Categories: Diseases & Treatment Plans

UTI

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
  • Cranberry Complex (Mediherb)
Herbal
  • Cranberry
    • Inhibits adherence of bacteria to uroepithelial cells.
    • Juice, tablets, or capsules
If Reoccurring:
Consider Testing
  • Complicated UTI screen
  • Vaginal Microbiome Testing
Combination Product
      • Cranberry Complex (Mediherb)
    AND/OR
    • Probiotics
      • Most UTIs come from stool bacteria
      • Biome Her (Activated Probiotics), used vaginally
      • 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.
    OR
    • 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
      • Biome Her (Activated Probiotics), used vaginally
      • 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
    • Cranberry Complex (Mediherb)
    • Uroplex (Metagenics)
    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.
    • Complicated UTI screen
    • Vaginal Microbiome Testing
    • 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
    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
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