Infections are among the most common health challenges encountered.  The most common site of viral infections is the respiratory tract, which includes the nose, sinuses, throat, trachea, bronchial tubes and lungs.  The most common site for bacterial infections, however, is the urinary tract, which is comprised of the kidneys, ureters, bladder, and urethra. 

Each individual normally has two kidneys.  They are located high in the abdominal cavity, just below the diaphragm and behind other abdominal structures.  The kidneys are responsible for filtering impurities from the bloodstream and maintaining fluid, electrolyte, and acid-base balance in the body. 

The fluid that is filtered from the blood by the kidneys is called urine.  Urine passes from the kidneys to the bladder via tubes called ureters.  Urine is stored in the bladder until it is emptied through another tube called the urethra.

Infection can occur anywhere in the urinary tract.  The medical terms commonly used to describe urinary tract infections are urethritis (an infection of the urethra), cystitis (an infection of the bladder), and pyelonephritis (an infection of a kidney).  Each type of infection will be discussed separately.

Urethritis

Although both sexes can have urethritis, the diagnosis is most commonly made in males.  Since the urethra is much shorter in women it is relatively rare for a woman to have an infection of the urethra without simultaneously having an infection in the bladder.  Urethritis is characterized by a burning sensation with urination.  A discharge, which may be either thin and clear or thick and cloudy, is often present. 

Urethritis is classified as either gonococcal or non-gonococcal.  It is almost always a sexually transmitted disease.  Gonorrhea is the most common cause, accounting for approximately 80 % of all cases.  A number of organisms are capable of causing non-gonococcal urethritis.  These include Chlamydia, ureaplasma, mycoplasma, and trichomonas. 

When a man presents with urethritis laboratory tests are used to determine whether gonorrhea is present.  In most cases, no effort is made to identify other organisms.  When gonorrhea is identified it is standard practice to treat urethritis with an antibiotic combination that will eradicate Chlamydia as well, since a co-infection is often present.  A different combination of antibiotics is used if gonorrhea is not found or if the urethritis persists after treatment for gonorrhea and Chlamydia. 

In many cases the symptoms of urethritis will disappear without treatment.  The individual can remain infectious to others, however, and untreated urethritis can lead to more serious infections including prostatitis (an infection of the prostate gland) and epididymitis (an infection of the sperm collecting system). 

In some cases, arthritis and eye inflammation will occur following an episode of urethritis.  This is referred to as Reiter’s Syndrome.  Reiter’s Syndrome is believed to be triggered by the presence of Chlamydia in the body.  Some individuals appear to have a genetic predisposition to the disease.  Unfortunately, antibiotic treatment does little to alter its course. Drugs used in the treatment of Reiter’s Syndrome can cause very serious adverse effects.  Nutritional supplements that enable the body to respond effectively to inflammation can eliminate the need for drugs in many instances.  These include omega-3 fatty acids (fish oils) and systemic enzymes.  A sample regimen would be Marine Lipids 2 or 3 capsules twice daily in combination with Panzymes 4 to 6 capsules taken at least one hour before or two hours after eating 2 or 3 times daily.

Cystitis

Bladder infections account for the overwhelming majority of urinary tract infections.  It is estimated that one out of every two women will experience a bladder infection at some time in her life.  Each bladder infection will significantly limit activities for two to three days.  The resulting economic cost is estimated to be $1.6 billion annually.

While a bladder infection can develop without the affected person being aware of its presence, most are unmistakable.  A typical bladder infection comes on abruptly, without warning.  The urge to urinate suddenly becomes overwhelming and a burning sensation is felt as the urine is passed.  Within a few minutes the urge to urinate returns with the same or even greater intensity.  The urine may have a strong, disagreeable odor, and it may become cloudy or even bloody.  A low-grade fever may be present, but in many cases the body temperature is normal.  Low abdominal or low back pain may be noted. 

The reason that women are particularly susceptible to bladder infections is because the urethra is much shorter in women than it is in men.  This means that bacteria can easily migrate from the skin surface into the bladder, where they can cause an infection.  Bladder infections are almost always caused by bacteria such as E. coli that are normally found in the intestinal tract.  This provides clues on how to prevent and manage bladder infections.

The two most important principles in the prevention of bladder infections are maintaining dilute urine and emptying the bladder frequently.  I cannot count the number of occasions on which a woman has presented with symptoms of a bladder infection following a road trip or a day at a public event.  Not wanting to stop too often to use the restroom on the trip or not wanting to use the public restrooms at a park the woman has elected to restrict her fluid intake.  The urine has become concentrated, allowing bacteria entering the bladder to get close to the bladder wall.  They have also been given time to multiply and establish colonies.  The result is an infection that appears a day or two later. 

The first rule in prevention of bladder infections is to drink enough fluid to keep the urine pale.  When the urine is dilute any bacteria entering the bladder will float harmlessly in the urine and will not have the opportunity to attach themselves to the bladder wall.

The second rule is to empty the bladder often.  It is a good practice to empty the bladder every two or three hours while awake, even if there is not a great urge to do so.  Emptying the bladder frequently washes bacteria out of the bladder before they can multiply and cause and infection.

There are specific times when the bladder should be emptied.  These are after taking a tub bath, after swimming in a pool or sitting in a hot tub, and after sexual activity.  When water is present, as in a tub or pool, bacteria have an easier time entering the bladder.  Therefore it is important to change out of a wet swimsuit and empty the bladder as soon as possible after leaving the water. 

I discourage the use of "bubble bath” as the bubbling action is more likely to carry bacteria into the bladder.  This is particularly true in young girls.  If they do indulge in a bubble bath it is important to instruct them to void as soon as possible after the bath is completed.

Infections following sexual activity are common.  The term "honeymoon cystitis” is used to describe the occurrence of a bladder infection early in a marriage.  Such infections occur because sexual activity pushes bacteria close to the opening of the urethra and into the bladder.  While it may not seem romantic, taking a few moments to empty the bladder, washing away any bacteria that may have entered during intercourse, is highly effective in preventing those infections.

Over 1/3 of women who develop one bladder infection will have another within a year.  The reason for this is believed to be due to the cells lining the bladder wall becoming more "sticky” after being invaded by bacteria during the initial infection.  A substance in cranberry, alpha D mannopyranoside, has been found to reduce the ability of bacteria to attach to the bladder wall.  Cranberry also contains proanthocyanadins, which make the bladder lining less sticky.  If cranberry is used for prevention of bladder infections it should be consumed in the form of unsweetened cranberry juice or cranberry powder capsules.  The sugar in popular cranberry cocktail drinks can actually encourage the growth of bacteria in the bladder.  One glass of unsweetened cranberry juice or 2 cranberry capsules twice daily is the usual amount required.

If a bladder infection does occur a number of supports will help the body eliminate it.  One should immediately begin drinking more water, which will cause the urine to become more dilute and encourage frequent emptying of the bladder. 

The herb uva ursi (bearberry) contains a number of substances that have antimicrobial effects.  These include arbutin, hydroquinone, and tannins.  Uva ursi is generally well-tolerated, but it is capable of causing nausea and turning the urine green.  It should not be used for longer than 10 days at a time, and it is not approved for use in children, in pregnancy, or by nursing mothers.  Concurrent use of vitamin C may limit its effectiveness.

One of the safest means of treating bladder infections is with a sugar, D-mannose.  While it is a sugar, it is not metabolized by the body.  When absorbed it remains in the bloodstream until it is removed by the kidneys and excreted in the urine.  E-coli bacteria use arm-like structures to attach to the bladder wall.  D-mannose coats those structures, effectively preventing E-coli from attaching and causing an infection.  It is not effective against other bacteria.  D-mannose is available as a powder.  One teaspoon is taken every two or three hours until the signs of a bladder infection disappear, which is usually within two or three days.  One teaspoon may be taken daily to prevent recurrent infections.  It is said to be at least ten times more effective than cranberry in coating bacteria and preventing bladder infections. 

Antibiotics may be required to clear bladder infections.  While in the past antibiotic treatment was commonly prescribed for 7 – 10 days it is now known that 1 – 3 day treatment regimens are effective when complicating factors are not present.  Factors that would indicate a need for a more prolonged course of treatment would be an obstruction to urine flow, the presence of a catheter, or when the individual is elderly, diabetic, pregnant, post-menopausal, male, has a history of recent antibiotic use, or has had symptoms for over a week. 

Pyelonephritis

Kidney infections, although much less common than bladder infections, are a great deal more severe.  Symptoms are not localized like those of bladder infections, but tend to involve the body as a whole.  A high fever of 102 degrees Fahrenheit or greater is usually present.  Muscles ache.  Nausea and vomiting commonly occur.  Pain may be present high in the back, just below the rib cage.  Even if back pain is not present, the region is exquisitely tender.  Tapping over the lower ribs close to the spine will elicit severe pain, which usually causes the person to jump or cry out. 

Kidney infections generally arise when bacteria have spread from the bladder via the ureter.  For this reason, bladder infections should be not be neglected, but treated promptly.  Kidney infections are more common during pregnancy, because the pressure of the growing womb on the ureter slows urine flow from the kidney, allowing bacteria to move upstream and enter the kidney.  The same is true of conditions that prevent complete emptying of the bladder, such as prostatic enlargement. 

A kidney infection must be treated immediately and aggressively.  If a kidney infection is not addressed promptly the infection can spread to the bloodstream and the resulting condition, called sepsis, can be fatal.  Because nausea and vomiting are often present hospitalization and the administration of intravenous antibiotics may be necessary. 

Chronic urinary tract infections

Most urinary tract infections come on suddenly and are of short duration.  Such infections are referred to as acute infections.  Infections that occur twice within six months, last for longer than two weeks, or do not respond to treatment are referred to as chronic infections.  Individuals with chronic urinary tract infections are at much higher risk for kidney infections because when bacteria persist in the bladder they have a greater opportunity to spread to a kidney.

Antibiotics are often prescribed for as long as two years for chronic urinary infections.  This can lead to a disruption of the body’s normal balance of microorganisms.  This can weaken the immune system and predispose to other infections.

Before resorting to long-term antibiotic therapy an attempt should be made to identify and correct the cause of the infection.  In many instances the cause will be a failure of the bladder to empty completely.  The primary cause for urinary retention in men is enlargement of the prostate gland.  Prostatic enlargement often responds to supplementation with grape seed extract, saw palmetto berry extract, pygeum, and plant sterols.  The two products I personally recommend in my practice are OPC 2000 and Prostazyme.

In women the leading cause of urinary retention is a "fallen bladder”.  Because a part of the bladder remains lower than the opening of the urethra some urine will remain in the bladder after each voiding episode.  Leaning forward during urination can cause the bladder to "rise” or come forward so that it will empty more completely.

Narrowing of the urethra, called a stricture, can also slow urine flow and prevent complete emptying of the bladder.  If a stricture is present it should be corrected by a urologist (a surgeon who specializes in disorders of the urinary tract). 

When a urine infection persists despite adequate antibiotic treatment in the absence of an anatomical obstruction to urine flow a biofilm may be present.  A biofilm is a sophisticated colon of microorganisms that have surrounded themselves with a protein coating that is impervious to antibiotics.  A biofilm is also effective in preventing the body’s immune system from attacking and eliminating the organisms that are causing the infection.  Herbal preparations can break up biofilms so it is possible for antibiotics and elements of the immune system to effectively attack the infecting organisms.   The preparation I typically recommend for elimination of biofilms is called Microstat. 

Summary

An overwhelming majority of urinary tract infections can be prevented.  This is accomplished by drinking enough fluid to keep the urine pale and emptying the bladder every 2 to 3 hours while awake.  Women and girls should wipe from front to back carrying bacteria away from the bladder opening and avoid bubble baths, void immediately after getting out of a pool or tub, and change immediately into dry clothing after completing a swim.  Women should also empty the bladder immediately after sexual activity. 

If a second infection occurs within six months of the first, 8 ounces of unsweetened cranberry juice, two cranberry capsules twice daily, or 1 teaspoon of D-mannose daily should be consumed.  If infections become chronic, conditions that prevent the bladder from emptying completely should be addressed and use of a preparation to break up biofilms should be considered. 

Urinary tract infections need not be frequent, nor should they become complicated.  Applying simple preventative measures will avert most bladder infections and addressing those infections promptly when symptoms appear will prevent bacteria from reaching the kidneys.  This will result in a healthier urinary tract throughout life.