Urinary Tract Infections (UTI)

Introduction

What Should I Know about UTI?

Urinary tract infections are one of the most commonly occurring bacterial infections in medicine today and account for 7 million patient visits annually. (1) It is estimated that 20% of women will suffer with symptoms of a urinary tract infection some time in their lives, with many having more than one. (2) Infections of the urinary tract cover a wide variety of syndromes including urethritis, cystitis, prostatitis, and pyelonephritis.

Under normal circumstances, the urinary tract is pretty resistant to infection by bacteria. This is partly because of the very nature of urine itself. Urine has a very low pH, which along with its high concentration of urea and the manner in which it sets up or crosses membrane barriers, allows it to kill or at least slow the growth of many organisms. There are several ways in which professionals classify UTI’s. One of these methods simply refers to where the infection is. Lower urinary tract infections include cystitis (bladder), urethritis (urethra), prostatitis (prostate gland), and epididymitis. Pyelonephritis is considered an upper urinary tract infection and involves the kidneys.

Another way to classify them is as either complicated or uncomplicated. Uncomplicated urinary tract infections involve a patient who lacks structural or functional abnormalities that interfere with normal urine flow. These infections occur most frequently in women of child bearing age who are otherwise healthy individuals. Complicated UTI's, on the other hand, are the result of something structural or functional such as a birth defect, an injury, a stone or obstruction, to name a few. When these and other conditions interfere with the normal flow of urine, then the condition is considered to be complicated. Complicated infections occur in both genders and frequently involve the upper and lower urinary tract. (3)

UTI's are disorders involving a repeated or prolonged bacterial infection of the bladder or lower urinary tract. Most urinary tract infections occur in the lower urinary tract, which includes the bladder and urethra. Cystitis occurs when bacteria, along with the accompanying inflammation infect the lower urinary tract which is normally a sterile environment. If an individual has frequent infections or if the infection does not respond to treatment, then the condition is considered chronic. Chronic or recurrent urinary tract infections include repeated episodes of cystitis, or urinary tract infections that do not respond to usual therapies or that last longer than two weeks. UTI's are most common in women; however, men and children may experience them as well.

About one in every five women will experience a UTI at least once in their lifetime, and many will have recurring infections. Also, the elderly population is at an increased risk for developing cystitis due to incomplete emptying of the bladder associated with many of the conditions that accompany aging. Also, a lack of adequate fluids, bowel incontinence, immobility or decreased mobility, and placement in a nursing home, all place the person at increased risk for developing cystitis. (4)

The majority of UTI's are caused by a single organism, however in complicated urinary tract infections, more than one organism may be the problem. There are several ways in which the bacteria can enter into the urinary tract with the ascending route being the most common. The source of those bacteria can be from fecal material, use of spermacides, and the use of diaphragms as contraception. (5) The fact that UTI's are more common in females than males due to the anatomic differences in location and length of urethra seems to support the theory that the ascending route is the most common acquisition route.

Descending (Hematogenous) spread is another route by which infection of the kidney may occur. This generally occurs as a result of the spread of germs from a distant site of infection. Infections involving the descending route are relatively rare and account for less than 5% of UTI's that actually get reported.

A third route that has been proposed is through the lymphatic system. While there are lymphatic communications between the bowel and kidney, as well as the bladder and kidney, there is currently no scientific proof that bacteria come through this route. Once bacteria reach the urinary tract, three factors usually determine whether or not infection will follow. Those are: size of the bacteria, strength of the bacteria present, and how strong the body’s defense mechanisms are at the time. Most infections occur because the body is not able to defend itself.

When the bacteria invade the bladder, the bladder wants to empty immediately. If the individual is not able to completely empty their bladder, they have a greater risk of getting an infection. In fact even the slightest amount of residual urine in the bladder makes the infection more difficult to treat successfully. Normally the cells in the bladder are coated with a marvelous mucus called glycosaminoglycans which keep the bacteria from sticking to the cells in the bladder so the bacteria cannot set up house. If that layer of mucus is removed, the bacteria move in and grow rapidly.

Another amazing feat of the defense mechanism of the bladder is known as Tamm-Horsfall protein. This protein is secreted into urine and contains residues which bind with the hair like projections of bacteria and then the bacteria is washed out with urine flow.

Some invading bacteria have rigid hair like "arms" on their cell wall which is very strong and resists all of the body’s efforts to remove it. With this type of bacteria, the infection can grow and invade other tissues like the kidneys.

Statistic

National Institute of Diabetes and Digestive and Kidney Diseases, 1999.

    Each year, urinary tract infections (UTIs) account for about 9.6 million doctor visits. Women are especially prone to UTIs for reasons that are poorly understood. One woman in five develops a UTI during her lifetime. UTIs in men are not so common, but they can be very serious when they do occur. Nearly 20 percent of women who have a UTI will have another, and 30 percent of those will have yet another. Of the last group, 80 percent will have recurrences.

American Society for Microbiology, 2002.

  • There are an estimated 150 million urinary tract infections per annum worldwide.

Signs and Symptoms

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Lower urinary tract infection symptoms may or may not precede those of upper urinary tract infection, but often occur 1-2 days prior to symptoms of an upper UTI. Increased pain and fever are a sign that the infection has gone untreated and it needs attention.

Lower Urinary Tract Infections

  • Trips to the restroom for urination are hurried and necessary
  • Increase in the number of trips to the restroom at night
  • Increased difficulty in starting the urine stream
  • Painful, difficult urination (dysuria)
  • A feeling of heaviness in the lower abdomen or pubic area

Upper Urinary Tract Infections

  • Pain in the lower back
  • Tenderness in the rib area
  • Abdominal pain
  • Fever
  • Nausea and vomiting
  • Tiredness

Treatment Options

Conventional

The goals of treatment are to 1.) prevent or treat the symptoms, 2.) eradicate the invading organism, and 3.) prevent reoccurrence of infection. The type of antibiotic prescribed should be easy to tolerate, have a history of success with the microbe in question, be well absorbed and be able to concentrate at high levels in the urine. The initial selection of antibiotic is usually based on the signs and symptoms, site of infection, and whether the infection is determined to be uncomplicated or complicated.

The physician may prescribe one of the following drugs as treatment.

    Trimethoprim-sulfamethoxazole Penicillin Quinolones Nitrofurantoin Azithromycin Fosfomycin Methenamine hippurate/mandalate Cephalosporins Tetracyclines

Nutritional Suplementation


Vitamin A

Vitamin A plays a role in the maintenance of healthy epithelial cells, such as those in the bladder, and helps facilitate effective barriers against infection. (6) Adequate intake of vitamin A has even demonstrated a reduced risk to various epithelial-cell cancers, including that of the bladder. (7) , (8)


Vitamin C

The first evidence of vitamin C’s antibacterial activity was published back in 1937, where it was reported that vitamin C inhibited the growth of the tuberculosis bacterium. (9) In the classic book titled The Healing Factor: Vitamin C against Disease, Irwin Stone, M.D., reported the effectiveness of ascorbic acid against numerous types of bacteria. (10)

Herbal Suplementation


Uva Ursi

Uva ursi has been used worldwide as a diuretic, astringent, and antiseptic for centuries. It has historically been recommended for nephritis, kidney stones, cystitis, and as a tonic for the liver. (11) Its antiseptic activity is claimed to soothe the membranes of the urinary tract in much the same manner as phenazopyridine.

Certain properties in the plant are believed to contribute in making the urine alkaline.


Cranberry

Cranberry fruit juice is for individuals with urinary tract infections, with research supporting its uses. (12) , (13) Cranberry is a close relative of the American blueberry and European bilberry. It has been used for centuries in cooking and as a garnish. In the United States, cranberry has been used to prevent kidney stones, as well as to remove unwanted toxins from the body. (14) As early as the 1840's, German researchers were examining the connection between using the cranberry and the incidence of UTI. Researchers thought that cranberry worked for UTI by acidifying the urine, preventing the bacteria from growing. In 1984, a researcher reported that cranberry does not acidify the urine sufficiently to produce an antibacterial effect in the bladder. (15) Instead, cranberry prevented E. coli from adhering to the cells lining the bladder wall, thus preventing infection. (16) Studies also report that other members of the Vaccinium genus have similar properties, including bilberry and blueberry. (17)


Grapefruit Seed

Grapefruit seed extract has been reported to be a broad-spectrum antimicrobial. Studies indicate that the antimicrobial activity of grapefruit seed extract exists in how it keeps the bacteria from breathing long enough to cause death. (18)


Olive Leaf

Olive leaf extract has been reported to be an effective antimicrobial agent against a wide variety of pathogens, including Salmonella typhi, Vibrio parahaemolyticus and Staphylococcus aureus (including penicillin-resistant strains), Klebsiella pneumonia, and Escherichia coli, causal agents of intestinal or respiratory tract infections in man. (19) The component usually associated with olive leaf’s antimicrobial properties is oleuropein. (20) , (21)

References

  1. View Abstract: Bacheller CD, Bernstein JM. Urinary tract Infections. Med Clin North Am. 1997;81:719-729.
  2. View Abstract: Plumridge RJ, Golledge CL. Treatment of urinary tract infection: Clinical and economic considerations. Pharmacoeconomics. 1996;9:295-306.
  3. DiPiro JT, et al. Pharmacotherapy, A Pathophysiologic Approach fourth edition. Appleton and Lange. Stamford, Connecticut.1999;1779-1794.
  4. View Abstract: Lara LL, Troop PR, Beadleson-Baird M. The risk of urinary tract infection in bowel incontinent men. J Gerontol Nurs. May1990;16(5):24-6.
  5. View Abstract: Bacheller CD, Bernstein JM. Urinary tract Infections. Med Clin North Am. 1997;81:719-729.
  6. View Abstract: Bennett RT, Mazzaccaro RJ, Chopra N, Melman A, Franco I. Suppression of renal inflammation with vitamins A and E in ascending pyelonephritis in rats. J Urol. May1999;161(5):1681-4.
  7. View Abstract: Clamon GH. Retinoids for the prevention of epithelial cancers: current status and future potential. Med Pediatr Oncol. 1980;8(2):177-85.
  8. View Abstract: Clifford JL, Sabichi AL, Zou C, et al. Effects of novel phenylretinamides on cell growth and apoptosis in bladder cancer. Cancer Epidemiol Biomarkers Prev. Apr2001;10(4):391-5.
  9. Boissevain CH, Spillane JH. Effect of synthetic ascorbic acid on the growth of tuberculosis bacillus. 1937;35:661-662.
  10. Stone I. The Healing Factor: Vitamin C against Disease. New York: Grosset and Dunlap. 1972.
  11. Newall CA, et al. Herbal Medicines: A Guide for Health Care Professionals. London: The Pharmaceutical Press. 1996;258-59.
  12. Leaver RB. Cranberry Juice. Prof Nurse. 1996;11(8):525-26.
  13. View Abstract: Nazarko L. Infection Control. The Therapeutic Uses of Cranberry Juice. Nurs Stand. 1995;9(34):33-35.
  14. Leung A. Encyclopedia of Common Natural Ingredients Used in Foods, Drugs, and Cosmetics. New York: Wiley-Interscience Publication. 1996;50-53.
  15. View Abstract: Schmidt DR, et al. An Examination of the Anti-adherence Activity of Cranberry Juice on Urinary and Nonurinary Bacterial Isolates. Microbios. 1988;55(224-225):173-81.
  16. View Abstract: Zafriri D, et al. Inhibitory Activity of Cranberry Juice on Adherence of Type 1 and Type P Fimbriated Escherichia coli to Eucaryotic Cells. Antimicrob Agents Chemother. 1989;33(1):92-98.
  17. Ofek I, et al. Anti-Escherichia coli Adhesion Activity of Cranberry and Blueberry Juices. Adv Exp Med Biol. 1996;408: 179-83.
  18. Ionescu G, et al. Oral Citrus seed extract. J Orthomolecula Med. 1990;5(3):72-74.
  19. View Abstract: Bisignano G, et al. On the in-vitro antimicrobial activity of oleuropein and hydroxytyrosol. J Pharm Pharmacol. Aug1999;51(8):971-4.
  20. View Abstract: Bisignano G, Tomaino A, Lo Cascio R, Crisafi G, Uccella N, Saija A. On the in-vitro antimicrobial activity of oleuropein and hydroxytyrosol. J Pharm Pharmacol. Aug1999;51:971-4.
  21. View Abstract: Coni E, Di Benedetto R, Di Pasquale M, et al. Protective effect of oleuropein, an olive oil biophenol, on low density lipoprotein oxidizability in rabbits. Lipids. Jan2000;35:45-54.