A common problem for women

Marysia Kratimenos discusses the homeopathic management of urinary tract infections

Urinary tract infections are very common in adult women and may become recurrent. The most common is cystitis, an infection of the bladder, but infection may occur in any part of the urinary system, including the kidneys. Infection is caused by the growth of the gut bacteria within the urinary system, but in many cases bacteria are not found on urine culture, despite obvious symptoms of bladder discomfort. The close proximity of the anus and urethra (opening from the bladder) in women allows for the bacterial movement, especially if there is irritation of the delicate perineal tissues.

Urinary tract infections are rare in boys and men because of the length of the urethra. In most cases there is an underlying cause, usually an obstruction to the normal urine flow, or reflux of urine to the kidney. All cases of proven urinary infection in men and boys must therefore be fully investigated, preferably by a urologist. Recurrent infections in women, more than three within a year, also warrant investigation, although the chances of finding an underlying cause are less likely. Occasionally, kidney stones or bladder warts may present with recurrent bladder infections.

Homeopathy can be used alongside conventional treatment with antibiotics and for cases where no infection is found. It can be very helpful in building up the constitution, thus reducing the risk of recurrence. There are also many other simple measures that can reduce the chances of re-infection.

In all cases of suspected urinary tract infection a detailed history is essential, not least of all to find the appropriate homeopathic remedy. A urine sample should always be sent off for analysis in the laboratory. A preliminary inspection of the urine is very useful. A strong smell, cloudiness or the presence of small amounts of blood are highly suggestive of a bacterial infection, but clear urine does not exclude it. The doctor may use a reagent strip to see if there are any blood or pus cells not visible to the naked eye.

In a simple case of cystitis, when there is no fever or obvious general illness, the GP will usually wait for the results of the urine culture before prescribing antibiotics. As this can take several days, it is well worth trying a homeopathic remedy in the meantime to alleviate the discomfort.

Acute cystitis
The most common symptoms of a bladder infection are pain on passing urine and frequency of urination, although these are often absent in very young and older people. An uncomplicated case of cystitis will rarely give much more than a mild fever and does not make the person feel terribly unwell.

Pain may be felt in the urethra, as a burning, scalding sensation and/or as a dull ache in the pelvis. If the pain extends to the loins or the temperature is very high, this indicates the infection has possibly ascended to the kidneys (pyelonephritis) and medical intervention must be sought urgently. The passage of blood also warrants prompt medical attention.

Kidney infection may lead to scarring of the kidneys and prompt treatment with antibiotics is imperative. It is perfectly safe to use homeopathy alongside antibiotics.

Non–infective cystitis
Many women present with symptoms identical to cystitis but urine culture yields no growth of bacteria. Often they do get courses of antibiotics prescribed which do little to help the symptoms. In some cases there is a local cause such as inflammation of the urethra or bladder (chronic interstitial cystitis), or the delicate tissues of the perineum. Herpes infection can lead to cystitis-like symptoms, as can chronic vaginal discharges or irritation. In the vast majority of cases no cause is ever found and the patient is told she has an “irritable bladder”.

Homeopathy can be very helpful in this situation, as treatment is aimed at the whole person rather than the results of a single investigation. Careful dietary management may be indicated as some women do seem to be sensitive to certain acidic foods. A professional homeopath should be consulted.

General management
Drinking large amounts of clear water is essential. A very minor infection may be cleared by this simple action. Coffee and regular tea often aggravate the symptoms, so should be avoided. Certain herbal teas may be helpful in controlling symptoms and helping to clear minor infections, but are best avoided in pregnancy. Golden seal tea encourages urine flow and is quite palatable.

Changing the acidity of the urine is helpful. Drinking cranberry juice, or taking tablets of cranberry concentrate, make the urine too acidic for the bacteria to thrive. The sachets of powder, available at chemist shops to relieve the symptoms of cystitis, work on the same principle. Some contain large amounts of bicarbonate to make the urine too alkaline for the bacteria to thrive.

It is important to keep the bladder empty, however painful this may be. “Holding on” to urine will only make matters worse and encourage a more serious infection. If one is prone to recurrent infections, it is helpful to “double void”, that is to return to the bathroom about five minutes after passing urine and empty the bladder again. It is often surprising how much urine has been left in the bladder.

In women infection may be precipitated by sexual intercourse, a condition known as “honeymoon cystitis”. It is advisable to empty the bladder after sex to avoid infection. In some cases there is no infection, the urethra is irritated by friction and this can mimic the symptoms. Adequate lubrication and a change in sexual position may often solve this problem.

Some women develop an allergic reaction to the latex of condoms or the spermicide they contain, and this can lead to bladder symptoms. A change of contraception may be indicated if this is the case.

Local vaginal infection with thrush also predisposes to urinary infection. Many women get thrush after a course of antibiotics. Antibiotics are not highly selective, they also eliminate the so-called friendly bacteria, and the normal range of bacteria in the gut is altered. Abnormal bacteria, thrush and other fungi proliferate, leading to a condition known as gut dysbiosis. Abdominal bloating, bowel disturbance and food intolerance may result, as well as recurrent infections in the urinary system. This leads to further antibiotic courses, which derange the bacterial content of the bowel even more. In these cases homeopathy is immensely helpful in breaking the vicious circle.

Acidophilus may be prescribed alongside the remedy to repopulate the bowel with healthy bacteria, as well as remedies and anti-fungals to clear the yeast infection.

Chlamydia, a sexually transmitted infection, may mimic a urinary tract infection. It is becoming increasingly common in young women and may lead to fertility problems if left untreated. There is often no associated vaginal discharge and so the infection can go unnoticed. A vaginal swab taken at the local genito­urinary clinic can detect chlamydia and other infections, which will require specialised antibiotic therapy.

Local irritation of the perineal tissues predisposes to infection. Bubble baths, harsh soaps and deodorants should all be avoided, as well as thongs and tight trousers. Pure cotton underwear is best, as are stockings rather than tights. It is important to teach girls to wipe their bottoms from front to back after a stool.

Homeopathic remedies
Treatment with homeopathy is in two parts: first to treat the infection, and secondly to improve the general health so as to avert further infections. This deeper treatment is best left to a professional homeopath.

For an acute attack a relatively high potency, 30c, is indicated. It can be repeated every hour, decreasing the frequency of the remedy as the symptoms improve. If there is no improvement after three or four doses, professional homeopathic treatment should be sought.

Arnica montana
Arnica is very useful for cystitis that occurs following bruising injuries of the perineum. It is therefore well indicated for urinary problems following childbirth. There may be trouble emptying the bladder and some involuntary dribbling.

Sepia
Sepia is immensely useful for recurrent urinary tract infections, especially when there is also a history of lots of antibiotic use and thrush. The woman often loses her libido, because sex is painful and she fears cystitis may result. She is often worn out by the recurrent infections, so exhausted by the struggle to keep going that she cries when expressing herself. Genital herpes may be present.

Aconite
The symptoms come on very suddenly and without any warning, often after a fright or exposure to cold. Diving into icy water may bring on cystitis. There is a lot of fear and this may lead to retention of urine. There is a sensation of pressure in the bladder and burning before urination.

Pulsatilla
This remedy is often prescribed constitutionally for shy little girls with a highly emotional and changeable nature. As they do not drink much they are more prone to urinary tract infections. Pulsatilla is often prescribed for older women, who are soft and yielding in character. They are prone to cry whilst relating their story, and evoke sympathy in the listener. The pain is worse when urination is delayed, and after urination. The symptoms are changeable, and the urine tends to spurt out.

Cantharis
The Spanish fly is a urinary tract irritant, well known to the Marquis de Sade and his followers. It produces the most agonising pain before, during and after urination. Each drop of urine feels like scalding acid and it may be easier to pass urine in a hot bath. The surrounding skin may become excoriated, and there may be blood in the urine. The patient is beside herself with pain and avoids drinking so that she won’t have to pass urine.

Nux vomica
There is intense chilliness and the person feels very irritable with the cystitis. There is constant urging and a sense that the bladder is full, although tiny amounts of urine are passed. This remedy is well indicated when frequency is the predominate symptom. A constitutional Nux vomica is the typical Type A personality – driven, ambitious and very competitive, with a short fuse.

Staphysagria
“Honeymoon cystitis” frequently responds very well to Staphysagria, as do urinary tract infections that come on after pelvic examination, operation or labour. It is indicated where there is suppressed anger and grief. The anger is hidden, the person appears mild tempered and gentle, yet there is often a history of abuse or deep sorrow. Cystitis occurs after sex and the pain is felt during and after urination.

Sarsparilla
This remedy is frequently used for infections when the pain comes on after urination. There may be some blood in the urine and severe symptoms of cystitis. It is easier to pass urine whilst standing up and there is a tendency to urinary retention.