Urinary Tract Infection

Based on host factors, they can be classified as uncomplicated or complicated. 1. Uncomplicated UTIs occur in otherwise healthy individuals, usually women, in whom the infection is limited to the bladder. 2. Complicated UTIs occur in individuals with structural or functional abnormalities of the urinary tract, immunosuppression, pregnancy or other underlying medical conditions like Diabetes Mellitus that predispose the patient to more severe infections, treatment failures, and recurrence (Jauhari et al., 2022) (Geerlings, 2016) (Foxman et al., 2000). Recurrent UTI refers to having 2 or more episodes in a 6-month period or 3 episodes within a 12-month timeframe.

• Painful urination • Burning sensation when urinating • Frequent urination or inability to start urination • Urgency • Suprapubic (lower abdominal) discomfort • Blood in urine • Lower back pain, flank pain, pain below the ribs • Fever and/or chills • Fatigue and confusion • Rarely, blood or pus in the urine

The organisms that cause UTI are primarily bacteria, like Escherichia coli (most common), Enterobacter spp, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa. Although bacteria are the primary causative organisms, UTIs can also be caused by fungi like Candida or viruses like Adenovirus. Women are affected more often due to factors such as shorter urethral length, proximity of the urethra to the anus which causes organisms to translocate to the urethra, and hormonal changes. (Jauhari et al., 2022). Along with the additional factors such as unprotected unsafe sex , Medical procedures/devices, immunosuppressants, poor urinary tract & vaginal microbiome, etc Kidney infections most commonly result from poorly treated bladder infections, but they can also be a result of blood borne infection.

• Incomplete bladder emptying due to anatomical abnormalities like urethral obstruction, stricture, BPH etc. • Lack of voiding before and after sexual intercourse • Unsafe, unprotected sex • Medical devices like urinary catheter use • Medical procedures like cystoscopy • Pregnancy • Systemic disorders e.g. Diabetes, immunosuppression, gut dysbiosis, and other chronic diseases • Poor hygiene habits such as wiping from back to front after bowel movements • Hormone changes such as decreased oestrogen levels in postmenopausal women can lead to vaginal atrophy and increased UTI risk. • Diet rich in sugars and processed foods can lead to inflammation that can weakened the immune response.

Urine routine analysis and urine culture are the gold standard tests for diagnosing a UTI. Additional tests can include a complete blood count, kidney function tests, vaginal and stool cultures to identify microbial imbalances, hormone testing (sex hormones, salivary cortisol), imaging studies like ultrasound or CT scan to evaluate the structural anatomy of the urinary tract. (Cloyd, 2023)

Medical treatment - Antibiotics like Nitrofurantoin, Trimethoprim-sulfamethoxazole, Fosfomycin or Fluoroquinolones are commonly used to treat UTIs. But they can cause side effects like diarrhoea, nausea, headaches, vaginal irritation, Candida infection etc. While antibiotics are highly effective in removing harmful bacteria, they cannot differentiate between pathogenic and beneficial bacteria. This can lead to gut dysbiosis and weakened immunity. Prolonged antibiotic use can contribute to antibiotic resistance. Sometimes, UTIs resolve spontaneously without antibiotic treatment, especially in otherwise healthy women with uncomplicated infection. Diet - Increased water intake with at least 1.5 - 2 litres per day is important. Avoiding certain foods that can cause bladder irritation like caffeine, alcohol etc. can be beneficial. Following an anti-inflammatory diet may help promote healing. Foods that may have potential benefits include unsweetened cranberry juice, blueberries, onion, garlic, probiotic rich foods like yogurt and other fermented foods. Hygiene - Practising good hygiene habits such as wiping from front to back, urinating before and after sexual activity, avoiding tight fitting clothes, avoiding douching can help prevent UTIs. Lifestyle changes - Stress management through mindfulness practices like yoga and medication, exercise, and 7-8 hours of quality sleep are important for overall immune function and reducing susceptibility to UTIs.

• Uva- Ursi: Contain arbutin, an antibacterial agent effective urogenic pathogens • Berberine - Demonstrates antimicrobial activity • D- mannose: Prevents adhesion of bacteria to bladder wall. • Vitamin C - helps to acidify urine and inhibit bacterial growth • Corn silk - Has anti-inflammatory and diuretic effects • Marshmallow root - Anti inflammatory • Probiotics - Help restore healthy vaginal microbiome. Important strains are Lactobacillus rhamnosus, Lactobacillus reuteri, Lactobacillus fermentum • Zinc – immune support • Garlic capsules – antimicrobial and immune support • Herbs like Horseradish, goldenseal, asparagus, lovage, parsley, peppermint, birch and rupturewort have also been studied for their benefits in UTIs • Anti-inflammatories such as garlic, turmeric (curcumin), bilberry, yarrow, and Boswellia