Urinary Tract Infection

UTIs are one of the most common bacterial infections encountered in out-patients and General Practitioners. UTIs are considerably more common among women, and nearly half of all women will experience a UTI during their lifetime.

A UTI typically forms when bacteria, or fungi, enter the urinary tract through the urethra. UTIs can also occur in association with the use of urinary catheters, which are medical devices that drain the bladder when a person is not able to get up and use a bathroom.

There are various forms of bacteria that can cause UTIs, with Escherichia coli (E. coli) being the most common. Less commonly, fungi (esp. Candida species) may also be the cause of UTIs. Fungal infections are more frequent in hospital settings or in individuals with predisposing diseases and/or structural abnormalities of the urinary tract.

The bacteria that causes UTIs are similar to those naturally found in the colon and other areas of the body, but they have some characteristics that allow them to cause UTIs. One of the most important characteristics, especially in the case of E. coli, is the ability of these bacteria to adhere to the mucous membranes in the urinary tract.

The mucous membranes of the lower urinary tract contain a variety of molecules, which includes mannose, a sugar. Strains of E. coli can adhere (or attach) to these mannose molecules using small projections, called fimbriae. This binding between the molecules prevents bacteria from being cleared from the urinary tract by the flow of urine, which is normally a deterrent to bacterial colonisation. Once the bacteria have bound to the cells that line the urinary tract, they can then invade these cells. This process also helps the bacteria to avoid being killed by antibiotics or the immune system.

In women, symptomatic UTIs are typically caused by the spread of potentially pathogenic bacteria from the bowel to the urinary tract. Although UTIs can occur in anyone, certain factors increase risks which include:

• family and personal history of UTIs,
• sexual intercourse,
• female gender,
• pregnancy,
• allergies,
• diabetes,
• abnormalities in the flow of urine,
• sustained urinary catheterization, incontinence,
• low oestrogen levels, and
• antibiotic use.

The majority of females will report having had a UTI by 32 years of age, and they are more common in Woman because:

(1)Women have shorter urethras than men. This makes it easier for bacteria to access their bladders causing potential infection;

(2)The urethral opening is closer to the external genitalia and anus. This biological fact can cause the increased risk of bacterial cross-contamination.

Sexual intercourse is a risk factor for UTI development. This risk factor is particularly true for women that have sexual intercourse more than once per week. Women that make use of diaphragms for their contraception method also have an increased risk of developing UTIs. A new sexual partner in the past year is another sexually related risk factor for UTI in women.

• Family History: If you have one, or more, first-degree female relatives (mother or sister) with a history of UTIs it can increase the personal risk of infection.
• Personal History: Having a personal history of UTIs, either recurrent or otherwise, is another major risk factor for the development of a subsequent UTIs.
• Pregnancy: Women that are pregnant appear to have an increased the risk that a UTI will spread and cause kidney infection which has associated symptoms of fever, chills, and flank pain. This is because pregnancy can cause hormonal changes, as well as a shift in the position of the urinary tract, which makes it easier for bacteria to spread to the kidneys.
• Allergies: Women who are allergic to certain compounds that may come in contact with the genital area, such as bubble baths, vaginal creams, and soaps may be at greater risk of developing UTIs. This is because irritation of this sensitive region may allow bacteria access to the urinary tract and spread.
• Diabetes: Patients being treated for diabetes have an increased risk of developing bacteria in the urine that does not cause symptoms UTIs, and kidney infection. Diabetes causes the patient’s immune system to be impaired and makes it harder for the body to fight off infections. In addition, to the more common UTIs caused by E. coli, people with diabetes are also more likely to acquire UTIs caused by other bacteria, including Klebsiella and group B Streptococcus.
• Urinary Flow Abnormalities: If there are disruptions in the urinary flow it can also predispose people to UTIs. In children, anatomical abnormalities that affect the urinary tract can lead to recurring urinary tract infections. If there are anything else that blocks the flow of urine, such as kidney stones, a narrow urethra, or an enlarged prostate, it can also increase the risk of UTI.
• Urinary Catheters: People who require a urinary catheter have a higher incidence of UTI. This is because the use of a urinary catheter disrupts the body’s natural defence against bacterial infections and provides an easier route by which bacteria can travel to the bladder. It is highly recommended that urinary catheters be used for the shortest possible time to reduce the risk of UTIs.
• Incontinence: Incontinence is associated with an increase in UTIs as well as acute kidney infections.
• Low Estrogen Levels: The risk of UTI increases after menopause as hormonal levels of oestrogen drops in the body drop. Oestrogen is responsible for maintaining the health of vaginal walls. Thus when oestrogen levels are low, either due to menopause, surgery, or congenital problems, vaginal walls become thin, and this increases susceptibility to invading bacteria which can lead to UTIs. Some studies have found that hormone balancing with oestrogen prescriptions, such as creams and vaginal rings, may help prevent UTIs.
• Antibiotic Use: Patients who have taken antibiotics recently (or on a regular basis) may have an increased risk of developing a UTI. Antibiotics deplete the urinary tract of the beneficial bacteria Lactobacilli, which are protective against E. coli and other infectious bacteria.

A variety of signs and symptoms may suggest lower and/ or upper urinary tract infection, which include various elements:

1) Cystitis involves the lower urinary tract. Typical signs/ symptoms include:

• The need to urinate more frequently
• Cloudy, red, pink, or dark-coloured urine
• Discomfort or pressure in the lower abdomen
• Urine with a strong odour
• Pain in the pelvic area (women) or rectum (men)
• Fever.

2) Pyelonephritis is a serious infection involving the upper urinary tract (kidneys). Signs/ symptoms of pyelonephritis include:

• Flank/Abdominal pain
• High Fever
• Chills
• Vomiting
• Frequent/Painful urination

Pelvic pain, urinary urgency, and night-time urination are often associated with UTI. However, these symptoms may be the result of a different, somewhat more obscure condition called Interstitial Cystitis or, sometimes, Painful Bladder Syndrome.

As is the case with UTIs, interstitial cystitis affects women more often than men and can considerably decrease quality of life. Unfortunately, opinions about interstitial cystitis, and the techniques used to diagnose and treat it, are somewhat inconsistent within conventional medicine. This can often lead to delayed diagnosis in many cases.

• One reason for this is that a specific cause has not been identified.
• Upon examination, bacteria are not present in the urine of those with interstitial cystitis.
• Inflammatory damage to the bladder lining and some level of immune system derangement are thought to be involved, but the origins of these phenomena are unclear.

Since very little is understood about the development of interstitial cystitis, protocols for its treatment lack a robust evidence base and often hinge upon physicians’ clinical experience or data from relatively small clinical trials. Once a patient has been diagnosed with interstitial cystitis, which can only be accomplished by ruling out other causes of symptoms since no laboratory test can identify the condition, physicians may prescribe a number of treatment therapies, including:

• DMSO (injected into the bladder)
• Some antidepressants (eg amitriptyline)
• Antihistamines
• Behavioural therapy (eg, retraining voiding patterns)
• Pentosan polysulfate sodium (Elmiron®)
• Transcutaneous electrical nerve stimulation (TENS)
• Intra-vesical lidocaine (ie, injection of the local anaesthetic lidocaine into the bladder)
• Corticosteroids, and many others
Despite the fact that an estimated 180 different strategies have been tried as potential treatments for interstitial cystitis, only very few have been shown to be effective. One such drug is pentosan; it is FDA-approved to treat interstitial cystitis and is marketed under the brand name Elmiron®. Pentosan is thought to work by supporting the integrity of the urothelial layer in the bladder.

UTIs can be difficult to diagnose in some cases since patients do not always have typical symptoms. Also, there are various other conditions that have symptoms which are similar to those of UTI (i.e. gonorrhea, chlamydia, interstitial cystitis, and diabetes).

1. If there is a presence of red or white blood cells, bacteria or other certain chemicals in the urine, it usually indicates a UTI presence.

2. In most cases, a urine dipstick test is used to confirm the diagnosis of UTI in individuals with suggestive symptoms. This test evaluates a urine sample to detect nitrites, which are chemicals produced by E. coli, a bacteria that can cause UTIs. In additional, it also measures levels of proteins produced by immune cells responding to the infection.

3. In some complicated cases, a urine culture may be used to help guide treatment.

Doctors commonly prescribe powerful antibiotics to treat UTIs, and individuals with recurrent UTI may be prescribed a longer course of treatment to alleviate symptoms. Continued antibiotic use may lead to the emergence of antibiotic-resistant bacterial strains, which can cause UTIs that are more serious and difficult to treat. Probiotics appear to have the advantage of not increasing the risk of antibiotic-resistant microorganisms, it is therefore advised that patients take probiotics in conjunction with antibiotics.

No single antibiotic is recommended for treating every UTI, but nitrofurantoin, trimethoprim-sulfamethoxazole (Bactrim™), fluoroquinolones, and beta-lactam (eg, Augmentin®) may all be used.

Although there is a wide choice of antibiotics that can be prescribed to treat UTIs, one of the main factors that determine which antibiotics are chosen is the bacterial resistance pattern of the infection. There are certain strains of E. coli that are resistant to antibiotics and are found throughout the world.

Other strains of bacteria that cause UTIs, including species of Proteus and Klebsiella, may have also developed resistance to specific antibiotics. As a result, the choice of antibiotic prescribed is usually governed by susceptibility of the pathogenic organism responsible for an individual’s case and/or community history of microbial antibiotic resistance. Some guidelines recommend avoiding a particular antibiotic if local resistance rates to that antibiotic are greater than 20%.

Scientific studies suggest certain natural compounds such as those found in extracts of Hibiscus sabdariffa and cranberry may reduce adherence of bacteria to the urinary tract, thereby reducing UTI recurrence. One of the advantages of using cranberry juice, or related products such as the actual berry (or dried version), is that cranberries are relatively inexpensive, easily obtainable, natural, and it should not contribute to the growing problem of antibiotic resistance.

Probiotics represent a potential treatment option, as these “good bacteria” may be able to displace pathogenic bacteria and modulate the immune system to help fight infections. (Probiotics should be taken with antibiotics to save the “good bacteria”.) Low oestrogen levels cause thinning the vaginal walls, which increases a woman’s risk of developing UTIs. As a result, topical oestrogen may represent a treatment option in some cases of UTI among women. There are two different methods of administering topical oestrogen that has been effective at reducing the frequency of recurring UTIs in postmenopausal women. These applications include an estradiol-releasing ring and intravaginal estriodol cream.

Cranberry. Cranberry juice and powders made from cranberry extract have been used for decades to prevent and/or treat UTIs. Evidence suggests that substances known as proanthocyanidins, which are found in cranberries, may interfere with the adhesion of bacteria (particularly E. coli) to the walls of the urinary tract. When is can be prevented that E. coli bind to the urinary tract cells, proanthocyanidins can keep bacteria from fully colonising and invading the urinary tract. One of the advantages of using cranberry juice or related products is that cranberries are relatively inexpensive, natural, and should not contribute to the growing problem of antibiotic resistance.

Another study found that consuming natural cranberry juice three times per day produced a trend towards reducing the incidence of UTIs during pregnancy. However, avoid sugar-laden cranberry juice cocktails as they have limited benefits because of the high sugar content and the fact that many of these beverages are blends of different juices. This blending and high sugar content reduces the proanthocyanidin content and may also obscure the benefits of cranberries in their natural form.

D-mannose. D-mannose is a sugar that can be found in, among other things, cranberries. One of the interesting aspects of D-mannose is that it is able to bind to the cells that line the urinary tract and to prevent bacteria, such as E. coli, from adhering to the lining of the urinary tract.

Blueberry: Much like cranberries, blueberries also contain compounds that can inhibit the adhesion of E. coli to the cells that line the urinary tract. In addition, both blueberries and cranberries contain compounds that are able to help prevent large aggregates of bacteria from forming. The clinical effect of blueberries on UTIs has yet to be thoroughly investigated.

Probiotics: They are very beneficial bacteria that reside in the gut and positively impact the health of their host. Probiotics are a promising natural treatment for UTIs. There are many possible ways that probiotics may prevent UTIs:

• They may compete with other bacteria for resources, secrete natural antibacterial chemicals and prevent pathogenic bacteria from adhering to the urinary tract.
• Bacteria in the Lactobacillus family, normally found in the female vagina, are thought to prevent UTI. Taking antibiotics or using spermicidal agents can kill off these Lactobacilli, which can then increase the risk of UTI. In addition, recurrent UTIs are often associated with decreased levels of Lactobacillus bacteria and increased colonisation with E. coli.
• As a result, supplementing the vaginal flora with probiotic Lactobacilli may represent a viable technique for preventing UTIs. In particular, there is evidence that the Lactobacillus rhamnosus GR-1 and Lactobacillus reuterii RC-14 strains are clinically effective.
• Probiotics appear to be more effective than trimethoprim-sulfamethoxazole (an antibiotic combination) in complicated cases, which is likely due to the presence of baseline antibiotic resistance rates in these cases.
• Probiotics appear to have the advantage of not increasing the risk of antibiotic-resistant microorganisms.
Berberine: This chemical is known as a plant alkaloid, and has historically been used in Chinese and Ayurvedic medicine. Berberine can be found in many plants, including goldenseal, Orgeon grape, coptis, barberry, and turmeric. This chemical has natural antibacterial properties and is effective at inhibiting the growth of many opportunistic pathogens, including E. coli. Some studies have found that Berberine prevents E. coli from adhering to cells that line the urinary tract, thus providing a possible mechanism of action for its UTI-preventative properties. One study suggested that Berberine may represent a new target for the development of pharmaceuticals. Berberine may not be safe for pregnant women, however, because it can induce uterine contractions and may cause jaundice in newborns.

Hibiscus: The Hibiscus is a part of a family of plants that has traditionally been used to treat many different infections, including UTIs. This plant contains many compounds that have antibacterial, antifungal, and antioxidant properties. There is one compounded in particular, gossypetin, has been shown to have antibacterial activity against common UTI-causing bacteria, including E. coli and Pseudomonoas aeurginosa.

Vitamin C:, which is also known as ascorbic acid, is one of the most commonly used vitamin supplements and it has a variety of effects on the human body. One potential benefit is that it may acidify the urine, which has the potential to help inhibit the growth of infectious bacteria in the urinary tract. This acidification of the urine may also convert bacterial nitrates into nitric oxide, which is toxic to bacteria and can lead to their death. In addition, vitamin C is important for the function of the immune system. Studies have found that taking 100 mg of vitamin C daily during pregnancy can reduce the incidence of UTIs.

Pumpkin seed extract. Urinary urgency and/or frequency are often associated with UTI. Although not studied specifically in the context of UTI, pumpkin seed extract has been shown to support bladder function and combat the symptoms associated with an overactive bladder.

The importance of early management of any condition cannot be overstated. Once certain conditions set in and damage to organs occurs, complete recovery may be difficult to attain. Best results for prevention and longevity is early detection of a possible problem combined with conventional treatments , nutritional supplements and a healthy diet and lifestyle.

Increased fluid intake: increasing ones fluid intake will lead to increased amounts of urine produced, which will help flush out bacteria. If poor fluid intake is happening it is a risk factor for recurrent UTI in female children and increased fluid intake does appear to be protective against more serious upper UTIs that can affect the kidneys.

Some behavioural changes may also help prevent UTIs, particularly in children. Recurrent UTIs in female children are associated with:

• Infrequent urination, delaying urination after the urge to urinate manifests, and delaying of defecation, but not poor bathroom hygiene.
• Similarly, women who delay urination for more than one hour post-urge have an increased risk of developing UTIs, which suggests that urinating shortly after feeling the need to urinate could help prevent UTIs.
• Avoiding diaphragms and spermicide as contraception methods may also prevent UTIs.
• Although some sources suggest that urinating shortly before and after intercourse also helps to reduce a female’s risk of developing UTIs, there is no conclusive evidence that frequent voiding or voiding after intercourse significantly reduces UTI risk.
• Wearing cotton underwear may reduce the risk of developing a UTI include.
• Avoiding tight-fitting clothing.
• To this end, for those afflicted by UTIs, especially chronic UTI sufferers, taking steps to improve bladder tone and support healthy voiding patterns may be beneficial.

A multi-gene DNA test can routinely be added to assessment of:

• blood cholesterol and
• glucose levels,
• blood pressure and
• body mass index (BMI) as part of Wellness Programs offered by healthcare practitioners.

It includes analysis of variation in clinically useful genes that may contribute to:

• abnormal cholesterol levels,
• homocysteine accumulation,
• blood clotting,
• iron overload and
• inflammation.

Some of these abnormalities contribute to the development of type II diabetes, obesity and hypertension. Oxidative stress, detoxification of carcinogens and oestrogen exposure are also important considerations in this context.

This pathology supported genetic test is performed in conjunction with assessment of any food allergy or intolerances known to be associated with many chronic disorders. The results of the genetic test are combined with clinical indicators and lifestyle factors to identify a combination of risk factors that may lead to disease development or progression if left untreated.

For all health conditions, the nutraceuticals are individually tailored by the Health Renewal Doctor. The doctor will decide- based on your history, physical examination and blood tests what would be the best for you and your specific needs and/or deficiencies. It cannot be over-emphasized that one must not self-medicate. Self-Medicating is done when a person takes prescription medication or nutraceuticals on their own without a doctor's supervision and/or consent. By not having a physical examination and blood testing done by a qualified and practising integrative medical practitioner, you could be not treating vital deficiencies or conditions such as elevated blood pressure, high sugar level, high stress levels (that can lead to adrenal burnout ) and high blood clotting factors that could lead to heart attacks and stroke. In addition, a program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. There is no single supplement prescribed to clients as there is no magic bullet that can support all the essential nutrients that one's body needs. Today's food is not functional and we need to supplement in order to maintain optimal bodily functions and nutrition.

Make an appointment to consult with your Health Renewal Doctor who is an integrative doctor and he or she will assist you in determining your risk factors and how best to prevent any problems or conditions that you may be susceptible to. The importance of early management of any condition cannot be overstated. Once certain conditions set in and damage to organs occurs, complete recovery may be difficult to attain. Best results for prevention and longevity is early detection of a possible problem combined with conventional treatments, nutritional supplements and a healthy diet and lifestyle.

The initial medical consultation at Health Renewal will be approximately 45 minutes. As this is a prolonged medical consultation, the initial consultation fee will be R 975 on arrival (for non-loyalty programme members) you will have to complete an in-depth questionnaire before the consultation so please arrive 20 minutes before the time. During the 45 minute consultation, your Health Renewal doctor will obtain a FULL medical history from you to determine your personal risk. A physical examination will be done after which the Doctor will decide which blood tests need to be requested from your local pathology laboratory. If you have a medical aid, these should be able to be claimed as well.

Once your blood results are received, they will then be analysed by your Health Renewal doctor who will begin working on a unique prescription plan for you with the compounding pharmacy. At your pre-scheduled second appointment 2 weeks later, the results and examination findings will be discussed with you. This will determine what abnormalities or deficiencies exist and you will be advised on your treatment options. These options may range from prescription medications, nutraceuticals, bio-identical hormonal creams or tablets or alternatively to having bio-identical implants or pellets inserted.

In office treatments such as carboxytherapy may also be recommended for certain conditions such as hair loss, erectile dysfunction ED, menopause or PMS. If you need to lose weight our Body Renewal Medical Weight loss program may be recommended. All these recommendations will be summarised on a sheet or print out which you can take home with you. The nutraceuticals offered at Health Renewal are of superior quality (Solgar) and are not rancid nor contain Hg (mercury ) or PCB'S (which is very important for Omega 3 Essential fatty acids EFA's). They are also free of gluten, preservatives, wheat, dairy, soy, yeast, sugar, artificial flavour, sweetener and colour. We have a great professional team made up of doctors, trained and registered nurses and therapists to support you at any time.

1. You are kindly requested to bring any supplements that you are currently taking, along to your consultation. The doctor can check the ingredients in take this into account when prescribing a treatment plan for you.

2. Also, if you have had any blood work done in the past 6 months, please bring the results along to the consultation. Should you not be in possession of the hard copies, please request these results from the lab you visited. Usually your ID number is sufficient.

Depending on the exact prescription given, you may be required to return to the doctor within 1-4 months’ time, in order to ensure optimum hormone levels are achieved. This will be determined by a repeat blood test and may be requested by your Health Renewal doctor.

You should ensure that you are current with your gynaecological visits/breast exams/mammograms (for female patients) and prostate exams (for male patients) as recommended by your GP/gynaecologist.

After the two week follow up, the initial blood results will be discussed and patient specific nutraceuticals may be initiated. A second follow up another evaluation and blood test at 8 weeks is recommended to measure serum improvements in your Lipogram, homocysteine and other essential blood results. Follow up appointments should be very 6 months.

Some days you need some help staying motivated to live a healthy lifestyle. Our compilation of health and wellness quotes and sayings provide the inspiration or the laugh you need to keep making positive choices for your overall wellbeing.

Here are ten quotes from great thinkers to challenge, motivate and inspire us to exercise, eat right and live healthier lives: Health and intellect are the two blessings of life.

• "From the bitterness of disease man learns the sweetness of health." – Catalan Proverb
• "A man’s health can be judged by which he takes two at a time–pills or stairs." – Joan Welsh
• "Just because you’re not sick doesn’t mean you’re healthy." – Unknown
• "The part can never be well unless the whole is well." – Plato
• "Leave all the afternoon for exercise and recreation, which are as necessary as reading. I will rather say more necessary because health is worth more than learning." – Thomas Jefferson
• "Life is not merely to be alive, but to be well." – Marcus Valerius Martial
• "The mind has great influence over the body and maladies often have their origin there." – Moliere
• "It is health that is wealth and not pieces of gold and silver." – Mahatma Gandi
• "The first wealth is health." – Ralph Waldo Emerson
• "To wish to be well is a part of becoming well" – Seneca