. So and, and it’s important to always stay hopeful and always continue to work towards getting better.

With the Happy Pelvis, a lot of patients also have endometriosis and that’s another condition that predisposes patients to bladder problems. I think I read recently 40% or 45% of endo patients potentially have deposits on their bladder or bladder symptoms. So yeah, again, another one that is another complicating factor to these to what’s going on in the pelvis of many, many patients.

Michelle, The Happy Pelvis: Like you said, every patient is different and every single treatment or plan that you put in place will be different.

Dr. Ashley Girard: Exactly right.

All right. Let’s talk about Hiprex.

Methenamine Hippurate is the chemical name, but most people are just using that short form the Hiprex. And it’s a really, really neat drug, essentially. It’s very unique and has a very good safety profile. Antibiotics, they’re great, too, but they have they have a larger issue with adverse effects, unfortunately. So Hiprex is not an antibiotic. It’s considered a urinary antiseptic. And what that means is it prevents the growth of bacteria in the urinary tract when it’s active.

This drug has been around, I think I read 100 years. It’s been around for a very long time. It fell out of favor because antibiotics showed up on the scene and that seemed to work a little better or are a lot better. Keeping in mind back then, recurrent urinary tract infections were not as prevalent as they are now. We actually do know that it’s becoming a bigger problem. Women who get one UTI are 40% more likely to develop another and another and another.

Michelle, The Happy Pelvis: 40%….Wow.

Dr. Ashley Girard: It didn’t used to be like that. There were lots of women (assigned female at birth) that would just get one offs. They would take their antibiotics and that was it. It eradicated it. But these bacteria are becoming smarter and more difficult to treat as time goes on because of antibiotics. Antimicrobial resistance, right.

So antibiotics are great, but they are starting to not be as effective for a lot of patients. Now we’re starting to look to old drugs and new drugs. Development of new drugs always takes time. So sometimes it’s faster to look backwards and see what used to work.

This is what’s happened with Hiprex.

Hiprex in many countries around the world is over the counter. You do not need a prescription for it. I believe in, I think it’s Greece or Turkey. If you get a prescription for it, it makes it a lot cheaper. So that’s always helpful for those patients. But and that’s how patients here are getting it is they’re ordering it from these countries where it’s sold over the counter and having it shipped here. And one of the reasons they’re doing this is because their antibiotics aren’t working as well. And it’s being more and more recognized by specialists in this field that Hiprex is potentially a good to therapy.

There’s a lot of different ways that it can be used in terms of the patient type. But one of the most ideal candidates is a patient who knows they have a specific trigger intercourse (probably being the one of the most common) and then using it, you use it continuously every day and it works almost as well as an antibiotic used prophylactically.

We actually just had a new study that came out just a few months ago, and it again demonstrated it’s not the first one. There’s been another one before this in 2019, but it does show that it’s just slightly less effective, not statistically significant, but a little bit less effective than compared to a prophylactic antibiotic, but almost as good.

So a lot of patients won’t be able to see the difference. I think it was it decreases the number of infections per year with a prophylactic antibiotic, I think it’s about, 0.9 infections. If you’re taking that continuously. And with Hiprex, it’s 1.3. So again, that’s not really a lot of patients who are going to notice that difference and it has a better safety profile and there’s less chance of building antimicrobial resistance or you can’t because the bacteria can’t become resistant to Hiprex which is very useful.

Michelle, The Happy Pelvis: Ah yes, because it’s not an antibiotic.

Dr. Ashley Girard: It’s not an antibiotic. And the way that it works is very different. Bacteria can’t form a resistance to the compound that it activates into in the bladder.

So what is Hiprex? What’s it doing?

It converts in an acidic environment to its active form, which is essentially formaldehyde and other weak acids. Formaldehyde, most people know it. It’s been used as a cleaning agent, as a disinfectant. So it sounds kind of scary, right.

But the bladder is very is used to holding toxic waste. So that is one of the benefits of putting it in the bladder is the bladder can actually resist that type of chemical in the bladder. Not that it’s my favourite and I like it better than antibiotics, but it’s all about patients reaching a point where they’re feeling better and they’re having less infections because these infections really do for many, can significantly decrease their quality of life.

There are so many behavioural changes that many are making that may not be necessary. There’s a lot of fear, anxiety, trigger avoidance and dietary changes that are maybe completely unnecessary for some.

So, you know, it’s definitely something that patients should consider if they’re afraid of an antibiotic, especially because they’re worried about, again, the antimicrobial resistance or the fact that they could have side effects or that antibiotic could trigger a yeast infection or another type of infection. And this might be kind of that in between that grey zone that might be more desirable for some patients. It’s not natural, of course, but it is something that maybe to try before going on a prophylactic antibiotic. And unfortunately, a lot of urologists here don’t know about it. One of Canada’s top IC doctor and researcher, Dr. Curtis Nickel, who now is retired, is an advocate for using Hiprex. It’s just a matter of the fact that it’s not approved here in Canada. So it’s in a gray zone, right?

Michelle, The Happy Pelvis: So that leads me to my next question, if a Canadian were to seek out Hiprex, how do they go about doing so? Seek out a Naturopath?

Dr. Ashley Girard: Well, I would say probably most naturopaths don’t know about this particular medication (Hiprex) either. So it’s not necessarily a conversation that they can have with most other naturopaths. A urologist just might know about it. And it’s it a lot of this is self-directed decision making that patients are doing on their own right to try and help themselves. It’s it’s wonderful when we have things approved. Here in Canada, but Canada can be slow at adopting medications. I don’t know if HIP is even on Health Canada’s radar, but UroImmune is and we’re all have our fingers crossed for the urinary vaccine coming out hopefully soon.

Michelle, The Happy Pelvis: I recently read about that. Yes. Very exciting news!

Dr. Ashley Girard: Yeah, if they can find a urologist that’s knowledgeable about it and can direct them, that’s great. Patients can find lots of information about how to get it online and make that decision. But there’s also other things that patients should consider before using it. So like I said, the ideal patient is that patient that has that trigger, gets an acute UTI and then doesn’t have any symptoms until their next one. so those are those are the really ideal patient for it. But then there’s also patients that have a catheter and catheter patients can really benefit from using it. They use that at a little bit higher of a dose.

But you also need to have acidic urine. So part of how it activates is when it goes into the bladder, it will be inert until the PH in the bladder is below six, essentially 5.7, if we’re going to get really specific. But I usually tell patients they’ve got to get urine strips and they want to at least see their PH six or lower when they’re in the hours after they’re taking it for it to be effective. Otherwise, unfortunately, they may just be peeing it out right and it will be inert. So first morning urine is usually pretty acidic. So patients that sleep through the night, this, they could take it right before bed, for example, and then it’s active in their bladder while they sleep and they have acidic urine through the night. Other patients, right after they wake up, they take it. And that way they take it during a more acidic point. Like usually urine is more acidic towards the morning or overnight and then it becomes more alkaline through the day. Some patients are acidic all the time. They can take it whatever the heck they want. Some patients are never acidic, so it’s not a good thing.

Michelle, The Happy Pelvis: We’re all so different. We’re all snowflakes!

Dr. Ashley Girard: Yes, we are! So that’s another thing to check into. If you’re serious about considering using it. Then you would check your urine PH for a little bit with strips throughout the day and trying to figure out when could you take it? Are you a good candidate to take it? Vitamin C is sometimes taken with it to acidify the urine. I’ve seen mixed results in patients with that. Sometimes that seems to work and sometimes it doesn’t. And then there’s other things that patients try to take to acidify the urine. And again, I’ve seen mixed results with that. So, that’s if you really want to try it, you can try those extra supplements with it and see if that improves things. The other part of this is that it can trigger some digestive upset because the stomach is acidic. So it does partly activate in the stomach, but then when it moves out of the stomach, it goes into the small intestines where the PH goes up and it deactivates and then it absorbs into our bloodstream and circulates until it gets to the bladder, through the kidneys.

So in the stomach it activates and sometimes triggers some digestive upset or some reflux in patients. And if that happens, then all you do is you buy clear vegetarian capsules and you encapsulate it. So that way it doesn’t dissolve in the stomach and it passes through and gets to the it doesn’t start breaking down until it’s in the small intestine. So there’s that.

Patients who are taking a sulfa drug like Bactrim or Septra, shouldn’t be using Hiprex alongside that. So, one of the things with taking Hiprex is, of course, it helps to reduce, but it doesn’t entirely always prevent every infection. So sometimes patients do still need a course of antibiotics while they’re taking Hiprex. And in those events, you just would want to make sure you’re not taking the Bactrim or Septra class of drugs. Which is the most common, and is one of the best UTI drugs. So it’s important to mention that.

Yeah. So that’s that’s Most of the information about Hiprex. What do you do? You have any specific questions about it?

Michelle, The Happy Pelvis: It’s interesting that when you talk about Hiprex and other supplements and other things that can help, you talk about how finding a lot of these things online and/or on forums or other communities that have been experiencing the same thing. And I just it really resonates with me because on my journey, when I was looking for help with my UTIs, I stumbled upon D-mannose being a positive thing, which I still use to this day. And I also wanted to ask you about a supplement which sounds similar in a sense that it’s an antiseptic and it’s something I currently use as a prophylactic is Uva Ursi. Is that sort of similar to Hiprex where it’s an antiseptic? And if people are taking Uva Ursi, should they not be taking it with Hiprex at the same time?

Dr. Ashley Girard: Dmannose is great. I think of that as like an anti-adherent. It helps to prevent the specifically e coli from sticking to the walls, the euro epithelium and then triggering an infection. So that’s kind of separate.

Uva Ursi, it is a urinary antiseptic, but I also consider it an antimicrobial. More like an antibiotic for the urinary tract. And Uva Ursi really shouldn’t be used continuously. It can be hard on the liver. So that’s a problem. Uva Ursi is more for somebody who has an acute infection and then you keep them on it for a week, is safe for most patients. If you’re going to do it longer, you should probably be under the care of somebody. I sometimes use it up to a month and then patients should switch to a different prophylactic.

The problem with Uva Ursi and Hiprex is they’re kind of opposites because Uva Ursi works really well in alkaline urine. It actually doesn’t really convert to the active ingredient until it’s in alkaline urine above a PH of seven. So that’s actually sometimes an approach that patients will take, is that when they’re urine is acidic, they’ll take Hiprex and when their urine is alkaline, they’ll take Uva Ursi. If they’re really trying to get an infection level down.

Michelle, The Happy Pelvis: Mm hmm. Interesting. Okay.

Dr. Ashley Girard: So, yeah, so Uva Ursi probably is one of my favourite urinary herbs for infections, because it does work so well. But it does need to be used carefully, that’s all.

Michelle, The Happy Pelvis: That’s a reason I wanted to bring it up, because I have noticed that is a common herb many bladder pain patients use very frequently. And many are warned that it does have an effect on the liver after long term use. So, in regards to side effects and the least amount of side effects. Hiprex would probably be the better route to go as a prophylactic use from a trigger, than Uva Ursi, correct?

Dr. Ashley Girard: For me, personally, it’s the anti-adherence first. So cranberry Dmannose is by far the safest. And then herbs could be used. I wouldn’t use Uva Ursi for prophylactic use. That would be for acute. I would use potentially other herbs for prophylactic use that can be used for a longer period of time. And then I would consider Hiprex.

That’s called the therapeutic order. That’s how naturopaths are trained. We follow changes that are going to have the least amount of side effects. So diet and lifestyle is your first area to change. And then we try herbs and nutraceuticals and then we go to drugs and then more significant higher drugs and then surgical interventions. And also, there could be physical abnormalities in there that may need a physio like a pelvic floor therapist or a chiro or an osteopath might be able to help with. So then again, it all depends on the patient.

Michelle, The Happy Pelvis: Let’s chat IC/BPS patients. Can they use Hiprex?

Dr. Ashley Girard: Patients who are IC patients and also get acute UTIs on top of that, are still potentially a candidate to use Hiprex. But just so they know, they may get worse before they get better. Because Hiprex works in an acidic bladder and acidic urine often triggers IC patients. Then sometimes there is a period where when they start Hiprex they actually feel worse for a couple of weeks, but then they start to get better because unfortunately a lot of IC patients are chronic UTI patients and they have flare ups of their bacterial load, but it really is bacteria that’s causing their IC unfortunately. So that, again, figuring that out takes some help with a practitioner, but. That is something to consider also for IC patients

Michelle, The Happy Pelvis: Is Hiprex safe for children or anyone breastfeeding? Any more important takeaways?

Dr. Ashley Girard: We can use it in in children aged six and up, but we use it at a much lower dose safe and in breastfeeding as well. Not in pregnancy though.

So patients who are on a prophylactic antibiotic and they’re trying to get off of it, there has been some success with overlapping them (prophylactic antibiotic + hiprex) for a few months. You continue on your prophylactic antibiotic, you add the Hiprex. You probably won’t notice much of a difference, right? Because everything is probably pretty well managed. And then after a few months, you peel away the antibiotic and then you see if Hiprex alone is enough to maintain the health of your urinary tract and the benefit of doing this again is potentially taking away the antibiotic that your bacteria could develop resistance for right? And then that saves that antibiotic for future use as well as decreases that risk of an adverse effect eventually developing because of that.

Macrobid is the classic one that’s used prophylactically for long periods of time. And those crystals that go into the urinary tract that cleanse the urinary tract can also, unfortunately, deposit in the lungs. And so long-term use, especially in the elderly can. unfortunately develop crystals in their lungs. And one of the telltale signs is they’ll start to develop a dry cough, and that immediately means that those patients should come off of that medication (Macrobid) anyways.

Michelle, The Happy Pelvis: I have not heard of that. That is the first time I’ve heard of that side effect from Macrobid. Thank you for sharing.

Dr. Ashley Girard:  And Macrobid is very safe. You know, I’m not really too worried about it, but it does happen. And although it’s not supposed to be very common, I have heard of it happening in young women as well.

Again, we’re all snowflakes and genetic differences are going to make us handle drugs differently than other people. So starting with something that has very little side effects is sometimes the route to go.

Michelle, The Happy Pelvis: Thank you so much for sharing this information today. It’s really great for sufferers from Chronic UTI, IC and bladder pain syndrome to know that there’s other options out there and that “aha” moment of knowing that there is something else you can try, that it’s not the end of the line and you’re not going to give up. That is huge for somebody living with chronic bladder pain, so this is incredibly helpful.

How can our listeners reach out to you if they’re looking for a naturopath to help with their bladder pain?

Dr. Ashley Girard: It’s on my website. I run a very small practice. It’s just me. There’s no receptionist. I am the reception.

My email is dr.ashley@girardnd.com

It is best to go to my website, look at my contact information and then just shoot me an email and if you’re looking for someone locally, I can try to see if let you know if there’s somebody locally.

I don’t know if your audience is very Ontario based or if it’s all over the place. But there are a couple of other practitioners out there that are like me, but we are kind of far and few between. Yeah. So that’s it. Just go to my website bladdercare.ca and all of my contact information is there.

Michelle, The Happy Pelvis: Thank you so much, Ashley, for your time. It was wonderful to learn all about Hiprex today. I’m actually going to look a little bit more into this for myself!

Dr. Ashley Girard: Yeah, that’s the thing, right? When there’s always more. And that’s the one thing I tell patients is whether, you know, whether it’s me or it’s another. You have to keep on going on your journey because we don’t get much movement in your case. There is always so much more out there. There are lots of practitioners globally that are specializing in this. And it just might take a very specific practitioner that helps to figure out the reasoning behind why you have chronic pelvic pain, right? So yeah, never give up.

There are so many options and there are so many people out there that have had experience, even practitioners now and are doing this. I mean, Ruth Kriz, a lot of people know her name. She had IC too. There’s another naturopath I know about Dr. Berman. She apparently had urinary issues, too. There’s me, you know, like there’s just enough of us women out there that are getting it that there are lots of practitioners that are coming to this field and dedicating themselves to it because we know in urology, it’s a lot of men. It’s a lot about men and their conditions and a lot less about women and our conditions, even though we’re half of the population.

Yeah, so just keep learning and keep searching and keep finding people that are going to help you get better.

Michelle, The Happy Pelvis: Thank you so much, Ashley. Those are wonderful final words. Great inspiration.

Dr. Ashley Girard: You’re welcome. Have a great day!