A urinary tract infection, also called “cystitis” is a infection which can affect one or more parts of the urinary system: the kidneys, ureters, bladder and urethra. It is most often manifested by pain or a burning sensation during urination (= the emission of urine), sometimes with abdominal pain and fever.

Here are the main functions of the different parts of the urinary system:

• The waist ensure blood filtration. They allow the elimination of waste and also play an important role in the regulation of body fluids and blood pressure.
• The ureters are small channels that allow urine to pass from the kidneys to the bladder.
• La bladder acts as a urine reservoir.
• THEurethra leads urine from the bladder to the outside of the body.

The different types of urinary tract infections

There are 3 types of urinary tract infections, depending on the location of the infection.

Infectious cystitis, when the bacteria are found Escherichia coli in urine

By far the most common form of urinary tract infection, cystitis almost exclusively affects women. It is an inflammation of the bladder. Most often, inflammation is caused by the overgrowth of intestinal bacteria such as Escherichia coli, which are numerous around the anus. Bacteria pass from the anal and vulvar region to the bladder, ascending through the urethra. Anything that interferes with emptying the bladder increases the risk of cystitis because it increases urine retention and therefore bacteria growth time. Cystitis is always accompanied by urethritis, the inflammation of the urethra.

Infectious urethritis

If the infection affects only the urethra (the conduit that connects the bladder to the urinary meatus), it is called urethritis. These are often sexually transmitted infections (STIs) common in men. And women can suffer from it too. Different infectious agents can cause urethritis. The most common are chlamydia and gonococcus (the bacteria responsible for gonorrhea). In men, urethritis can be accompanied by prostatitis (infection of the prostate).

The pyélonéphrite

Pyelonephritis is a more serious condition. It refers to inflammation of the pelvis (the kidney cavity collecting urine) and the kidney itself. This usually results from a bacterial infection. It can be a complication of an untreated or badly treated cystitis which leads to the rise of bacteria from the bladder to the kidneys, and their proliferation there. Acute pyelonephritis occurs more often in women, and it is even more common in pregnant women. It is also common in children whose malformation of the ureters causes urine to flow back from the bladder to the kidneys. See more information on pyelonephritis. 

Most affected by urinary tract infections: men or women?

The frequency of urinary tract infections depends on age and gender.

Urinary tract infection in women

The women are much more affected than men, because the urethra of women, shorter than that of men, facilitates the entry of bacteria into the bladder. It is estimated that 20% to 40% of women in North America have had at least one urinary tract infection. Many women will contract more than one in their lifetime. About 2% to 3% of adult women are said to have cystitis each year.

Urinary tract infection in men

Young men are little affected by this condition, mature men with prostate problems are at greater risk.

As to children and, they are more rarely affected. About 2% of newborns and infants get urinary tract infections. It is mainly male babies who have a urinary tract abnormality that suffer from it. By the age of 6, 7% of girls and 2% of boys have had a urinary tract infection at least once¹⁹.

What are the causes of urinary tract infection?

Normally, urine is sterile. It contains 96% water, salts and organic components, but is free from microorganisms. The urinary system has many defenses against infections:

• le urinary flow expels bacteria and makes it more difficult for them to climb to the bladder and kidneys;
• theacidity urine (pH less than 5,5) inhibits the growth of bacteria;
• la very smooth surface of the urethra makes it difficult for bacteria to rise;
• la forms ureters and bladder prevent urine from flowing back to the kidneys;
• le immune system generally fighting infections;
• la bladder wall contains immune cells as well as antibacterial substances;
• in men, secretions prostate contain substances that slow the growth of bacteria in the urethra.

However, in case ofurinary tract infection, infectious agents (bacteria in most cases) manage to “colonize” the urinary system. The urine is then contaminated: it is by looking for the presence of bacteria in the urine that the doctor confirms the diagnosis of urinary infection. Bacterial contamination is often made easier by not drinking enough.

In over 80% of urinary tract infections, the causative organism is a intestinal bacteria Type Escherichia coli. Other bacteria frequently found are Proteus mirabilis, Staphylococcus saprophyticus, Klebsiella… Certain sexually transmitted infections (gonococcal, Chlamydiae) can also manifest as urethritis.

Very rarely, UTIs can be caused by bacteria that have spread to the urinary system from an infection elsewhere in the body.

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What are the possible complications of cystitis?

If theinfection left untreated, the infectious agent continues to multiply and invade the urinary tract. This can lead to a more serious kidney problem, such as pyelonephritis. Exceptionally, a urinary tract infection may worsen to the point of causing sepsis or kidney failure. In all cases, it is important to consult a doctor if there are signs of a urinary tract infection.

Most common symptoms

• benefits pain to burns in urinant.
• An unusually high frequency of urination during the day (sometimes the need to urinate also occurs at night).
• A persistent feeling of needing to urinate.
• Cloudy urine that gives off an unpleasant odor.
• A heaviness in the lower abdomen.
• Sometimes blood in the urine.
• No fever if it is a simple cystitis.

In the case of a kidney infection

• High fever.
• Chills.
• Severe pain in the lower back or abdomen or sexual organs.
• Vomitings.
• A deterioration of the general condition.
• Symptoms of cystitis (burning, frequent urination) may or may not be present. They are absent in 40% of cases²¹.

In children

In children, urinary tract infections can appear more atypical. Sometimes the cystitis causes fever without any other symptoms. A stomach ache and bedwetting (bedwetting) can also be signs of a urinary tract infection. In toddlers, the burning sensation when urinating can manifest as complaints or crying when urinating.

In newborns and infants, UTI is even more difficult to recognize. It is usually accompanied by fever, refusal to eat, and sometimes gastrointestinal disturbances and irritability.¹⁹.

In the elderly:

The symptoms of urinary tract infection can also be misleading: fever without other symptoms, urinary incontinence or digestive disorders (loss of appetite, vomiting, etc.).

• Women, especially those who are sexually active. The infection rate is 50 times higher than in men.
• Men with benign prostatic hyperplasia or prostatitis (inflammation of the prostate). As it grows in size, the prostate compresses the urethra, which slows down urine output, increases the risk of keeping some residual urine in the bladder after urination, and facilitates infections.
• Pregnant women are particularly at risk because of the pressure exerted by the baby on the urinary system, but also hormonal changes inherent in pregnancy.
• Women after menopause¹⁷, which are more prone to vaginosis, bacterial vaginal infections. In addition, the drop in estrogen levels associated with menopause contributes to UTIs.
• People with diabetes, because of the high sugar level in their urine, which is a favorable environment for bacterial growth, and their increased susceptibility to infections.
• People who have had a catheter inserted into the urethra. People who cannot urinate, who are unconscious or seriously ill often need a catheter while they recover their urinary function. Some people with nervous system damage will need it all their life. The bacteria then move up the surface of the flexible tube to the bladder and can infect the urinary tract. When contracted in hospital, these bacteria may have developed some resistance requiring the use of stronger antibiotics.
• People who have a structural abnormality of the urinary tract, who suffer from kidney stones or various neurological disorders.
• The elderly, who often combine several of the above factors (bed rest, hospitalization, urinary catheter, neurological disorders, diabetes). Thus, 25% to 50% of women and 20% of men over 80 are prone to frequent urinary tract infections.

In women

• Sex, especially if it is intense and frequent after a period of abstinence. This phenomenon is also described as ” honeymoon cystitis ».
• In some women using a diaphragm as a contraceptive method, the urethra will become compressed, preventing the bladder from emptying completely and making it easier for bladder infections.
• After having a bowel movement, wiping from back to front with toilet paper is a risk factor. the wiping movement should always be done from front to back so as not to contaminate the urethra with bacteria from the anus. In addition, the anal and genital areas should be cleaned carefully regularly, which helps to counter the proliferation of bacteria.
• In some women, the use of spermicides can cause urethritis.
• The time of menstruation is a risky period, as the blood from the napkins or tampons is an ideal culture medium for bacteria. It is therefore important not to keep these protections in place for too long.

At men’s

• Sodomy without condom increases the risk of becoming infected, as the bacteria involved are present in the anus.

Dr Catherine Solano intervenes in video to explain how to treat a urinary tract infection: 

What to do in case of mild urinary tract infections (urethritis, cystitis)?

The bacterial urinary tract infections can be treated quickly and easily usingantibiotics. For cases caused by the bacteria E. coli, the doctor uses a variety of antibiotics including amoxicillin (Clamoxyl®, Amoxil®, Trimox®), nitrofurantoin (Macrodantin®, Furadantin®) sulfamethoxazole combined with trimethoprim (Bactrim®, Eusaprim®, Septra®) and trimethoprim alone (Trimpex®, Proloprim®). The choice of antibiotic is made blind initially, then based on the results of the urinalysis as soon as they are available.

This can be given as a single dose or as a 3, 7 or 14 day regimen. In the majority of cases, a 3-day therapy is offered (trimethoprim-sulfamethoxazole). When the infection appears a few days after unprotected sex, the doctor will make sure that it is not a sexually transmitted infection (STI) (gonorrhea or chlamydia), which would justify special antibiotic treatment.

Once processed, symptoms usually go away within 24 to 48 hours, sometimes less. It is important, however, that the period of limitation be followed to the letter. If the antibiotic chosen is not effective after 48 hours, inform your doctor, who can then suggest another.

To promote the elimination of bacteria, it is also necessary to drink more than usual during the treatment. People who feel pain or a pressure in the lower abdomen can get relief by taking pain medication. You can also place a warm compress on the abdomen.

The pregnant women are systematically screened. It is indeed very important to detect the presence of a urinary tract infection during pregnancy and to treat it if necessary. In one third of cases, the infection can spread to the kidneys with the possibility of premature delivery or a low birth weight baby. The use of antibiotics that are safe for the mother and the fetus will be suggested even if the infection is not accompanied by symptoms.

What to do in case of severe urinary tract infections (pyelonephritis)?

Persistent cystitis

If symptoms of cystitis persist after 1 week despite a well-followed antibiotic treatment, it may be an infection antibiotic resistant common. This is often the case with infections acquired in a hospital environment, due to a urethral catheter or surgery, for example. Cystitis contracted outside hospitals is also increasingly resistant to antibiotic therapy. The doctor will then prescribe the appropriate antibiotics based on the results of a bacterial culture taken from a urine sample. It should be noted that the risk of infection acquired from a urethral catheter can be reduced by using a leak-proof and sterile urine collection system, antiseptic ointments and by taking short-term antibiotics.

Pyelonephritis (kidney infection)

Pyelonephritis can be treated with a high dose oral antibiotic, most often a fluoroquinolone (Oflocet®, Cipro®, Levaquin®, Oflox®…). The treatment will then be continued for 14 days (sometimes 7). In severe cases, hospitalization is necessary and antibiotics can be given by injection.

Prostatitis

At themen, a urinary tract infection which is accompanied by pain in the lower abdomen or fever may be complicated by prostatitis (diagnosed by a digital rectal examination performed by the doctor). This situation requires a 3 week course of antibiotics, with antibiotics similar to those used for pyelonephritis.

Obstruction of the urinary system

Rarely, the urinary tract infection can be related to a urinary tract obstruction. It’s about a medical emergency. The cause of the obstruction (enlarged prostate, anatomical abnormality, kidney stones, etc.), revealed by an ultrasound, must be taken care of quickly. An intervention allowing the drainage of the urine is necessary²¹.

See also our article “How to treat a urinary tract infection?”

Prevention

The following approaches can help prevent recurrence.

 Cranberry or Cranberry (Vaccinium macrocarpon). The cranberry has long been used for prevent urinary tract infections. A systematic review¹ published in 2008 and several randomized and controlled studies^2-5 carried out with women subject to recurrent cystitis indicate that the consumption of cranberry (or a dried fruit extract) reduces the relapse rate. In addition, the consumption of cranberry is safe during pregnancy²². According to studies, the recurrence rate would decrease by 35% over 1 year in young women. The preventive effectiveness of cranberry is, however, less evident in children, the elderly or patients with neurological disease²⁰.

Dosage

Taking cranberry must correspond to 36 mg of proanthocyanidin, its active principle, whatever its presentation: juice, concentrate, powder or capsules (Source: Dr Sophie Conquy. Recurrent cystitis and Cranberry, who, when, how? Nov 2006. Current questions .)

Drink 250 ml to 500 ml per day of juice cranberry or take, 2 times a day, the equivalent of 300 mg to 400 mg of solid extract in the form of capsules or tablets. You can also consume fresh or frozen fruits at a rate of 125 ml to 250 ml per day.

Notes. Prefer tablets of extract of cranberry or pure juice, because cocktails from cranberrycontain more sugar or fructose.

 Acupuncture. In 1998 and 2002, 2 randomized controlled studies conducted by Norwegian researchers found that acupuncture can help in the treatment of urinary tract infections in women who have it repeatedly.^8,9. Acupuncture would help patients to better empty their bladder and thus minimize the risk of bacterial infection.

 Vitamin C. In 2007, a clinical trial conducted among 110 pregnant women has shown the benefit of taking vitamin C (100 mg per day) during pregnancy to prevent urinary tract infections²³.

 echinacea (Echinacea sp.). Echinacea is recognized for its properties of stimulating the immune system, which have been demonstrated through numerous studies. So, Echinacea can help prevent UTIs by strengthening the immune system. The World Health Organization recognizes the use of the roots ofE. augustifolia and E. pallida as an adjunct to urinary tract infections. To prevent and treat recurrent infections, the German Commission E recognizes the use of aerial parts of theE. purpurea.

Dosage

Use internally. See the Echinacea fact sheet.

Processing

To increase urine flow

Therapyirrigation consists of drink large amounts of liquid (from 2 liters to 4 liters of liquid per day) with medicinal plants in infusion, to increase the urine flow and facilitate the expulsion of bacteria. Note that irrigation therapy is contraindicated in people who have an elimination problem characterized by water retention.

 Nettle (Urtica dioica). Commission E and ESCOP recognize the use of the aerial parts of nettle internally to irrigate the kidneys, bladder and urinary tract in the event of inflammation.

Dosage

Infuse 2 g to 5 g of dried nettle leaves and flowers, for 10 to 15 minutes, in 150 ml of boiling water. Take 3 times a day.

Cons-indications

Because nettle could have an abortive effect, it is contraindicated in cases of pregnancy, although no cases have been reported in humans and it has traditionally been given as a tonic to pregnant or breastfeeding women.

 Horsetail (Equisetum arvense). Herbalists use the aerial parts of the plant collected in the spring to improve circulation in the urinary tract in case of bacterial infections. The German Commission E recognizes the use of this plant to treat bacterial infections of the bladder and urethra. Field horsetail is attributed slightly diuretic virtues that come from the saponins it contains, which make it possible to evacuate bacteria more easily from the urinary tract. No clinical trials have been performed on humans to verify its effectiveness.

Dosage

Make an infusion by putting 2 g of aerial parts of field horsetail in 150 ml of boiling water. Let steep for 10 to 15 minutes. Drink a cup, 3 times a day.

 Goldenrod (Solidago virgaurea). This plant has the property of increasing urine volume by increasing blood flow and filtration of the kidneys. Commission E and ESCOP recognize its therapeutic utility for improving circulation in the urinary tract in cases of bacterial infections of the bladder or urethra.

Dosage

Infuse 3 g of aerial parts of goldenrod in 150 ml of boiling water for 10 to 15 minutes. Drink a cup of infusion 2 to 4 times a day between meals.

For their antibacterial effects

 Cranberry (Vaccinium macrocarpon). The only trials that focused on the actual treatment of cystitis with cranberry were conducted in the 1960s. The number of subjects was small and the protocols poorly described¹⁴. In addition, it seems that in some cases bacteria resist the action of cranberry¹⁵.

 Horseradish (Armoracia rusticana). Horseradish is found in Southeastern Europe and Western Asia, where it has been cultivated since time immemorial. Only studies carried out in Germany in the 1960s looked at the action of this plant on urinary tract infections and the antibacterial activity of the essential oils that compose it. Nevertheless, Commission E recognizes its effectiveness as adjunctive treatment for urinary tract infections. In the United States, horseradish roots are used in Rasapen®, an antiseptic drug prescribed for urinary tract infections. In addition, the FDA recognizes the safety of this plant.

Dosage

Infuse 2 g of fresh or dried horseradish roots in 150 ml of boiling water for 5 minutes. Drink several times a day.

Cons-indications

Horseradish is not recommended for pregnant or breastfeeding women, people with peptic ulcers and those with kidney problems.

 Grape bears (Arctostaphylos uva ursi). According to studies in vitro, the leaves of uva ursi, also called bear grape, would have an antibacterial action. In North America, First Nations used it to treat cystitis. The main active element of this plant is said to be hydroquinone, a metabolite of arbutin. Thus, it is the hydroquinone which would act asantiseptic in the urinary tract. Commission E and ESCOP approve the use of uva ursi leaves in the treatment of uncomplicated infections of the bladder and urethra.

Dosage

Infuse 3 g of uva ursi leaves in 150 ml of boiling water for 15 minutes. Consume 4 times a day with food, resulting in a daily arbutin intake of 400 mg to 840 mg.

Cons-indications

Uva ursi is contraindicated in pregnant or breastfeeding women and children under 12 years of age.

Notes. Due to the toxicity of hydroquinone, uva ursi should not be used long term (do not exceed a few weeks). In addition, uva ursi would be more effective when the urine is alkaline. Do not combine taking uva ursi with juice cranberry or vitamin C supplements, which would make it less effective.

 Hydraste du Canada (Hydrastis canadensis). Goldenseal is renowned for its action against urinary tract infections. It contains berberine, an alkaloid that concentrates in the bladder²². Its antibacterial action is said to result from its ability to prevent bacteria from adhering to the bladder wall rather than killing infectious agents, as antibiotics do. Similar to uva ursi, the effectiveness of this herb is at its best when urine is alkaline.

Dosage

See the Goldenseal sheet.

Cons-indications

Pregnant and nursing women should avoid consuming goldenseal, according to some authors.

Notes. Limit the duration of treatment to around 2 weeks.

To strengthen the immune system

 echinacea (Echinacea sp.). Echinacea is recognized for its immune system stimulating properties, which have been demonstrated through numerous studies. Thus, Echinacea can help fight UTIs by strengthening the immune system. The World Health Organization recognizes the use of the roots ofE. augustifolia and E. pallida as an adjunct to urinary tract infections. To prevent and treat recurrent infections, the German Commission E recognizes the use of aerial parts of theE. purpurea.

Dosage

Use internally. See the Echinacea fact sheet.

 Food. In naturopathy, we note the importance of a diet excluding sugars (and therefore sugars) to promote healing or prevent recurrence.¹⁶. According to this form of medicine, it is possible that food allergies or nutritional deficits feed the recurring nature of UTIs. Consult a naturopath for a personalized assessment.

The influence of diet on urinary tract infections is currently being studied. The foods we eat influence the composition of the stool in bacteria, often involved in urinary tract infections. Thus, researchers believe that it would be possible to reduce the risk of urinary tract infection by eating differently.

The probiotics, these beneficial bacteria for the intestinal and vaginal flora, arouse interest in preventing recurrent urinary tract infections¹³. In 2005, for example, a trial of 453 women with cystitis showed that consuming probiotics for 90 days reduced the rate of urinary tract infections by 34% over 1 year.²⁴. Conversely, other studies have shown a lack of efficacy of probiotics. The data are therefore still insufficient.

In addition, a study carried out in 2007 showed that the high meat consumption (especially poultry) could play a role in the occurrence of urinary tract infections resistant to antibiotics. The bacteria present in meat, often resistant, could thus contribute to contaminate the urinary tract.²⁵.

 Chinese Pharmacopoeia. In Traditional Chinese Medicine, the preparations Dao Chi San et Huang Lian Jie Du Wan are used to fight urinary tract infections, especially cystitis. Consult the sheets of the same name in the Chinese Pharmacopoeia section.

Canada

Born and grow.com

To find reliable information on urinary tract infection and on appropriate treatments for children, the Naître et grandir.net site is ideal. It is a site dedicated to the development and health of children. The disease sheets are reviewed by doctors from the Hôpital Sainte-Justine in Montreal and the Center hospitalier universitaire de Québec.

www.naitreetgrandir.com

Quebec government’s Health Guide

To learn more about drugs: how to take them, what are the contraindications and possible interactions, etc.

www.guidesante.gouv.qc.ca

United States

American Foundation for Urologic Disease

www.afud.org

National Kidney and Urologic Diseases

www.niddk.nih.gov