Urinary tract infection is a bacterial infection that affects the urinary system which includes kidneys, ureters, the bladder, urethra, sphincter muscles and prostate gland. The infection is generally caused by bacteria E. coli.
Urinary infection mainly characterized by painful micturation, frequent desire for urination, cloudy urine, haematuria (blood in urine), back and abdominal pain etc.
Population like older adults and people with a history kidney disease, kidney stones or illness like diabetes, AIDS are more prone to infection.
Urine is normally sterile, but it becomes infected when bacterial growth occurs. UTI implies multiplication of organisms in the urinary tract and is defined by the presence of more than hundred thousand organisms per ml in a freshly void midstream sample of urine. Most of urinary tract infections are not serious, but are painful. It involves kidney, ureters, bladder or urethra. UTI is common infection affects women more then men.
There is an increased in the rate of UTI during puberty, related in part to the onset of sexual activity and pregnancy. This problem affects primarily adolescent females; adolescent males have very low rates of infection. The diagnosis in women is further complicated because the symptoms of Urinary tract infection can be similar to those of vaginitis or a sexually transmitted infection.
Urinary tract infection refers to presence of microorganism in the urinary tract, causing a host response. It should be differentiated from colonization though colonization precedes infection. Transient introduction of bacteria in to the urinary tract probably occurs in the healthy, especially sexually active women.
Urinary tract infection may present as asymptomatic bacteriuria, urethritis, cystitis or acute pyelonephritis in women. In men, they often present as acute prostatitis, chronic prostatitis and pyelonephritis.
Urinary tract infection may be classified as complicated or uncomplicated. A UTI is described as uncomplicated when it occurs without presence of physiologic or anatomical abnormalities, not due to instrumentation and is community acquired. An infections is labeled complicated when there are structural or functional abnormalities present in the urogenital tract.
Risk Factors associated with urinary infection
Uncomplicated urinary infection
- Bacterial virulence
- Sexual intercourse
Complicated urinary infection
- Urethral stricture
- Pelviuretric junction
- Prostate hypertrophy
- Uretric stricture
- Bladder neck obstruction
- Renal cysts
- Neuropathic bladder
- Renal scarring
- Uretric stent
- Diabetes mellitus
- Iron overload
Site of Infection
A urinary tract infection, or UTI, is an infection that can happen anywhere along the urinary tract. The urinary tract includes the:
• Ureters – the tubes that take urine from each kidney to the bladder.
• Urethra – the tube that empties urine from the bladder to the outside.
Causative organism of UTI
Causative organisms of UTI includes –
- E. coli.
Sign and Symptoms of Urinary Infection
Symptoms of bladder infection
- Frequent urination along with the feeling of having to urinate even though there may be very little urine to pass.
- Nocturia: Need to urinate during the night.
- Urethritis: Discomfort or pain at the urethral meatus or a burning sensation throughout the urethra with urination (dysuria).
- Pain in the midline suprapubic region.
- Pyuria: Pus in the urine or discharge from the urethra.
- Hematuria: Blood in urine.
- Pyrexia: Mild fever
- Cloudy and foul-smelling urine
- Increased confusion and associated falls are common presentations to Emergency departments for elderly patients with UTI.
- Some urinary tract infections are asymptomatic.
- Protein found in the urine. Cloudy urine
- Foul or strong urine odor
- Frequent or urgent need to urinate
- Low fever (not everyone will have a fever)
- Need to urinate at night
- Pain or burning with urination
- Painful sexual intercourse
- Pressure in the lower pelvis
Symptoms of kidney infections
- All of the above symptoms.
- Emesis: Vomiting is common.
- Back, side (flank) or groin pain.
- Abdominal pain or pressure.
- Shaking chills and high spiking fever.
- Night sweats.
- Extreme fatigue. Chills and shaking
- Fever above 102 degrees Fahrenheit, which lasts for more than 2 days
- Flank (side) pain
- Flushed, warm, or reddened skin
- General ill feeling
- Mental changes or confusion (in the elderly, these symptoms often are the only signs of an UTI)
- Nausea and vomiting
- Severe abdominal pain (sometimes)
Painful urination is usually caused by a urinary tract infection, associated symptoms mainly include frequent or urgent urination, an inability to release more that a small amount of urine followed by an urgent need to urinate again, and a burning sensation while urinating.
If kidney also is infected, you may experience pain in your abdomen or back, a fever or vomiting. A kidney infection is a serious condition that requires immediate medical attention.
Dysuria is defined as “painful urination. Causes of dysuria mainly include
Causes in females
- Cystitis lower UTI, with or without pyelonephritis.
- Urethritis caused by a sexually transmitted disease, Chlamydia, neiseria gonorrhoeae, herpes simplex virus.
- Vulvovaginitis-bacterial vaginosis, trichomoniasis, yeast, genital HSV.
Causes of dysuria in males
- Urethritis caused by Chlamydia, N gonorrhoeae, yeast (uncircumcribed – balanitis), HSV.
- Cystitis (if culture positive, possible anatomic abnormality, further workup indicated).
- Prostatitis, acute more common than chronic.
- Penile lesions, trauma, sexual abuse.
- Benign prostatic hypertrophy particularly in older men. Infection can be evident but is primarily an obstructive process.
Urine cloudiness – cloudy, murky, or turbid urine reflects the presence of bacteria, mucus, leucocytes or erythrocytes, epithelial cells, fat, or phosphates (in alkaline urine). It’s characteristic of urinary tract infection.
Diagnosis of urinary tract infection
History and physical examination should be considered in order to diagnose urinary tract infection. Urine sample especially midstream urine should be obtained for urinalysis. Urine culture is also done in case of suspected urinary tract infection.
- Urine routine examination and culture from a mid-stream sample
- Ultrasonography of kidney and bladder and plain abdominal radiography to exclude stones and lubosacral defects
- Urine flow rate and post-void ultrasonography of bladder (to measure residual volume) in any patient with evidence of bladder outflow obstruction
- CT with contrast to exclude abscess if renal symptoms persist.
- IV pyelography gives important anatomical about the urinary tract
- MSU in patient with complicated urinary infection
Treatment of urinary tract infection
Treatment of urinary infection mainly depends upon the cause and the medical condition.
Prevention of UTI
- Drink plenty of liquids to flush bacteria out of the urinary system.
- Wipe from the vagina to the anus after defecation to avoid spreading bacteria.
- Drink water before and after sex so that one will urinate a good volume with a steady stream afterwards. This will help eliminate any bacteria that may have entered.
- Consider using another method of birth control or a different brand of condom for your spouse if you suspect that chemical over the condom is causing irritation.
- Avoid tight clothing. It may irritate tissues, trap heat, and promote bacterial growth.
- Wear cotton underwear. Cotton is less irritating and provides more ventilation than nylon.
Complications of UTI
- Renal calculi.
- Chronic renal failure.
General management of UTI
- Bed rest.
- Plenty of fluids.
- Regular voiding of urine.
- Maintain alkalinity of urine.
- Local hygiene.
- Salt restriction, if blood pressure is high.
- Protein restriction, if blood urea is high.
Homeopathic treatment of urinary infection
Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach.
This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering.
The aim of homeopathy is not only to treat urinary tract infection but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several well-proved medicines are available for urinary infection treatment that can be selected on the basis of cause, sensation and modalities of the complaints.
For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. Some important homeopathic remedies are given below for urinary tract infection treatment:
Aconite, Apis mel, Cantharis, Dulcamara, Terebinth, Equisetum, Staphysagria, Merc sol, Belladonna, Sulphur, Pulsatilla, Clematis, Sarsaparilla, Thuja, Medorrhinum, Cannabis sativa, Natrum mur, Pulsatilla, Arsenic alb, Lachesis and many other remedies.
The symptoms of scanty urine always leads one to consider whether Apis is or is not the remedy, for although Apis produces scanty urine there are number of other drugs that will do the same thing. The keynotes for Apis in urinary affections are scanty or suppressed urine, drowsiness, oedema in various parts, thirstlessness and suffocation on lying down. The urine is dark, highly albuminous, and contains casts, so it is readily seen how Apis may correspond to any form of Bright’s disease. In difficult micturition of children Apis is often a useful remedy. It has frequent desire, with the passage of a few drops at a time. Among other symptoms are great irritation at the neck of the bladder and incontinence of urine. It is also the remedy to be thought of in retained urine or inflamed bladder after abuse of Cantharis.
Apocynum seems to act some what on the kidneys and give rise to various dropsical conditions. It produces a scanty urine, which is light in color, or, as it is given, sherry-colored. Its first effect is to produce a copious diuresis; this is followed by the scantiness of urine which results in dropsy. It also produces an incontinence and may be useful in enuresis. A sinking bruised feeling at the stomach is an indication for its use. It differs from Arsenic and Apis in the fact that it has unquenchable thirst. Arsenic wants little and often, Apis is thirstless.
Outside of its action on the genito urinary system Berberis is seldom thought of,land it is one of our principal remedies for troubles of this system. It seems to correspond to many symptoms which occur in cases of renal calculi. It has severe tearing pains in the kidneys, not merely backache, but pains deep in the kidneys themselves; these pains extend down the back in the kidneys themselves; these pains extend down the back and down the ureters into the bladder;nor do stop here,for we find cutting pains in the bladder extending into the urethra. These pains in the back and along the ureters are very severe; they are worse stooping, lying or sitting, and relieved by standing. In the bladder they cause a desire to urinate, and the patient is constantly urinating, for the bladder seems imperfectly emptied. The bladder aches. The urine itself is reddish, has a reddish deposit consisting of mucus, epithelium and lithates. It differs from the Pareira brava urine in being more slimy. Another characteristic symptoms of Berberis is pain in the hips while urinating. Coccus cacti has some similar symptoms to Berberis, especially the tearing pains extending from the region of the kidneys, the frequent urging to urinate, the deposits of uric acid and the urine of Coccus cacti is dark. These remedies must be distinguished very carefully as they present many symptoms in common. Berberis has rather more back pains, and seems to act deeper. It is especially indicated in genitourinary troubles, which are due to conditions of atony, or faiblesse.
Cantharis symptoms are usually the first ones inquired after when a case of urinary difficulty presents itself. Its symptoms are clear cut, and should not be confounded with those of any other remedy. There is a persistent and violent urging to urinate, with great tenesmus; the urine is passed only in drops and seems like molten lead passing through the urethra, so intense is the burning. There is with this, usually an aching in the small of the back. It is often indicated in acute cystitis, gravel and urethritis, the great keynotes being the burning and the tenesmus of the bladder; haematuria also calls for Cantharis under certain conditions. Baehr doubts that Cantharis is ever suitable to the chronic form of cystitis.
In paralytic conditions about the bladder Causticum deserves first place. It is one of our great remedies in enuresis, and its characteristics are involuntary micturition at night in sleep, when coughing, sneezing or blowing the nose, showing a weakness of the sphincter. Another indication of this is the difficulty the patient has in passing the last few drops of urine; the fact that he has to wait a long time before it starts, and that during the act it is expelled very slowly, showing not only a weakness of the sphincter but a weakness of the whole muscular system of the bladder. Nocturnal wetting of the bed in children, occurring during the first sleep at night,calls for Causticum. Paralysis of the bladder after labor also calls for this remedy. Zincum is another excellent remedy in these bladder troubles, and it has some symptoms similar to Causticum, such as involuntary spurting of urine when coughing or sneezing; there is apt to be more pain in Zincum cases, however; Scilla and Natrum muriaticum also have involuntary micturition when coughing. Another symptom of Causticum is an excessive deposit of urates in the urine. Another remedy which clinically has proved very useful in enuresis from weakened muscular action is Ferrum phosphoricum. Rhus aromatica has enuresis of nervous origin, and has been used successfully in senile cases.
The urinary symptoms of Digitalis consist of a dragging and pressure in the bladder which micturition does not relieve. It has been found useful in inflammation in the neck of the bladder with intense desire to urinate, which is increased even by the passage of a few drops. The patient walks about in great distress; at the same time there is tenesmus of the rectum. The patient is relieved somewhat of these symptoms by lying on the back. The pain at neck of the bladder is throbbing. The urine is scanty, thick and turbid, and contains a sediment of brick-dust, like Lycopodium. The urging to urinate in cases calling for Digitalis is often due to the enlargement of the prostate gland, for which it is a remedy.
Equisetum acts similarly to Cantharis, but it has less tenesmus and haematuria, and the urine is less scalding. There is pain in the bladder as if too full, not relieved by micturition; the constant desire to urinate is not even relieved by copious urination. The urine is scanty,high colored and contains much mucus. Much mucus in the urine is more indicative of Equisetum than of Cantharis. Chimaphila also has much mucus, is especially useful in prostatic troubles, and has made some cures when there were great quantities of ropy mucus in the urine, which was quite offensive. This is a wonderful remedy in the cystic irritation of old men, characterized by a constant teasing desire to urinate with little or no relief following micturition; the patient being
frequently compelled to rise at night. The state is one of irritation rather than inflammation. Dr. Hughes considered it a favorite remedy in chronic cystitis. The general aggravation of Equisetum seems to be after urinating. Difficulty in beginning to urinate, strains a great deal, scanty urine. It has proved useful in enuresis with marked vesical irritation,being similar here to Eupatorium purpureum, which is a useful remedy in the vesical irritation of women, with much burning in the urethra during urination. With the foregoing symptoms, Equisetum becomes an important remedy in the treatment of cystitis. It has been suggested in the dysuria of children; the pain being worse after urinating will distinguish it from Petroselinum, which has the symptom that the child dances up and down with pain when the urging to urinate comes on.
Has tenesmus of the bladder with intense burning. The burning is less, but the tenesmus is greater, than in Cantharis. The passing of the urine drop by drop reminds of Aconite, which has the same symptoms. Aconite, however, is adapted to sudden retention of urine, for as soon as the disease becomes fully localized as an inflammation Aconite ceases to be the remedy. Cantharis and Nux vomica have also a similarity in the frequent fruitless efforts to urinate. In the region of the kidneys there is cutting pain which extends into the abdomen, the bladder and urethra. The most distressing symptom is the constant urging to urinate, even a few spoonfuls of urine in the bladder bringing on this urging, which is accompanied by the terrible distress at the neck of the bladder. This pain is aggravated immediately following micturition, showing that with this drug the trouble is more urethral. The urine itself under Cantharis is of a deep red color, deposits a sediment of mucus and often contain fibrinous casts. Belladonna, too, is a remedy for painful urination. Hughes says that it is a rarely failing remedy for nervous dysuria.
Characteristic symptoms in UTI are sensation as if ball is rolling in the bladder on turning over. The urine is almost black, frequent, foaming and dark; has to urinate on lying down, day or night; floating of black soot-like particles in the urine floating
The urging of urine is sudden and severe. Passage of urine with intense burning; there is sensation as if molten led is passing through the urethra. Urine discharge is very scanty, turbid, dirty brownish red color, and a peculiar smell of malt.
Spasmodic pains in the bladder after urinating. Haematuria after urination; Urine dribbles when emotionally upset. Heavy pressure and cramp in the bladder after urination; Urging to urinate on lying on back; Interrupted flow.
Tingling in urethra lasting for sometime after urinating; UTI with burning frequent urination; last drops causes violent burning; Urine starts and stops; or dribble after urination. Difficult to evacuate the urine in spell; There is mucus in the urine and not pus.
Nux vomica affects powerfully the urinary organs, yet it is seldom thought of as having anything specially characteristic about these organs. It affects the lower part of the spine, and we have as a consequence, in the first place, incontinence of urine; there is irritability at the neck of the bladder, and the same symptoms is found here as with the rectum. There are frequent ineffectual Efforts to urinate, and these are accompanied by burning and tearing pains; the urine passes in drops. Again, it is indicated in vesical torpor or paralysis; here we have dribbling of urine or retention. Haematuria from abuse of drugs calls of Nux vomica. Cystitis, with this painful urging and scanty urine indicates the remedy. The straining is violent at times, and the urine is dark with a red brick-dust sediment, or bloody, or mixed with a tenacious mucus. Opium is similar to Nux in having a partial paralysis of the bladder with spasmodic condition of the sphincter, but with Opium the patient is unconscious that the bladder is full, and there is no desire to pass water. The Stramonium patient passes no water because the urine has been suppressed; it is not secreted. Camphor gives prompt relief in spasmodic retention of urine. Nux is useful in the irritable bladder of gout and alcoholism, and to relieve pain and spasm in the passage of urinary calculi.
This is another drug very similar to Berberis vulgaris-as to pains in the back it is quite similar; yet they do not stop in the hips with Pareira as they do under mostly clinical. It has been found useful in cystitis where there is violent straining to urinate, where the patient has to kneel to urinate, where the urine scalds terribly and where these violent pains in the thighs are present. The urine has a strong ammoniacal odor. Contains thick viscid white mucus or deposits or red sand. The three- legged stool of the drug seems to be: the pain in the thighs, the getting down on all fours to urinate, and the ammoniacal odor of the urine. It is also a useful remedy in the condition known as irritable bladder, dull aching in bladder, feeling as if the bladder were distended, with pain.
One of the prominent homeopathic remedies for UTI and lithaemic conditions is Sepia, and the condition of the urine becomes an indication for its use. It has a reddish clay-colored sediment adhering to the vessel, a sediment of red sand so-called. The Sepia urine differs from others in being offensive. Sepia is also a remedy for wetting the bed at night during the first sleep. Lycopodium is a prominent remedy for the indication of red sand in the urine. It is a sort of gravel and is passed in quantities, so that often the child will scream with pain on passing the water. Lycopodium will then help. Sarsaparilla and Benzoic acid have similar symptoms, the latter having as a characteristic a strong horse-like urine. Natrum muriaticum also has their red sand or brick-dust sediment. Another remedy having this symptom very marked in Ocimum canum. This is a very useful remedy in renal colic and gravel. The patient has to micturate every few minutes, during which he wrings his hands and groans with pain. Nausea is often present. The quantity of sand deposited is very large. In cystitis, with a constant desire to urinate and dragging in the bladder, Sepia may prove useful; here it will be indicated by its general Symptoms. Vesicaria is recommended to favor expulsion of gravel and sand in urine, also Thlaspi bursa Pastoris.
The urine of Terebinth is one of its most characteristic features. It is smoky, turbid, depositing a sediment like coffee grounds, which indicates the presence of disintegrated blood cells. Haematuria from venous congestion of the kidneys calls often for Terebinth. It has burning during micturition and most painful strangury; the urine, too, may contain albumen and has the odor of violets. Peculiar odors to urine may be fond under the Viola tricolor, where it smells like that of the cat, and Benzoic acid, where it smells strong and ammoniacal,like that of a horse. Terebinth is a useful remedy in cystitis, with much tenesmus of the bladder and the scanty, bloody urine; there is also pressure in the bladder, which extends to the kidneys. In acute and chronic nephritis it is often indicated. The urine, oedema and the bronchial catarrh may all point to the remedy.