URINARY TRACT INFECTION

INTRODUCTION-

Symptomatic presence of micro-organisms within the urinary tract i.e. your kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract – the bladder and the urethra. Infection limited to your bladder can be painful and annoying. Serious consequences can occur if a UTI spreads to your kidneys.Women are at greater risk of developing a UTI than are men.

CAUSES OF UTI-

• Main cause of UTI is bacteria which reside around anus during infection these bacteria can move to urethra further to bladder and spread into kidneys.
• Excessive use of spermicidal contraceptives like diaphragm and ointments.
• Sexual intercourse are also responsible for UTI.
• Unhygienic conditions increase the chances of urinary tract infections
• Hospitals are also major cause of urinary tract infections.
• Some complications such as spinal cord injury and early menopause are also associated with UTI

PATHOGENESIS-

Four routes of bacterial entry to urinary tract-

1. ASCENDING INFECTION-

• It is a most common route.
• Organisms ascend through urethra into bladder

2. HEMATOGENOUS SPREAD-

• Blood borne spread to kidney
• Occurs in bacteraemia mostly S.aureus

3. DIRECT EXTENSION FROM OTHER ORGANS-

• Pelvic inflammatory diseases
• Genito-urinary tract fistulas

4. LYMPHATOGENOUS SPREAD

• Men -Through rectal and colonic lymphatic vessels to prostrate and bladder.
• Women-through periuterinelymphatics to urinary tract.

SIGN AND SYMPTOMS-

• Urgent and strong need to urinate
• burning sensation during urination
• pressure in the lower pelvis
• increase frequency of urination
• passing small amounts of urine
• incomplete feeling after urination
• Painfull urination (dysuria)
• cloudy appearance of urine
•  blood in the  urine that appears red, bright pink or cola-colored 
• There is a Strong-smell in urine
• High grade fever and mental changes
• Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone

Types of urinary tract infection

Each type of UTI may result in more-specific signs and symptoms, depending on which part of your urinary tract is infection

Kidneys (acute pyelonephritis)

• Upper back and side (flank) pain
• High fever and chills
• Suprapubic tenderness
• White blood cell casts in urine 
• Shaking and chills 
• Nausea  and Vomiting

Bladder (cystitis)

• lower Pelvic pressure
• Lower abdomen discomfort 
• Frequent and painful urination
• Blood in urine

 Urethra (urethritis) 

• Burning sensation during urination
• vaginal Discharge

RISK FACTORS –

Aging 

• Diabetes mellitus
• Impaired urine system
• Urine retention

Females

• Shorter urethra
• Use of Contraceptives
• After menopause
• Incomplete bladder emptying with age
• Sexual intercourse

Males

• prostatic hypertrophy
• Bacterial prostatis

Other-

• Use of catheter
• Pelvic region surgery
• Suppressed immune system
• Blockage in urinary tract
• Urinary tract abnormalities

DIAGNOSTIC CRITERIA-

• Urine culture test
• Imaging techniques like CT scan and MRI
• Analyzing a urine sample
• Microscopic examination of urine
• Ultra sound

LINE OF TREATMENT-

IN MODERN SCIENCE-

Symptomatic UTI- give an antibiotic therapy-

• Trimethoprim/sulfamethoxazole (Bactrim, Septra, others)
• Fosfomycin (Monurol)
• penicillins and cephalosporins
• Nitrofurantoin (Macrodantin, Macrobid)
• Cephalexin (Keflex)
• Ceftriaxone

Asymptomatic UTI-

• No treatment required except in special situations

Frequent infections-

If you have frequent UTIs, your doctor may make certain treatment recommendations, such as:

• Take Low-dose antibiotics, initially for six months but sometimes longer
• Self-diagnosis and treatment, if you stay in touch with your doctor
• A single dose of antibiotic after sexual intercourse if your infections are related to sexual activity
• Vaginal estrogen therapy if you’re postmenopausal

Non specific therapy-

• More water intake
• Maintaining acidity of urine by fluids like canberryjuice

Anti microbial therapy-

• Elimination of infection
• Relief of acute symptoms
• Prevention of recurrence and long term complications.

AYURVEDA APPROACH-

In Ayurveda it is believed that there are three energies vata, pitta and kapha in the body which are responsible for the good health. UTIs are due to the imbalance of tridoshas. As per Ayurveda UTI comes under “mutravaha srotas’’ roga. These infections cause inflammation, itching and pain in urinary tract. There are various herbs present in Ayurveda which helps in UTI.

 Examples-

• Tribulusterestris (Gokshura)
• Boerhaaviadiffusa ( Punarnnava) 
• Asparagus racemosus (Shathavari)

CHIKITSHA SUTRA-

1. Internal use of medicated ghees and oils –

• This procedure has ability to transport therapeutically effective components to different tissues   of Urinary Tract. 
• Herbal /medicated oil and ghees are also helps in achieving tone and neurological control of bladder musculature.

2. Vamana Karma–

• This procedure done only in kapha predominant conditions.

3. Virechana /purgation therapy–

• Virechna karma is a cleansing procedure. 
• This is a most significant step of UTI treatment.
• It is performed by giving some purgative herbs.
• It helps to eliminate pathways of Vatha humor and alleviates Pitta predominant symptoms.

4. Steaming /heating procedures-

• In Pitta predominant conditions, steaming is not required.

5. Basti/ Medicated enema-

• This procedure is useful in cleaning the urinary tract.
• It is most effective in Ayurvedic treatment bringing cleansing of channels or srothas spread all over the body. 
• This is very effective in aggravated Vatha through removal of blockage in pathways of vatha humor thus enable us to calm Vatha aggravation. 

6. Uttara basti-

• This is different from common vasthi in the way of administration, quantity and in ingredients.
• Medicine is applied to urinary bladder through urethral route. 
• Uttarbasti is more effective treatment in chronic UTI.

YOGA-

• Bhujangasana
• Surya namaskar
• Dhanurasana

HOME REMIDIES FOR UTI–

• Drinking sufficient quantities of water should become a habit. 
• Take vitamin-C enrich diet.
• Wear cotton and loose fitting innerwear and clothing.
• Applying a heat pad to the bladder or pubic area can help to relieve pain and discomfort temporarily.
• Use dry clothes after bath.
• Women should follow good personal hygiene practices especially during menses.
• Take probiotics
• Urinate when needs arries.
• Consume cranberry juice
• Change menstrul pads, tampons and menstrual cups frequqntly.