Urinary tract Infections

Written by Shabir

Overview of Urinary tract Infections

The urinary tract is the body's filtering system for removal of liquid wastes. Women are especially susceptible to bacteria which may invade the urinary tract and multiply, resulting in an infection.

Although most urinary tract infections (UTIs) are not serious, they are a major burden on both the patient and the physician. Approximately fifty percent of all women will have at least one UTI in her lifetime with many women having several infections throughout their lifetime. Fortunately, these infections are easily treated with antibiotics that cause the symptoms to quickly disappear. Some women seem are more prone to repeated infections than others and for them it can be a frustrating battle.

What Causes Urinary Tract Infections?

The most common cause of UTI is bacterial organisms which reside in the vicinity of the vagina and rectum. These organisms enter the urinary tract via the urethra. Once these organisms have entered the urethra they ascending up to the bladder and, rarely ascend up the ureters into the kidney

There are several ways as to how the bacteria can enter the urethra; one of the most common causes of UTIs in females is sexual intercourse. The shorten urethra and the frequent thrusting motion of the penis pushes the bacteria from the outside of the skin into the urethra. Honeymoon cystitis is a common diagnosis in newly married females.

Those females who have multiple sexual partners and have frequent intercourse are also more prone to UTIs, compared to females who are in a monogamous relationship. There are some rare unlucky females, who get a UTI every time they have intercourse.

Other rare causes of UTI include holding for long periods before urinating. The longer the urine sits in the balder, the weaker the bladder gets over time. As the bladder gets weak it is not longer able to contract normally and fails to empty the bladder. Residual urine is a common cause of UTIs. Other factors that have been associated with UTIs are pregnancy, diabetes, catheterization of the bladder and stroke.

What are the Symptoms of Urinary Tract Infections?

The symptoms of UTI are classic. The majority of females will present with painful urination or a burning sensation during urination. Other associated symptoms may include frequent urination and an odd ache in the lower abdomen and genital area. These symptoms generally do not spontaneously disappear unless the individual is treated.

In most cases, the treatment of UTIs is relatively simple. However, sometimes the bacteria may ascend up into to the ureter and may cause a severe infection of the kidney. Unlike UTI infection of the kidney is a much more painful condition, associated with fevers, back pain, vomiting, and nausea- the majority require admission to the hospital and have to be given intravenous antibiotics.

Diagnosis

The diagnosis of a UTI is straightforward. In many females the symptoms are so classic that the physician simply prescribes an antibiotic. However, the correct way to make a diagnosis is to collect a clean specimen of urine and analyze it for bacteria and the presence of white blood cells.

In many cases, the patient calls the physician over the phone and describes the symptoms. The physician usually calls in a prescription and if the symptoms disappear, the diagnosis was correct and there is no need for further testing. However, if a female is pregnant, confirmation about the bacteria must be made. This is because if inadequately treated, the bacteria can cause serious complications, including a miscarriage. On the other hand, if there is no infection, the pregnant female is saved from taking any antibiotics that may potentially harm her fetus.

Treatment options:

A variety of antibiotics are available for UTIs. The type of antibiotics depends on many factors, including whether the infection is simple or complicated, primary or recurrent. Treatment decisions are not always based on the presence of bacteria in the urine. If a female has symptoms and the bacterial count is low or normal, a UTI is probably present and antibiotic treatment should be considered.

Antibiotics for Uncomplicated UTIs:

Even though antibiotics cure the UTI in the majority of cases, a recurrence of UTI is a universal problem. Today, there are many sexually active young women who have no symptoms but have a high number of bacteria in the urine. The question is what is the best treatment for these individuals? With the increasing number of resistant bacterial strains and the benign nature of a UTI, there are many in the health community who do not recommend routine antibiotic treatment.

The treatment of UTIs with pharmaceuticals has become fairly standardized. There are numerous antibiotics which are used to treat UTIs. These include the sulphonomides (Bactrim, septra), Fluoroquinolones (Levaquin Cipro), cephalosporins and newer generation tetracyclines (vibramycin). For those females who are sick and have evidence of sepsis or pyelonephritis following a UTI, admission is generally required and IV antibiotics administered. For the majority of females, an oral antibiotic taken for a few days is sufficient to treat the infection.

After antibiotic treatment, most patients are free of infection. If the symptoms do not clear up within the first few days after treatment, the physician will generally recommend discontinuing the antibiotic and ask the female to provide a urine sample for culture -in order to identify the specific organism causing the UTI.

Relief of symptoms:

There are some agents like Phenazopyridine (Barodium, pyridium, Eridium) which can relieve the pain and burning associated with a UTI. The drug is only taken for 1-2 days and immediately provides relief. It does turn the urine reddish-orange and it is not something to worry about. The drug does not cure the UTI but only relieves the symptoms; and must be taken in combination with an antibiotic. In some rare cases, the drug may be associated with shortness of breath and kidney failure.

The problem with antibiotic therapy:

The rampant use of antibiotics for the past 50 years has now led to the development of resistance organisms to almost all antibiotics. The presence of resistant bacteria is growing at epidemic proportions all over the world. Almost all bacteria today are resistant to the penicillins and the percentage of resistant organism to other antibiotics is increasing annually. Today, numerous hospitals in the US are struggling to treat drug resistant pneumonias and soon the treatment of UTIs will most likely follow the same path.

In addition, the use of drugs is associated with side effects and complications. There is no drug that has no side effects and the same applies to the drugs used to treat UTIs. Allergies and skin rashes are common with drugs and with prolonged use, organ damage may occur. So in the long run, the less frequently the antibiotics are used, the safer it is for humans as a whole.

Dietary recommendations during UTI
Control sugar:

In all individuals who have high sugar (diabetic), the frequency of UTI is much higher. High sugar levels in the body are known to interfere with the immune system and thus lead to a proliferation of bacteria. Thus, control of blood sugar is essential in the treatment and prevention of UTIs. Other chemicals also known to depress the immune system include excessive alcohol and fat content. Like blood sugar, alcohol intake, chocolate, eggs, oranges, carbonated beverages, meat products and red wine should be curtailed and the ingested fat decreased to prevent recurrent UTIs.

Fluids:

To flush the bladder of the infectious bacteria, all females with a UTI are encouraged to drink fluids and empty the bladder frequently. However, coffee and alcohol should be avoided as they seem to worsen the symptoms of a UTI.

Vegetables:

To increase acidity of the urine and decrease the growth of bacteria, one should eat more vegetables. Spinach, potatoes, green beans, avocado, onion, grapes, broccoli, zucchini, yams and mustard greens are recommended. Vegetables, overall, are good for health and also help to control the blood sugars.

Cranberry Juice and Blueberries:

For more than 2 decades it has been known that cranberry can prevent UTIs. Studies have shown that cranberry in the form of a liquid or as a supplement pill, are equally effective in decreasing the frequency of UTIs. Cranberry juice works by preventing the attachment of E coli (this is the most common bacteria known to cause UTIs) to the bladder and urethral wall. Cranberry juice however, is not effective once an infection has already occurred, since the bacteria are already attached to the bladder wall. Thus most doctors do not recommend cranberry juice for acute attacks; - the agent is only recommended to prevent future/recurrent infections. Cranberry juice must be ingested daily either as liquid or a tablet to work effectively.

Like Cranberry, blueberry has been reported to decrease the frequency of UTIs. However, all the reports are anecdotal and it appears to decrease the frequency of UTIs but has no affect on the acute episode.

The chemicals found in both cranberries and blueberries which inhibit bacterial growth are known as the tannins. Tannins have the ability to prevent the bacteria from attaching to the vaginal and urethral lining.

Vitamins:

There is no doubt that vitamin C supplements are good for health. Vitamin C and A have both been touted as a cure for UTI. Some recommend mega doses of vitamins daily to prevent UTI. Todate, there is no evidence to show that vitamins can prevent or cure UTIs.

Other products:

Some proteolytic enzymes such as bromelain (from pineapples) and trypsin have been shown to act synergistically with antibiotics and rapidly cure the UTI. However, these products are very labile (get destroyed by the high acidity in the stomach) and thus do not get absorbed in the gi tract. Enteric coated products of these proteolytic enzymes are available and have to be taken with antibiotics in the treatment of UTI.

Herbs to treat UTI

Numerous nutrients and herbs have been widely used in Europe to treat UTIs. These include Asparagus (Asparagus officinalis), Parsley, garlic, birch (Betula spp.), Alfa Alfa, Echinacea, couch grass (Agropyron repens), goldenrod (Solidago virgaurea), horsetail, Java tea (Orthosiphon stamineus), lovage (Levisticum officinale), parsley (Petroselinum crispum), spiny restharrow (Ononis spinosa), juniper and nettle.

All these products appear to work by increasing the volume of urine by extra filtration and hence flushing the bacteria out of the urinary system. The majority of these herbs or nutrients are either added to tea or taken as a supplement by addition to some type of liquid.

Another not so pleasant nutrient is horseradish. It has been shown that the oil released from this product has antibacterial properties. Once ingested the oil kills the bacteria and thus may be effective in treating an acute episode. However, it is still too early to replace horseradish instead of the better known antibiotics, because no controlled studies have been yet been done to determine is effectiveness.

Numerous plants products containing the alkaloid, berberine, also have been found useful in the treatment of UTIs. .Plants like goldenseal which has high amounts of the alkaloid may be useful to treat UTI but their effectiveness and safety has not been confirmed in humans.

Finally, the herb, Uva Ursi, has been used for decades in Europe to treat UTIs. Uva ursi is a trailing evergreen shrub that flourishes in alpine forests in many regions, including North America, Europe, the Iberian Peninsula, Siberia, and the Himalayas. The plant thrives in humus-rich soil. Uva ursi is a dwarfed evergreen perennial with short, creeping, red-brown branches. Pink or white bell-shaped flowers bloom in the spring. Bears are said to be fond of the shiny, bright red or pink berries, which are edible but sour tasting. The herb when ingested is converted to an active agent (hydroquinone) which can kill bacteria. Most alternative health care practioners recommend that herb should be used only for acute infections. The powder is ingested 3 times a day.

While uva ursi is considered generally safe when taken in recommended doses and for brief periods, side effects have been reported. These include nausea and vomiting, irritability, insomnia, and an increased heart rate. Women who are pregnant or breastfeeding should not take uva ursi. It is also not recommended for those with high blood pressure.

Probiotics:  

It has been known for many years that the bacteria, lactobacilli (a human friendly organism) protect against genital and urinary tract infections. Many yogurt products contain lactobacilli and there are numerous reports of females who claim that that by taking yogurt daily, they have do not get as many UTIs. Lactobacilli containing products are now also available in health food stores. It is believed that lactobacilli protects against UTI by maintaining acidity in the genitalia and hinders bacterial growth.

Estrogen:

Urinary tract infections somehow are quite common in post menopausal females and it is not clear why. Recent studies indicate that daily application of an estrogen containing cream significantly decrease the frequency of recurrent infections compared to females who do not. This has been postulated to be due to the protective effects of these hormones on the vaginal mucosa. Other claims that estrogens lower the vaginal acidity, making it more difficult for bacteria to grow. However, ingestion of an oral estrogen pills is not associated with the same effect and in fact increases the frequency of UTI. Why this is so is not clearly understood and in any case, oral estrogen pills should not be taken by postmenopausal females, - estrogen increases the incidence of breast cancer.

Homeopathic approaches to UTI

For those who have trained in conventional medicine, it is hard to understand how holistic approaches may treat a UTI. However, one holistic approach to the treatment of UTIs has been the use of acupuncture, aromatherapy and reflexology. These holistic approaches have been widely used in the Orient to treat infections and a few studies have shown that it may reduce the number of recurrent UTIs. However, for these homeopathic approaches to be therapeutic, they have to be done regularly and for a long time. Even though some benefit may be derived in decreasing UTIs, the cost and duration of getting regular acupuncture/aromatherapy may be prohibitive for most females.

Preventive measures to decrease UTIs?

• Maintaining good hygiene goes a long way in the prevention of UTIs. The following are some suggestions in decreasing UTIs and include:
• Cleansing the genital and urinary areas from front to back with soap and water after each bowel movement. Rinsing with water is highly recommended
• Wearing tighter clothes causes friction in the genitals and moves the bacteria into the crotch area
• Showers instead of baths are recommended for individuals with recurrent UTIs
• Urinate frequently and drink a lot of fluid to flush the bacteria out
• All sanitary products should be changed after each urination
• Maintain good hygiene before and after sexual or anal intercourse
• Use of condoms has been associated with a decrease in UTIs.
• Avoid sex with multiple partners-this is not only a high risk factor for UTIs but also sexually transmitted disease.
• Drink lots of fluids and empty the bladder when the urge arises.
• For those with recurrent UTIs, supplements of vitamin C and cranberry juice may be helpful
• For those who have recurrent UTIs following intercourse, it is recommended that the female on top position be adopted since it reduces the thrusting action. For some females, a continuous course of antibiotics may be required.

Vaccines

Because UTIs are a universal health problem and since antibiotic resistance is increasing at an uncontrolled rate, vaccines are currently being developed to treat this infection. The clinical trial of the first vaccine, SolcoUrovac, has shown promise in women with recurrent UTIs. However, more long term follow up is required to document any side effects or complications. Unlike vaccines in children, this vaccine is administered as a vaginal suppository. Other research is being looked at vaccines which can prevent the attachment of the bacteria to the lining of the bladder.

References:

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