UTI

Published by NHC on January 5, 2021January 5, 2021

Urinary Tract Infections/Cystitis (UTI)

Info
Description	Urinary tract infections cover the conditions cystitis (bladder infection), pyelonephritis (kidney infection), and urethral syndrome.
Signs & Symptoms	Burning pain on urination (dysuria) Increased urine frequency (polyuria and nocturia) Lower abdominal pain Cloudy urine Dark and strong odour urine Blood in urine (haematuria) Increased WBC count in urine (pyuria) Bacteriuria on urinalysis Fever Disorientation in the elderly
Causes & Contributors	Improper bladder emptying Poor post sex practices Post sex urination Spermicidal contraceptions Disrupts vaginal microflora/microbiome Post menopausal Lowered estrogen More prone to bacterial colonisation Dehydration Anatomic abnormality Most common cause of recurrent UTIs in men Diabetes Fecal contamination Pregnancy Sexual intercourse Oestrogen changes OCP Menopause Endometriosis Trauma or irritation Sexual abuse
Pathophysiology/Aetiology	Common infections Escherichia coli Klebsiella spp. Proteus spp. Proteus mirabilis Saprophyticus spp. Staphylococcus spp. Candida Urine flow helps wash away bacteria The pH of urine inhibits bacterial growth The bladder surface has antimicrobial properties Prostatic fluid has antimicrobial properties in men Reflux of infected urine from the bladder into the kidney is involved in the development of kidney infection Primary cause of UTI is from stool bacteria
Commonly Affected	1st degree family relatives 50x more common in females Shorter urethra In children of 6-12 months, boys are more commonly effected by UTI Infants, pregnancy, elderly Diabetes, Multiple sclerosis, Spinal injury, Catheter use
Complications	Pyelonephritis Bacterial infection works its way up into kidney Kidney scarring Abscess Chronic renal damage/failure Development of hypertension
Treatment
Best Therapeutic Treatment	Refer for urgent medical intervention if any of the following occur: Significant results are not obtained within 12-24 hours The condition worsens Kidney pain is present Blood in the urine High fever, nausea and/or vomiting Consider: Referral for imaging if reoccurring (structural abnormality) Oestrogen changes/Post menopausal Education Correct wiping techniques Wipe away from vagina Healthy post sex practices Urination after sex Hygiene practices Condoms Wear cotton underwear Dietary Consume These: Water 2 Litres water a day for non UTI days up to 3 Litres a day for UTI days Unsweetened cranberry juice 0.5L/day Garlic and onion Immune stimulating properties Avoid These: Sugar and refined carbohydrates Sugar and refined carbs disturb the microflora balance and promote unhealthy organism inhabitation of the urinary system Soft drinks and Fruit juices Alcohol Coffee Tea Known food allergies Combination Product Bioceuticals Ultrabiotic urinary care OR Herbal Cranberry Inhibits adherence of bacteria to uroepithelial cells. Juice, tablets, or capsules If Reoccurring: Bioceuticals Ultrabiotic urinary care AND/OR Probiotics Most UTIs come from stool bacteria L rhamnosus L acidophilus L plantarum Orally and/or vaginally 1 teaspoon probiotic powder, 1 tbsp natural yoghurt (full fat), 1 vitamin E capsule broken open and mixed with oil. Mixture is applied topically, or into the vagina if required. Syringing into vagina and left overnight can be done for optimal results. Vitamin C Healthy immune function OR Combination immune product containing: Vitamin C Zinc Vitamin D
Herbal	Cranberry Inhibits adherence of bacteria to uroepithelial cells. Juice, tablets, capsules Blueberry Inhibits adherence of bacteria to uroepithelial cells. Pomegranate In combination with L plantarum been found to inhibit e coli replication in urinary tract
Nutritional	D mannose Active ingredient from cranberry Inhibits adherence of bacteria to uroepithelial cells. Probiotics Most UTIs come from stool bacteria L rhamnosus L acidophilus Orally or vaginally 1 teaspoon probiotic powder, 1 tbsp natural yoghurt (full fat), 1 vitamin E capsule broken open and mixed with oil. Mixture is applied topically, or into the vagina if required. Syringing into vagina and left overnight can be done for optimal results. Vitamin C Healthy immune function Zinc Healthy immune function Vitamin D Healthy immune function
Dietary	Consume These: Water 2 Litres water a day for non UTI days up to 3 Litres a day for UTI days Unsweetened cranberry juice 0.5L/day Garlic and onion Immune stimulating properties Avoid These: Sugar and refined carbohydrates Sugar and refined carbs disturb the microflora balance and promote unhealthy organism inhabitation of the urinary system Soft drinks and Fruit juices Alcohol Coffee Tea Known food allergies *Give food swap ideas if necessary
Lifestyle	Education Correct wiping techniques Wipe away from vagina Healthy post sex practices Urination after sex Hygiene practices Condoms Wear cotton underwear
Pharmaceutical	Initial treatment: Urine alkalinising agent (eg. Ural) relieves symptoms High fluid intake If no amelioration: Antibiotics Cephalexin Nitrofurantoin Trimethoprim Sulfamethoxazole Prophylactic: Antibiotics Chronic relapsing UTIs Intravaginal oestrogen Post menopausal women
Combination Products	Bioceuticals Ultrabiotic urinary care Cranberry extract Pomegranate L plantarum L rhamnosus Vitamin D
More
Differential Diagnosis	Pyelonephritis Additional symptoms: back pain, flank pain, fever, chills with shaking, and feeling generally unwell STI Urethral syndrome When symptoms are presented but with no raised WBC in urine. Interstitial cystitis Chronic inflammatory condition of the bladder Endometriosis screen for endometrial cells covering the bladder causing recurrent irritation
Diagnostic Criteria	Urinary findings WBCs in urine Positive for leucocyte esterase Bacteria in the urine (usually >100,000/mL Clinical presentation
Testing/Examinations	Urinalysis (Urine Microscopy, Culture and Sensitivities – Urine M/C/S) Dipstick can be beneficial but imprecise Tests for pH, protein, glucose, ketones, bilirubin, haemoglobin Presence of Nitrites Gram-negative bacteria convert nitrates to nitrites, therefore bacteria present. WBC count Vaginal discharge can contaminate results Intravenous pyelogram (urogram) To determine structural abnormality Ultrasound To determine structural abnormality
Additional Notes	RA is associated with antibodies to Proteus mirabilis, a common bacteria often involved in UTIs

References

Al-Badr, A., & Al-Shaikh, G. (2013). Recurrent Urinary Tract Infections Management in Women: A review. Sultan Qaboos University medical journal, 13(3), 359–367. https://doi.org/10.12816/0003256

Behzadi, P., Behzadi, E., Yazdanbod, H., Aghapour, R., Akbari Cheshmeh, M., & Salehian Omran, D. (2010). A survey on urinary tract infections associated with the three most common uropathogenic bacteria. Maedica, 5(2), 111–115.

Bone, K. (2007). The Ultimate Herbal Compendium. Phytotherapy Press

Braun, L., & Cohen, M. (2015). Herbs and Natural Supplements, Volume 2. Elsevier Health Sciences.

Das S. (2020). Natural therapeutics for urinary tract infections-a review. Future journal of pharmaceutical sciences, 6(1), 64. https://doi.org/10.1186/s43094-020-00086-2

de Llano, D. G., Arroyo, A., Cárdenas, N., Rodríguez, J. M., Moreno-Arribas, M. V., & Bartolomé, B. (2017). Strain-specific inhibition of the adherence of uropathogenic bacteria to bladder cells by probiotic Lactobacillus spp. Pathogens and disease, 75(4), 10.1093/femspd/ftx043. https://doi.org/10.1093/femspd/ftx043

Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature reviews. Microbiology, 13(5), 269–284. https://doi.org/10.1038/nrmicro3432

Guay D. R. (2009). Cranberry and urinary tract infections. Drugs, 69(7), 775–807. https://doi.org/10.2165/00003495-200969070-00002

Hechtman, L. (2018). Clinical Naturopathic Medicine. Elsevier Health Sciences.

Karlsson, M., Scherbak, N., Reid, G., & Jass, J. (2012). Lactobacillus rhamnosus GR-1 enhances NF-kappaB activation in Escherichia coli-stimulated urinary bladder cells through TLR4. BMC microbiology, 12, 15. https://doi.org/10.1186/1471-2180-12-15

Morelli, L., Zonenenschain, D., Del Piano, M., & Cognein, P. (2004). Utilization of the intestinal tract as a delivery system for urogenital probiotics. Journal of clinical gastroenterology, 38(6 Suppl), S107–S110. https://doi.org/10.1097/01.mcg.0000128938.32835.98

Reid, G., Beuerman, D., Heinemann, C., & Bruce, A. W. (2001). Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora. FEMS immunology and medical microbiology, 32(1), 37–41. https://doi.org/10.1111/j.1574-695X.2001.tb00531.x

Schaffer, J. N., & Pearson, M. M. (2015). Proteus mirabilis and Urinary Tract Infections. Microbiology spectrum, 3(5), 10.1128/microbiolspec.UTI-0017-2013. https://doi.org/10.1128/microbiolspec.UTI-0017-2013

Schmiemann, G., Kniehl, E., Gebhardt, K., Matejczyk, M. M., & Hummers-Pradier, E. (2010). The diagnosis of urinary tract infection: a systematic review. Deutsches Arzteblatt international, 107(21), 361–367. https://doi.org/10.3238/arztebl.2010.0361

Zuccotti, G. V., Meneghin, F., Raimondi, C., Dilillo, D., Agostoni, C., Riva, E., & Giovannini, M. (2008). Probiotics in clinical practice: an overview. The Journal of international medical research, 36 Suppl 1, 1A–53A. https://doi.org/10.1177/14732300080360S101