Urinary tract infection (UTI) is a common infection that usually occurs when bacteria enter the opening of the urethra and multiply in the urinary tract. The urinary tract includes the kidneys, the tubes that carry urine from the kidneys to the bladder (ureters), bladder, and the tube that carries urine from the bladder (urethra). The special connection of the ureters at the bladder help prevent urine from backing up into the kidneys, and the flow of urine through the urethra helps to eliminate bacteria. Men, women, and children develop UTIs.
Types
Urinary tract infections usually develop first in the lower urinary tract (urethra, bladder) and, if not treated, progress to the upper urinary tract (ureters, kidneys). Bladder infection (cystitis) is by far the most common UTI. Infection of the urethra is called urethritis. Kidney infection (pyelonephritis) requires urgent treatment and can lead to reduced kidney function and possibly even death in untreated, severe cases.

Incidence and Prevalence
Approximately 8 to 10 million people in the United States develop a UTI each year. Women develop the condition much more often than men, for reasons that are not fully known, although the much shorter female urethra is suspected. The condition is rare in boys and young men.

Twenty percent of women in the United States develop a UTI and 20% of those have a recurrence. Urinary tract infections in children are more common in those under the age of 2.

Causes and Risk Factors

Escherichia coli (E. coli) causes about 80% of UTIs in adults. These bacteria are normally present in the colon and may enter the urethral opening from the skin around the anus and genitals. Women may be more susceptible to UTI because their urethral opening is near the source of bacteria (e.g., anus, vagina) and their urethra is shorter, providing bacteria easier access to the bladder. Other bacteria that cause urinary tract infections include Staphylococcus saprophyticus (5 to 15% of cases), Chlamydia trachomatis, and Mycoplasma hominis. Men and women infected with chlamydia trachomatis or mycoplasma hominis can transmit the bacteria to their partner during sexual intercourse, causing UTI.

Sexual intercourse triggers UTI in some women, for unknown reasons. Women who use a diaphragm develop infections more often, and condoms with spermicidal foam may cause the growth of E. coli in the vagina, which may enter the urethra.

Urinary catheterization (i.e., insertion of a small tube into the bladder through the urethra to drain urine) can also cause UTI by introducing bacteria into the urinary tract. The risk for developing a UTI increases when long-term catheterization is required.

In infants, bacteria from soiled diapers can enter the urethra and cause UTI. E. coli may also enter the urethral opening when young girls do not wipe from front to back after a bowel movement.

Other risk factors include the following:

• Bladder outlet obstructions (e.g., kidney stones, BPH)
  Conditions that cause incomplete bladder emptying (e.g., spinal cord injury)
  Congenital (present at birth) abnormalities of the urinary tract (e.g., vasicoureteral reflux)
  Suppressed immune system
  Being uncircumcised

Certain blood types enable bacteria to attach more easily to cells that line the urinary tract, causing recurrent UTIs.

Signs and Symptoms

Symptoms of UTI in young children include the following:

• Diarrhea
  Excessive crying that cannot be resolved by typical measures (e.g., feeding, holding)
  Loss of appetite
  Fever
  Nausea and vomiting

Older children may experience the following symptoms with UTI:

• Flank or lower back pain (with a kidney infection)
  Frequent urination
  Inability to produce more than a small amount of urine at a time
  Incontinence
  Pain in the abdomen or pelvic area
  Painful urination (dysuria)
  Urine that is cloudy or has an unusual smell

Symptoms of lower UTI (e.g., cystitis, urethritis) in adults include the following:

• Back pain
  Blood in the urine (hematuria)
  Cloudy urine
  Inability to urinate despite the urge
  Fever
  Frequent need to urinate
  General discomfort (malaise)
  Painful urination (dysuria)

Symptoms that indicate upper UTI (e.g., pyelonephritis) in adults include the following:

• Chills
  High fever
  Nausea
  Pain below the ribs
  Vomiting

Complications
Hormonal changes and shifts in the urinary tract during pregnancy increase the risk for kidney infection. Prenatal care includes regular urine testing because bacteria are often present without causing symptoms and UTI during pregnancy may result in complications (e.g., premature birth, high blood pressure) for the mother and fetus. Diseases that suppress the immune system (e.g., HIV) and debilitating diseases (e.g., cancer, sickle cell anemia) increase the risk for UTIs and complications.


Diagnosis

A clean-catch urine specimen is obtained to diagnose UTI. This test involves cleansing the area around the urethral opening and collecting a mid-stream urine sample, preventing bacteria in the genital area from contaminating the sample. Urinalysis is performed to determine the level of white blood cells that destroy harmful bacteria (leukocytes) in the urine. A large number of these cells may indicate bacterial infection. A culture and sensitivity (induced growth of the bacteria) may be done to determine the type of bacteria and how to treat the infection.

Treatment

UTIs are treated with antibacterial drugs. The type of drug used and the duration of treatment depend on the type of bacteria. Most UTIs are treated with trimethoprim-sulfamethoxazole (e.g., Bactrim®, Cotrim®, Septra®), amoxicillin (e.g., Amoxil®, Trimox®), or fluoroquinolones (e.g., Levaquin®, Cipro®). The infection may improve within a couple of days, but 1 to 2 weeks of medication is may be prescribed to prevent a kidney infection.

UTIs that are caused by bacteria such as chlamydia trachomatis and mycoplasma hominis require a longer course of treatment with tetracycline (e.g., Achromycin®), trimethoprim-sulfamethoxazole, or doxycycline (e.g., Periostat®).

Infections complicated by bladder outlet obstructions (e.g., kidney stone, BPH) and other risk factors (e.g., spinal cord injury) may require surgery to correct the cause of UTI. Kidney infections may require hospitalization and as many as 6 weeks of antibiotic treatment to prevent serious kidney damage.

Over-the-counter pain relievers (e.g., Tylenol®, Advil®) and a heating pad may be used to relieve discomfort caused by UTI. Drinking plenty of water helps to cleanse bacteria out of the urinary tract. Coffee, alcohol, and smoking should be avoided.

Frequent UTI (3 or more per year) may be treated with low-dose antibiotics for 6 months or longer or with a 1 to 2 day course when symptoms appear.

Follow up urinalysis is performed after treatment to make sure that the urinary tract is bacteria free.

Prevention

The following measures can reduce the risk for UTI:

• Avoid products that may irritate the urethra (e.g., bubble bath, scented feminine products).
  Cleanse the genital area before sexual intercourse.
  Change soiled diapers in infants and toddlers promptly.
  Drink plenty of water to remove bacteria from the urinary tract.
  Do not routinely resist the urge to urinate.
  Take showers instead of baths.
  Urinate after sexual intercourse.
  Women and girls should wipe from front to back after voiding to prevent contaminating the urethra with bacteria from the anal area.

Naturopathic Treatment

The natural therapeutics outlined in this section may help patients get through an existing urinary tract infection (UTI) without antibiotics. Some doctors believe that antibiotics contribute to recurrent infections from increasingly resistant bacteria. Lifestyle precautions and supportive natural measures can help reduce recurrent urinary tract infections.

Alkalinize the Urine
Although some controversy remains concerning what pH level is most conducive to bacteria growth in the urinary tract, most evidence indicates that UTIs benefit from an alkaline pH. The easiest way to alkalinize the urine is with minerals, specifically potassium citrate and sodium citrate. All citrates encourage an alkaline shift; so patients already taking a calcium/magnesium supplement should switch to a calcium citrate/magnesium citrate preparation. Mineral supplements should be taken before bedtime, as urine that remains in the bladder during sleep may irritate the tissue and promote an infection.

Disinfect the Urinary Tract
Some herbs have been clinically shown to have antiseptic properties. Drinking these herbs in beverage form throughout the day may be beneficial.

Drinking at least 16 ounces a day of cranberry or blueberry juice (not the sugar-sweetened variety) can have a preventative and therapeutic effect. These juices have antibiotic properties that interfere with the ability of bacteria to adhere to the bladder or urethral tissue. Choose a juice sweetened with apple or grape juice.

Herbal Therapeutics
The following herbal remedies usually do not cause side effects when used regularly at the suggested doses. Rarely, an herb at the prescribed dose causes stomach upset or headache. This may reflect the purity of the preparation or added ingredients such as synthetic binders or fillers. For this reason, only high quality, standardized extract formulas are recommended.

If possible, consult with a natural health practitioner such as a holistic medical doctor or licensed naturopathic physician before beginning any alternative treatment plan. As with all medications, more is not better and overdosing can lead to serious illness and, in rare cases, death.

A naturopathic physician may prescribe that one of these herbal preparations be used 3 to 4 times per day during a urinary tract infection:

• Goldenseal root – This herb has a long and well-documented history as a powerful antimicrobial agent. Use as a tea made from 1 tsp of dried herb per cup of hot water; in capsule form (1000 mg); or as a tincture (1 to 2 teaspoons in warm water).
  Uva Ursi — Clinical research proves traditional use as an antiseptic with soothing and strengthening properties. Use as a tea made from 2 tsp of herb per cup of hot water; or as a tincture (1 to 2 teaspoons in warm water).

Other herbs to consider as tea:

• Cleavers (Galium aparine) has a long history of use in treatment of urinary infections.
  Marshmallow root (Althea officinalis) has very soothing demulcent properties. Best used in "cold infusion." Soak herb in cold water several hours, then strain and drink.
  Buchu is a soothing diuretic and antiseptic for the urinary system.
  Corn silk (Zea Mays) is a soothing diuretic.
  Horsetail (Equisetum arvense) is an astringent and mild diuretic with tissue-healing properties.
  Usnea Lichen is very soothing and antiseptic.

Also be sure to drink 2 to 3 liters of water daily.

Homeopathic Remedies

A trained homeopathic practitioner is required to diagnose and prescribe a deep acting, constitutional remedy. The following remedies may help to relieve some of the acute symptoms associated with urinary tract infections.

The standard dosage for acute symptom relief is 12c to 30c, 3 to 5 pellets, 3 or 4 times a day until symptoms resolve. If the chosen remedy is correct, symptoms should improve shortly after the first or second dose. Do not take any remedy longer than a day or two without consulting a homeopathic practitioner (naturopathic physician or medical doctor).

Warning: Most homeopathic remedies are delivered in a small pellet form that has a lactose sugar base. Patients who are lactose intolerant should be advised that a homeopathic liquid may be a better choice.

• Cantharis — for intolerable urging with burning, "scalding" urination
• Apis mellifica — for stinging pain that is worse with heat
• Staphysagria — for a UTI that is the result of sexual intercourse
• Sarsasparilla — for pain that burns after urination has stopped

Physical Medicine

Castor oil packs can be applied for UTIs that have associated bladder cramping or pelvic discomfort. Apply castor oil directly to the skin and cover with a soft piece of flannel and heat (hot water bottle) for 30 minutes to 1 hour. The anti-inflammatory action of castor oil aids in pain relief.
Sitz baths can be helpful if there is swelling or burning of the urethral opening. An infusion of golden seal is anti-microbial and soothing; the other herbs indicated will also be helpful

The above opinionated views and information serves to educated and informed consumer .  The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. .It should not replaced professional advise and consultation.A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions