Urinary Tract Infections

Words: Dr Ambika P NAYAK

Urinary tract infections [UTI] are common and prevalent in all age groups, across the country. They are also common worldwide.

UTI is one of the most common conditions that we encounter in clinical practice too. For some patients, it is also a recurrent issue.

The presenting symptoms of UTI are increased frequency of urination with burning, or pain, in the lower abdomen, or urethral opening, fever with chills, smelly urine, cloudy, or frothy appearance of the urine, sometimes bloody urine, including continual urge to urinate, which doesn’t seem to go away, even after urinating, along with incomplete voiding of urine, etc.

UTI is largely caused by bacterial infection — the most common being E coli, Proteus mirabilis, Klebsiella pneumoniae and Staphylococcus. The bladder, or the lower urinary tract, in general, is not a totally sterile system, so a small colony of bacteria may always be present and asymptomatic bacteriuria is common too.

UTI is usually triggered by improper hygiene habits and/or not drinking enough fluids. UTI is more common in women owing to their short urethral length.

When the bacterial ‘load’ increases, it causes inflammation in the lining of the urinary tract causing UTI symptoms.

Self-Help

  • Drink more fluids, especially water, through the day. The quantity required varies, based on age, environment, physical activities, weight and other factors. On an average, 1-1.5ltr for children and 2.5-3ltr a day for adults may be essential
  • Maintain good hygiene of the private parts, on a daily basis; wash it twice daily, with mild soap, whenever required, or other cleansing agents that are safe for use. Keep the undergarments clean; also, replace them from time to time.
  • While using a public toilet, especially women, the commode, or Indian-style squat toilets, is better. If one has to sit on the toilet seat in a common washroom at educational institutions, or workplaces, or recreational places, it is necessary to first clean the toilet seat with water and wipe it dry, or use a wet wipe
  • Wash the parts with water after urinating and keep the area dry by wiping with a soft cloth, or tissue paper. While wiping — especially, for women — one must take care to wipe from the front to back to avoid the germs from the anal region spreading to the vagina/urethra. Alternately, one may also dab and dry the parts.

Every physical system in the human body has its own immune framework. It is, therefore, necessary to maintain it and also bolster it.

Healing With Ayurveda

Some Indian spices, like coriander, cumin, fenugreek seeds and herbs like vetiver roots, Acacia catechu bark, or Indian sarsaparilla roots, if taken as infusion, or decoction, help to cleanse the urinary system — they have diuretic and cooling effects. So does barley water and banana stem juice.

There are also Ayurveda formulations available that help to treat UTI, viz., Usheerasava, Trinapanchamoola kashaya, Chandraprabha vati, Punarnavadi kashaya, aside from other proprietary medicines that may be used effectively to treating acute, or recurrent UTI — under the guidance of a professional Ayurveda physician.

Addendum: Clinical Review

Plants have consistently demonstrated their therapeutic worth; the study on the active components they offer has created new possibilities. Since they are antibacterial, naturally-occurring isothiocyanates [ITCs], which are produced by the enzymatic hydrolysis of glycosylates [found in items from the Brassicaceae family], may be employed as an alternative method of treatment. The entire plant of Oroxylum indicum and the roots of Vitex negundo were both effective against a few specific human uropathogens.

The Ayurveda medical system has various formulae and herbs that are quite effective at both prevention and treatment of UTI. They may also assist in reducing the prevalence of this illness. One of the most prevalent complementary medical systems in India is Ayurveda. Many urinary tract disorders are treated with Ayurveda medications.

The illnesses connected to UTI are known as vata dosha in Ayurveda. While the bladder and urethra are impacted when mutraghata rog occurs, the urinary system and kidneys are affected in mutravahasrota rog. Prameha refers to metabolic conditions that cause excessive urination [polyuria].

Thirty-seven effective plants have been mentioned in a review of Ayurveda medications against UTI. The Ayurveda remedies for treating UTI include Mutrakruchhantak ras, Trinetrakhya ras, Varunadilauh, Eladi churna, Tarkeshwar ras, Trunpanchmula, Gokshurkwath, Haritakyadiyog, Duralabhadikashaya, Varundya lauh, and Chandrakala ras.

Diuretics, often referred to as mutravirechana, are substances that accelerate and control urine flow while aiding in the treatment of UTIs. Some agents are harmful because they have virulence factors, like exotoxin, plasmids, and adhesive factors. The primary stage of virulence is attachment to a particular cell, or tissue; this adhesion is enabled by capsule, pili, or fimbriae, and if this stem is inhibited in any way, there are lower chances of getting an infection.

Most mutravirechaneeya dravyas, such as shali [Oryza sativa Linn], ksheera [milk], navadhanya, ikshu [saccharum officinarum Linn] and many more, are sheeta and increase kapha and dravata in the shareera, ikshu and gokshura [Tribulus terrestris Linn.] are shreshta, whereas dravyas, like ela, gomutra [cow’s urine], and vana palandu [Urginea indica Roxb], being ushna veerya, cause urination virechana.

Certain plant-derived active principles were found to induce diuresis. Vidarikanda contains sugar, and these substances, due to their osmotic action, inhibit the subsequent absorption of hydration from the glomerular filtrate. These substances cause more water elimination than sodium, resulting in diuresis.

Many plants in the Fabaceae, Liliaceae, Solanaceae, and other families contain spironolactone, a diuretic steroid. Arjuna [Terminalia arjuna Roxb.] contains arjunolic acid, a triterpinoid saponin that causes diuresis. Bacosides A and B, which can be identified in Brahmi [Bacopa monneiri Linn.], additionally trigger diuresis. Cardiac glycosides found in vanapalandu and shatavarin found in Shatavari [Asparagus racemosus Linn.] cause diuresis, as does the flavonol glycoside Psoralen observed in bakuchi seeds. Other than glycosides, diuretics include alkaloids, such as punernavoside that are present in punarnava [Boerhavia diffusa Linn.] and Purin alkaloids, such as caffeine, theobrominetheophylline found in drugs, such as coffee, cocoa, tea, and so on.

Diuretics such as Solidago spp [goldenrod] herb, Levisticum officinale [lovage] root, Petroselinum crispus [parsley] fruit, and Urtica dioica [stinging nettle] elevate urine volume in both healthy and sick people, which aids in flushing out potential threats. People who consume antiseptic and anti-adhesive herbs, such as arctostaphylos uva ursi [uva ursi], Juniperus spp [Juniper] leaf, and Vaccinium macrocarpon [cranberry] fruit excrete antimicrobial compounds — this can eliminate microbes, or interfere with their adhesion to epithelial cells, protecting against acute and chronic UTI. Berberine is abundant in the roots of Mahonia aquifolium [Pursh] Nutt. [Oregon grape] [Berberidaceae] and Hydrastis canadensis L. [Goldenseal] [Ranunculaceae]. Berberine is an important antibiotic that fights infections by preventing bacteria [E coli and Proteus species] from adherence to the host cell, implying its usefulness in treating UTI.

Ocimum sanctum [tulsi], Azadhirachta indica [neem], Juniperus spp., Punica granatum [anaar], Coriander leaf [dhania], Vaccinium macrocarpon [cranberry], Salvia officinalis [salvia], Terminalia chebula [Harad], Tribulus terrestris [gokharu], and Cinnamomum cassi [dalchini]. Hydrangea petiolaris, Zea mays and Equisetum arvense are herbal remedies that defend the urinary bladder against uropathogens. Plants with nephroprotective properties include Eupatorium purpureum, Berberis vulgaris, Boerhaavia diffusa and Agropyron repens. The juice made from the Aronia melanocarpa contains phenolic components that can lessen sensitivity to infections. E coli, K pneumoniae, P aeruginosa, and E faecalis may all be isolated, thanks to the screening of medicinal herbs by Sharma et al. They also learned that Zingiber officinale and Punica granatum alcohol extracts inhibit the growth of E coli.

When tested against E coli isolates, the essential oils, Thymus zygis, Origanum majorana and Rosmarinus officinalis showed the highest levels of inhibition.

Azadirachta indica, Anogeissus acuminata, Boerhaavia diffusa, Punica granatum, Soymida febrifuga, Tinospora cordifolia, Terminalia chebula, Bauhinia variegata, and Tribulus terrestris were flowering plants whose efficiency was assessed against eleven isolated uropathogens. P granatum, A acuminata and S febrifuga are three plants out of these 11 plants were active against all the investigated uropathogens. When the various solvent extracts of Clitoria ternatea leaves were evaluated against UTI caused by P mirabilis, it was discovered that the acetone fraction showed the greatest inhibition.  An Algerian shrub called Marrubium vulgare L. had flavonoid extract that had antibacterial activity. Additionally, it has been noted that Hibiscus sabdariffa‘s methanolic extract can stop K pneumonia. 

Considering the phytoconstituents present in the various plant sections, the antibacterial capabilities of most herbs serve as their primary mode of action [leaves, stem, flower, bark, and root]. The alkaloids, phenols, essential oils, terpenes, saponins, and other secondary metabolites are examples of these phytoconstituents. The other mechanism of action is that some plants can raise the body’s pH, which affects how easily germs can enter the urinary tract and how easily they can be removed from the body.

Dr AMBIKA P NAYAK, MD [Ayurveda], is Founder & Managing Director of Ayurvedeeyam, a speciality Ayurveda Clinic, based out of Bengaluru, with a branch in Udupi, Karnataka, India. Her passion for Ayurveda, the ancient, yet ‘completest’ natural medical system, and professional clinical skills are keyed to raising awareness for Ayurveda as a first choice of treatment for illness and healthy living. Dr Nayak also has credentials of being a family physician and she is loved by her patients of all age groups. She frequently shares talks regarding health with corporates and is a strong advocate of panchakarma, thanks to its fully holistic and proven therapeutic efficacy in the treatment and prevention of illness, or disease. She is also Assistant Editor [Ayurveda] @ ThinkWellness360.

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