Urinary tract infection (UTI) is a common infection that
usually occurs when bacteria enter the opening of the urethra
and multiply in the urinary tract. The urinary tract includes
the kidneys, the tubes that carry urine from the kidneys to
the bladder (ureters), bladder, and the tube that carries
urine from the bladder (urethra). The special connection of
the ureters at the bladder help prevent urine from backing up
into the kidneys, and the flow of urine through the urethra
helps to eliminate bacteria. Men, women, and children develop
UTIs.
Types
Urinary tract infections usually develop first in the lower
urinary tract (urethra, bladder) and, if not treated, progress
to the upper urinary tract (ureters, kidneys). Bladder
infection (cystitis) is by far the most common UTI. Infection
of the urethra is called urethritis. Kidney infection (pyelonephritis)
requires urgent treatment and can lead to reduced kidney
function and possibly even death in untreated, severe cases.
Incidence and Prevalence
Approximately 8 to 10 million people in the United States
develop a UTI each year. Women develop the condition much more
often than men, for reasons that are not fully known, although
the much shorter female urethra is suspected. The condition is
rare in boys and young men.
Twenty percent of women in the United States develop a UTI and
20% of those have a recurrence. Urinary tract infections in
children are more common in those under the age of 2.
Causes and Risk Factors
Escherichia coli (E. coli) causes about 80% of UTIs in adults.
These bacteria are normally present in the colon and may enter
the urethral opening from the skin around the anus and
genitals. Women may be more susceptible to UTI because their
urethral opening is near the source of bacteria (e.g., anus,
vagina) and their urethra is shorter, providing bacteria
easier access to the bladder. Other bacteria that cause
urinary tract infections include Staphylococcus saprophyticus
(5 to 15% of cases), Chlamydia trachomatis, and Mycoplasma
hominis. Men and women infected with chlamydia trachomatis or
mycoplasma hominis can transmit the bacteria to their partner
during sexual intercourse, causing UTI.
Sexual intercourse triggers UTI in some women, for unknown
reasons. Women who use a diaphragm develop infections more
often, and condoms with spermicidal foam may cause the growth
of E. coli in the vagina, which may enter the urethra.
Urinary catheterization (i.e., insertion of a small tube into
the bladder through the urethra to drain urine) can also cause
UTI by introducing bacteria into the urinary tract. The risk
for developing a UTI increases when long-term catheterization
is required.
In infants, bacteria from soiled diapers can enter the urethra
and cause UTI. E. coli may also enter the urethral opening
when young girls do not wipe from front to back after a bowel
movement.
Other risk factors include the following:
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Bladder
outlet obstructions (e.g., kidney stones, BPH)
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Conditions
that cause incomplete bladder emptying (e.g., spinal cord
injury) |
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Congenital
(present at birth) abnormalities of the urinary tract
(e.g., vasicoureteral reflux) |
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Suppressed
immune system |
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Being
uncircumcised |
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Certain blood
types enable bacteria to attach more easily to cells that
line the urinary tract, causing recurrent UTIs.
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Signs and Symptoms
Symptoms of UTI in young children include the following:
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Diarrhea
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Excessive
crying that cannot be resolved by typical measures (e.g.,
feeding, holding) |
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Loss of
appetite |
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Fever
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Nausea and
vomiting |
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Older
children may experience the following symptoms with UTI:
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Flank or
lower back pain (with a kidney infection)
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Frequent
urination |
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Inability to
produce more than a small amount of urine at a time
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Incontinence
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Pain in the
abdomen or pelvic area |
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Painful
urination (dysuria) |
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Urine that is
cloudy or has an unusual smell |
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Symptoms of
lower UTI (e.g., cystitis, urethritis) in adults include
the following: |
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Back pain
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Blood in the
urine (hematuria) |
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Cloudy urine
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Inability to
urinate despite the urge |
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Fever
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Frequent need
to urinate |
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General
discomfort (malaise) |
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Painful
urination (dysuria) |
Symptoms that indicate upper UTI (e.g.,
pyelonephritis) in adults include the following:
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Chills
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High fever
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Nausea
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Pain below
the ribs |
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Vomiting
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Complications
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Hormonal
changes and shifts in the urinary tract during pregnancy
increase the risk for kidney infection. Prenatal care
includes regular urine testing because bacteria are often
present without causing symptoms and UTI during pregnancy
may result in complications (e.g., premature birth, high
blood pressure) for the mother and fetus. Diseases that
suppress the immune system (e.g., HIV) and debilitating
diseases (e.g., cancer, sickle cell anemia) increase the
risk for UTIs and complications. |
Diagnosis
A clean-catch urine specimen is obtained to diagnose UTI. This
test involves cleansing the area around the urethral opening
and collecting a mid-stream urine sample, preventing bacteria
in the genital area from contaminating the sample. Urinalysis
is performed to determine the level of white blood cells that
destroy harmful bacteria (leukocytes) in the urine. A large
number of these cells may indicate bacterial infection. A
culture and sensitivity (induced growth of the bacteria) may
be done to determine the type of bacteria and how to treat the
infection.
Treatment
UTIs are treated with antibacterial drugs. The type of drug
used and the duration of treatment depend on the type of
bacteria. Most UTIs are treated with
trimethoprim-sulfamethoxazole (e.g., Bactrim®, Cotrim®, Septra®),
amoxicillin (e.g., Amoxil®, Trimox®), or fluoroquinolones
(e.g., Levaquin®, Cipro®). The infection may improve within a
couple of days, but 1 to 2 weeks of medication is may be
prescribed to prevent a kidney infection.
UTIs that are caused by bacteria such as chlamydia trachomatis
and mycoplasma hominis require a longer course of treatment
with tetracycline (e.g., Achromycin®),
trimethoprim-sulfamethoxazole, or doxycycline (e.g., Periostat®).
Infections complicated by bladder outlet obstructions (e.g.,
kidney stone, BPH) and other risk factors (e.g., spinal cord
injury) may require surgery to correct the cause of UTI.
Kidney infections may require hospitalization and as many as 6
weeks of antibiotic treatment to prevent serious kidney
damage.
Over-the-counter pain relievers (e.g., Tylenol®, Advil®) and a
heating pad may be used to relieve discomfort caused by UTI.
Drinking plenty of water helps to cleanse bacteria out of the
urinary tract. Coffee, alcohol, and smoking should be avoided.
Frequent UTI (3 or more per year) may be treated with low-dose
antibiotics for 6 months or longer or with a 1 to 2 day course
when symptoms appear.
Follow up urinalysis is performed after treatment to make sure
that the urinary tract is bacteria free.
Prevention
The following measures can reduce the risk for UTI:
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Avoid
products that may irritate the urethra (e.g., bubble bath,
scented feminine products). |
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Cleanse the
genital area before sexual intercourse.
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Change soiled
diapers in infants and toddlers promptly.
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Drink plenty
of water to remove bacteria from the urinary tract.
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Do not
routinely resist the urge to urinate.
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Take showers
instead of baths. |
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Urinate after
sexual intercourse. |
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Women and
girls should wipe from front to back after voiding to
prevent
contaminating the urethra with bacteria from the anal
area. |
Naturopathic
Treatment
The natural therapeutics outlined in this section may help
patients get through an existing urinary tract infeciton (UTI)
without antibiotics. Some doctors believe that antibiotics may
contribute to a tendency for recurrent infections with
increasingly resistant bacteria.
If you experience recurrent infections, there are precautions
and supportive natural measures you can integrate into your
lifestyle that may help eliminate recurrence.
Alkalinize the Urine
Although there remains some controversy about what pH is most
conducive to bacteria growth in the urinary tract, most
evidence indicates that the majority of UTIs benefit from an
alkaline pH. To easiest way to alkalinize the urine is with
minerals, specifically potassium citrate and sodium citrate.
All citrates will encourage an alkaline shift; so if you are
already taking a calcium/magnesium supplement, switch to a
calcium citrate/magnesium citrate preparation. Take your
mineral supplement before bedtime, as this is a time when
urine sits in the bladder where it may irritate the tissue and
promote an infection.
Disinfect the Urinary Tract
There are herbs that have been clinically shown to have
antiseptic properties. Drink them in beverage form throughout
the day.
Cranberry or blueberry juice, but not the sugar-sweetened
variety; choose one sweetened with an apple or grape juice.
These juices have antibiotic properties that interfere with
the bacteria’s ability to adhere to the bladder or urethral
tissue. Drink at least 16 ounces a day for a preventative and
therapeutic effect.
Herbal Therapeutics
The following herbal remedies usually do not have side effects
associated with regular use at the suggested doses. Rarely, an
herb at the prescribed dose causes stomach upset or headache.
This may reflect the purity of the preparation or added
ingredients such as synthetic binders or fillers. For this
reason it is recommended that you use only high quality,
standardized extract formulas.
If possible, consult with a natural health practitioner such
as a holistic medical doctor or licensed naturopathic
physician before starting any alternative treatment plan. As
with all medications, more is not better and overdosing can
lead to serious illness and, in rare cases, death.
Include one of these herbal preparations 3 to 4 times a day
during an infection: Goldenseal root — A long and well-documented history as a
powerful antimicrobial agent. Use as a tea made from 1 tsp of
dried herb per cup of hot water; in capsule form (1,000 mg);
or as a tincture (1 to 2 teaspoons in warm water).
Uva Ursi — Clinical research proves traditional use as an
antiseptic with soothing and strengthening properties. Use as
a tea made from 2 teaspoons of herb per cup of hot water; or
as a tincture (1 to 2 teaspoons in warm water).
Other herbs to consider as tea:
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Cleavers (Galium aparine) — Has a long history of use in
treatment of urinary infections. |
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Marshmallow root (Althea officinalis) — Very soothing
demulcent properties. Best used in "cold infusion." Soak herb
in cold water several hours, then strain and drink.
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Buchu — Soothing diuretic and antiseptic for the urinary
system. |
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Corn silk (Zea Mays) — Soothing, diuretic.
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Horsetail (Equisetum arvense) — An astringent and mild
diuretic with tissue-healing properties.
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Usnea Lichen — Very soothing and antiseptic.
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Also be sure to drink 2 to 3 liters of water daily.
Homeopathic Remedies
A trained homeopathic practitioner is needed to diagnose and
prescribe a deep acting, constitutional remedy. For acute,
symptomatic relief the following remedies have shown success
with some of the symptoms associated with urinary tract
infections.
The standard dosage for acute symptom relief is 12c to 30c, 3
to 5 pellets 3 or 4 times a day until symptoms resolve. If you
have chosen the right remedy, you should experience
improvement shortly after the first or second dose. Do not
take any remedy longer than a day or two unless you consult a
homeopathic practitioner (naturopathic physician or medical
doctor).
Warning: Most homeopathic remedies are delivered in a small
pellet form that has a lactose sugar base. If you are lactose
intolerant, be advised that a homeopathic liquid may be a
better choice for you.
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Cantharis — For intolerable urging with burning, "scalding"
urination. |
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Apis mellifica — For stinging pain that is worse with heat.
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Staphysagria — For a UTI that is the result of sexual
intercourse. |
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Sarsasparilla — For pain that burns after urination has
stopped. |
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Physical Medicine
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Castor oil packs can be applied for UTIs that have associated
bladder cramping or pelvic discomfort. Apply castor oil
directly to the skin and cover with a soft piece of flannel
and heat (hot water bottle) for 30 minutes to 1 hour.
Anti-inflammatory action of castor oil aids in pain relief.
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Sitz baths can be helpful if there is swelling or burning of
the urethral opening. An infusion of golden seal is
anti-microbial and soothing, the other herbs indicated will
also be helpful. |
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