Q:About two years ago, at the age of 26, my (Japanese) wife suddenly started to feel acute pain when urinating. She was under a lot of work related stress at the time and was generally fatigued. She put up with the pain for two days, then went to see

She decided she didn't want to keep taking western medicine, so she went to a Chinese herbalist and was given medicine in the form of a pill to take in conjunction with a tea infusion (again, we do not know the content of these medicines). She followed this regime for about 20 days and was again cured. Three days ago (a year later), she felt pain on urination and on wiping, noticed blood. It seems to me that the stress and fatigue felt at the original emergence and recent reappearance must be contributing factors to her cystitis, but are they the cause? If not, what is and what can she do to cure this illness? C D, Tokyo, Japan.......

A:Stress and tiredness aren't the cause of the problem, but they are the trigger. Cystitis in a sense is "caused" by the Escherichia coli bacteria, which resides in the urinary tract of all healthy individuals. Although most of us have certain factors in our urine and bladders to keep this bacteria in check by flushing it out of the body, some people, mainly women, may be genetically more predisposed to getting cystitis. Physical disturbance, such as caused by catheters or diaphragms and spermicides all appear to make women more susceptible to infections, as does, occasionally, sexual intercourse. And of course stress and fatigue lower the body's immune system, making it more susceptible to infections of any variety.

It's likely that your doctor gave your wife an antibiotic, which is the mainstay of cystitis treatment. The big drawback is that if she is prone to repeated infections, she will be dosed up with repeated courses of antibiotics, which can so alter gut flora in the body that she will be left open to candida albicans infections. Her body must also resist the antibiotics when she really needs them.

The effectiveness of cranberry extract in treating urinary tract infections (UTI) has long been known for some 35 years (and far longer in gypsy and other naturopathic medicines). Recent studies offer scientific proof that cranberry juice prevents E coli from attaching itself to the cells of the urinary tract (Medical Clinics of North America, 1991: 272-86). In one study, between 12-30 ounces of raw unpasturized cranberry juice was a good preventive treatment for many types of urinary tract infections (New Eng J Med, 1963; 268: 57).

Because cranberry extract is found to be the most potent way to take it, naturopaths in America and the UK have had success with several new products designed for acute infections and then maintenance in women who are susceptible. Biocare in the UK offer a cranberry powder (CP227), a teaspoonful of which is taken in a little water twice a day over four days. Once the infection is cleared, a maintenance product (UR228) provides lower dosage of cranberry as a once a day capsule for a month. Biocare combines the product with acidophilus, theoretically to help restore gut flora, an upset of which can help E coli to proliferate.

In the US, Solgar also offers a cranberry extract in capsule form, taken twice a day. All extract products should be taken a half hour before meals.

Rohan Mehta, the highly knowledgeable owner of the NutriCentre, England's largest natural pharmacy, suggests that if the cystitis returns, repeat the four-day acute stage followed by one-month maintenance regime.

Besides cranberry, your wife should drink lots of water and follow meticulous personal hygiene, perhaps using acidophilus baths, and avoiding bidets, notorious for spreading E coli. For excellent suggestions on preventive measures, get hold of Angela Kilmartin's seminal book on the subject, Understanding Cystitis (Arrow, London, 1985).

But first your wife must be properly diagnosed and a culture taken to confirm that the problem is bacterial and caused by E coli, rather than fungal. Oftentimes cystitis is blamed when the real culprit is the yeast candida albicans, which will not respond to cranberry. It's also vital that your doctor determine whether the infection is higher up in the urinary tract often the reason for blood, and not simply the usual symptoms of cystitis such as discharge, burning and a need to urinate frequently. A UTI may turn out to be serious, affecting the kidneys, if it isn't treated. If it does turn out to be an UTI, and it doesn't always respond to cranberry (as they don't in some cases), your wife may have to have antibiotics and medical supervision. After it is cleared, she can follow the preventive measures with cranberry taken as maintenance to avoid a recurrence.

A final recommendation is for you to resolve the stress which does seem to trigger her illness. And the next time your doctor or alternative practitioner gives you a drug, it's always prudent to find out what it is and any potential side effects before swallowing.