SHRI GUJARATI SAMAJ, INDORE

S. K. R. P. GUJARATI
HOMOEOPATHIC MEDICAL COLLEGE,
HOSPITAL & RESEARCH CENTRE

URINARY TRACT INFECTION

2013-
2014
Guided by: Submitted By:
Dr. S. P Singh sir Priti Bhatewara
Dr. Anjali Nigam Mam Internee
 CONTENTS

-Aim and Objectives

-Definition of UTI
-Incidence
-Etiology
-Risk Factor
-Pathogenesis
-Clinical Manifestation
-Diagnosis
-Differential Diagnosis
-General Management
-Homeopathic T/t of UTI
-Miasmatic Approach
-Case presentation
-Repertorial approach
-Basis for selection of potency
-Reference & Bibliography
AIM :-
- To role out the proper diagnosis & have a
exact preventive & prophylactic
measures against UTI.
OBJECTIVE :-

-To discuss the Homoeopathic

approach in management of UTI.

- As we treat a individual person, so

on the basis of therapeutic &
constitutional prescription the
physician cure the person, suffering
from UTI & even break the
recurrence of the symptoms.
 INTRODUCTION
Urinary system infections
Urine is sterile.
Presence of inflammatory cells or pathogens
in urine indicate
a urinary tract infection (UTI).
Urinary tract infection is the most common
bacterial infection
managed in general medical practice.
Up to 50% of women will have a UTI at some
point in their life.
UTI uncommon in men except over the age
of 60 when
urinary tract obstruction due to prostatic
 UTIs are named
according the place
of infection
In the urethra =
Urethritis
In the bladder = Cystitis
In the kidneys =
Nephritis
In the prostate (men) =
Prostatitis
 REVIEW OF LITERATURE

DEFINITION

UTI is a broad term that encompasses both

asymptomatic microbial colonization of the
urine and symptomatic infection with microbial
invasion and inflammation of urinary tract
structures.
 COMPLICATED UTI:-
Underlying structural or functional
abnormality that predisposes patient to UTI or
makes UTI more difficult to treat.

RECURRENT UTI:-
> 2 UTI in a 6 month period.
 INCIDENCE:-
Female:- 6-8%
Male:- 1.5-2%
Up to 11 yrs. = 1% boys & 3% girls
In older girls, there is 10 fold
increase in incidence as compared to
boys.
Around 55 yrs. Incidence is male =
female.
The incidence of asymptomatic
bacteriuria in female is about 4% . In
During infancy M:F ratio is
1:1.

Beyond infancy M:F ratio is

1:10.
Causative organism:-

Most common :-
E. coli, ( 80-90%,)
Klebsiella (8%)
Proteus (5-7%) [more common in male]

Others are:-Enterococci
Staphylococcus aureus
Streptococcus group B
{ more common in neonate}
Pseudomonas
FUNGI:- CANDIDA
especially after instrumentation of
the urinary tract and in poor
immune state.
others are:- Aspergillus &
Cryptococcus

VIRUS:- ADENOVIRUS.
 PREDISPOSONG FACTORS

o
The lower urethra is colonized with
bacteria early in life but the
bacteria are non-pathogenic. The
effect of oestrogen is also lacking.

oSexual intercourse increases the

ascent of the organisms from the
lower into the bladder.
oFull bladder Provided bladder is kept
empty completely & regularly, there is
least chance of UTI. But certain
circumstances favour atonicity of the
bladder & urinary stasis as in
pregnancy, puerperium & following
major pelvic surgery or pelvic tumors
producing outflow tract obstruction.
o Catheterization This is probably the
commonest cause of introducing
organisms from the lower urethra into
the bladder whatever meticulous
aseptic technique being taken.

It has been observed that an indwelling

catheter kept for 24 hrs. will produce
bacteriuria in 50% & if left for 4 days
will lead to bacteriuria in 100% of
cases.
o Hypo-estrogenic state as in
postmenopausal women when
defence of the bladder & urethral
mucosa is diminished.

o Immunocompromising disorders like

Diabetes mellitus.
RISK FACTORS:-
*young age
* female gender
*uncircumcised male
*vesico-ureteric reflux
*obstructive uropathy
- post. Urethral valve
- urethral stricture
-prostatic hypertrophy
*urethral
instrumentation.
 - constipation
-neurogenic bladder
-pregnancy

Surgically correctable:--calculi
-urethral
duplication
-obstructive
uropathy.
ROUTES OF INFECTION
PATHOGENESIS:-

i. Mostly ascending infection.

ii. Hematogenous origin in:- neonate

&
in pts of infective
endocarditis.
 CLINICAL MANIFESTAIONS
AND CLASSIFICATION:-

3 basic forms of UTI:-

1. Asymptomatic bacteriuria
2.Cystitis

3. Pyelitis or Pyelonephritis.
 1. ASYMPTOMATIC BACTERIURIA:-

The term asymptomatic bacteriuria is used

when a bacterial count of the same species
over 150,000/ml in midstream specimen of
urine on two occasions is detected without
symptom of urinary infection.

Count less than 150,000/ml indicate

contamination of urine from the urethra or
external genitalia.

Nearly 30% of women with asymptomatic

2. CYSTITIS:- Cystitis is the most common of the
UTI.
Symptoms include :
- Dysuria
- Frequency & urgency of
micturation
- Pain
- It produces painful micturation specially
at the end of the act.
- There may be suprapubic tenderness &
may have constitutional upset.
Investigations :

Midstream clean catch urine for

microscopic examination, culture &
drug sensitivity is to be done in case.

Microscopic examination usually

reveals plenty of pus cells & occasional
red blood cells. The culture will detect
the organism within 24 hrs. & it usually
exceeds 150,000/ml of urine.
3. PYELONEPHRITIS:-
Inflammation of the renal pelvis.
Symptoms include are:-
- Acute aching pain over the
loins,
- Fever with chills & rigor,
- Frequency of micturation &
- Dysuria.
- There may be anorexia, nausea
or vomiting.
The patient looks ill with dry
tongue.

The pulse rate is proportionate

with temperature.

There is varying degrees of loin

tenderness.
Investigations :
Midstream urine examination reveals
plenty of pus cells & red blood
corpuscles.
Culture will detect the organism.

Blood examination shows

leucocytosis; urea & creatinine level
may be raised.
 Prostatitis is suggested by
Pain in the lower back, perirectal
area and testicles.
High fever, chills and symptoms
similar to bacterial cystitis.
Inflammatory swelling of prostate,
which can lead to urethral
obstruction.
Urinary retention, which can cause
abscess formation or seminal
vesiculitis.
Investigations to detect underlying
factors

Mostly for patients with recurrent UTIs:

Culture of midstream urine sample (MSU) or

urine from suprapubic aspiration.
Microscopic examination or cytometry for
white and red cells.
Dipstick examination of urine for blood,
protein and glucose.
Blood culture if fever, rigors or evidence of
septic shock.
Pelvic examination for women with recurrent
DIAGNOSIS:-
1. Presumed diagnosis:-
Clinical picture
&
Routine urinalysis
and/or
the dipstick test for nitrite and
leucocytes esterase
on 1st morning void
In a symptomatic pts a UTI is possible even
if the urinalysis result is negative.
Pyuria {>5WBC/HPF} may occur in absence
of infection, and infection may be present
without pyuria.
2.Definite diagnosis:-
Positive urine culture growth of a single organism.
On clean catched mid stream urine sample.
> 1,00,000 colonies of a single organism.
{Repeat culture if 10,000-1,00000 colonies.}
Catheter sample-
>10,000 colonies.
{Repeat culture if 1000-10,000 colonies.}

Suprapubic aspiration-
Any colony growth is
significant.
URINE SAMPLE:-

The correct diagnosis of UTI depends

on having the proper sample of urine.
A clean catched mid-stream urine sample
is usually satisfactory.
Separating the labia in girls and in
uncircumcised boys retraction of prepuce
must be done.
OTHER LAB. FINDING:- Blood examination-

WBC- leucocytosis and neutrophilia.

Increased ESR and CRP.

Blood culture:- sepsis is common in

pyelonephritis particularly in infants.
 PREVENTION
The following guidelines are prescribed
in an attempt to prevent infection to
urinary tract:

1.To maintain proper perineal hygiene.

This consists of cleansing the vulvar
region at least daily, wiping the
rectum away from the urethra.

2.Catheter infection Whatever aseptic

3. Prophylaxis of the coital infection
To void urine immediately following
coitus. A single dose of nitrofurantoin
50 mg following coital act is an
effective means of prophylaxis. This
is helpful in women who have history
of postcoital exacerbation of
infection.
MANAGEMENT

The principles in the management are :

-To isolate the organism & drug

sensitivity, if time permits prior to
antimicrobial therapy.

- To administer effective drug for an

adequate length of time.

- To prevent reinfection.
Measures to prevent UTIs

Keep patients hydrated (Fluid

intake of at least 2litres per day)
Good personal hygiene
For women, avoid feminine
hygiene sprays
 Encourage regular complete
 Showers preferable to baths.
Cranberry juice maybe effective.
Frequently change those who use
incontinence pads.
Set reminders/timers for those who
are memoryimpaired to
use the bathroom.
Encourage front
to back
cleansing.
 Differential Diagnosis
Differentiating
Disease/Condition Differentiating Tests
Signs/Symptoms
Urinary urgency and Negative urine dipstick,
Overactive bladder frequency in the absence of microscopic urinalysis, and
a UTI. urine culture.
Urothelial carcinoma of the Microscopic and/or gross Positive urine cytology.
bladder or upper urinary hematuria in the absence of Tumor seen on cystoscopy
tract a UTI. or upper tract imaging.
Dysuria, possibly with
Negative urine dipstick,
irritative voiding
Noninfectious urethritis microscopic urinalysis, and
symptoms, in the absence
urine culture.
of a UTI.
Foreign body (e.g., stone,
Recurrent or unresolved stitch from prior pelvic
Foreign body in bladder
UTI. surgery) visualized on
imaging or cystoscopy.
 May present with pelvic Diagnosis is clinical.
fullness or pressure
Pelvic organ prolapse No evidence of infection
and/or voiding
dysfunction. in urine studies.

May present with voiding A urethral mass can be

symptoms or hematuria. visualized on cystoscopy
Urethral cancer and confirmed by
Urethral induration may be pathologic diagnosis of
noted on physical exam. biopsy specimen.

Hx of pelvic radiation. Findings on cystoscopy

include diffuse erythema,
Radiation cystitis May have voiding edema, vascularity,
symptoms and/or petechiae, and patches of
hematuria. pallor.
 MIASMATIC APPROACH:-

All three miasm may be present in UTI,

but psora is predominant miasm.

1)PSORA:- in case of inflammation,

itching, burning.

2)SYCOSIS:- in case of calculi, stasis or

any obstruction.
Homoeopathic Approach
Homeopathy is a very safe and
effective mode of treatment.
Whenever administered judiciously,
homeopathic remedies will break
the tendency of recurrent infection
and have provided permanent relief.
 HOMOEOPATHIC THERAPS
OF UTI
1)Apis Mellifica--

For stinging or burning pains that

tend to worsen at night and from
warmth.

This remedy is appropriate for

people who feel an intense urge to
urinate, yet can only do so in drops.
2)Berberis Vulgaris--
For UTIs with burning or shooting
pain during urination that may radiate
to the pelvis or back.

Sensation as if some urine remain

after urination.

When not urinating, an aching

sensation is present in the bladder
that worsens with movement.
3)Cantharis:
Strong urging to urinatewith cutting
pains that are felt before, during and
after urination.

Only several drops pass at a time, with a

scalding sensation. The person may feel
as if the bladder has not been emptied.
Burning during urination.
Haematuria present.
4)Borax:

This remedy can be helpful for

cystitis with smarting pain in the
urinary opening and aching in the
bladder, with a feeling that the urine
is retained.

Children may cry and screams

before passing urine.
5)Sepia:
This remedy may be helpful if a person
has to urinate frequently, with sudden
urging, a sense that urine will leak if
urination is delayed, and small amounts of
involuntary urine loss.
The person may experience a bearing-
down feeling in the bladder region, or
pressure above the pubic bone.
A person feels worn-out and irritable, with
cold extremities, and a lax or sagging
feeling in the pelvic area.
6)Staphysagria:
This remedy is often indicated for cystitis
that develops in a woman after sexual
intercourse, especially if sexual activity is
new to her, or if cystitis occurs after every
occasion of having sex.
Pressure may be felt in the bladder after
urinating, as if it is still not empty.
A sensation that a drop of urine is rolling
through the urethra, or a constant burning
feeling, are other indications.
Staphysagriais also useful for cystitis that
develop after the use of catheters.
7)Equisetum Hyemale:-
Severe dull pain in the bladder, as from
distension , not ameliorate after urination.
Frequent and intolerable urging to
urinate, with severe pain at close of
urination.
Constant desire to urinate; large quantity
of clear, watery urine but without
amelioration.
Sharp, Cutting, Burning pain in urethra
while urinating.
8)Causticum:-
Involuntary urine when coughing.
Involuntary during 1st sleep at night;
and also from slightest excitement.
Retention after surgical operation.
Loss of sensibility on passing urine.
OTHERS MEDICINES:-

Aconite
Belladonna
Capsicum
Cannabis Sativa
Lycopodium
Nux Vomica
Sarsaparilla
 CASE-PRESENTATION- 1

Regd no. -25500

Name Mrs. Nivedita Sharma Age -45 sex-f
Husbands name-Mr. Akhilesh Sharma
Add- Palasia
Occupation-H.W.
Date- 23/7/13

C/O - Burning micturition, since 1 week.

- Itching over vulva.
- Increased frequency and urgency of urine.
- urine-hot.
- Sour eructation.
- Acidity.
- Tingling in left hand.
- Pain both shoulders

Past History :
Hysterectomy due to uterine fibroid 5yr back
 Gynecological & Obstetrics
History :
Artificial menopause.
Hysterectomy due to fibroid., 5 yr
back

G1, P1, L1, B1

 Personal History
THERMAL RELATION- Hot pt.
APP. -Normal
THIRST -Normal
DESIRE- sour
AGG.-tight clothing(feel uneasy)
SLEEP- disturbed due to frequency of urine
DREAMS- not specific
Natural Elimination :

STOOL- alternate day.

URINE hot, burning with increased
frequency
Mental Gen. :
Talkative+++
Always wants company.
Cant tolerate tight clothing, feels
uneasy.

Gen. Examination :
Tongue- moist, clear
 RUBRICS FOR REPERTORIZATION
KENT REPERTORY

RUBRICS CHAPTER PAGE

1.Loquacity mind 63
2.Company,desire for mind 12
3.Clothing,loosening,amel gens 1348
4.Burning,urination,during urethra 675
5.Itching,vulva genitalia-female 720
6.Tingling,hand,left Extremities 1208
RUBRICS CHAPTER
PAGE NO
7.Pain, shoulders Extremities
1051
8.Desire,sour stomach
486
9.Constipation,alternate Rectum
607
day
10.Urine,hot urine
681
 Repertorial analysis
LACHESIS 7\15
SULPH - 6\14
NUX V - 6\14
PHOS - 6\12
ARS. ALB - 6\12
CAMPH - 5\12
23/7/13
Lachesis 200]5dose
4-4 glob BD3 days
Rubrum30]1dm
4-4 glob. TDS5 days
 3/8/13
Better in itching over vulva.
Burning micturition
Pain and swelling in small joints. Rx-
Stool with mucus.
Lachesis 200]4dose
Heaviness in abdomen.
BD 2 days
Continuous talking.
12/8/13
Phytum 200]1/2dm
Better Rx
Sac.Lac.
OD 530]1dm
days
BD 7 days.
 CASE-PRESENTATION- 2

Regd no. -25435

Name Mrs. Manorama Bhatt Age -63
Sex-f
Add-7/2 South Tukoganj
Occupation-H.W.
Date-10/7/13
C/O-
- Frequent micturition, 1 month on & off type.
- Very Painful micturition.
-Sometime involuntary dribbling of urine.
-Vertigo.
-Pain in B/L knee joints since 4-5 yrs.
-Pain in calf muscle
-HTN ( on allop. T/t)
- < in winter season, night.
-Acidity
Gynecological & Obstetrics
History :

Menopause.

G2,P2, L2, B1 G1
Personal History
THERMAL RELATION- chilly pt.
APP.- good
THIRST-decreased, 3 glass/day
DESIRE- salty, spicy
AVERSION- sweets
AGG.- winter, night
AME- rest
SLEEP- sound
DREAMS- not specific.
Natural Elimination :

STOOL- constipation.
URINE frequent micturation,
dysuria.
 Mental Gen. :
Religious.
Reserve nature.
Mild.
Helping nature.

Gen. Examination :

BUILT- obese
TONGUE- clean.
BP- 140/90 mm of Hg
 RUBRICS FOR
REPETORIZATION
KENT REPERTORY

RUBRICS CHAPTER
PAGE NO
1.Pain ,urination, during Urethra
673
2.Religious affections Mind
71
3.Reserved Mind
72
4.Mildness Mind
8. Pain, knee Extremities
1072

9.Winter, in Generalities
1422

10.Desire, highly seasoned Stomach

485
food.

11.Aversion, Sweets Stomach

482

12. Constipation Rectum

606
Repertorial analysis
CAUSTICUM- 10\22
PHOSPHORUS- 10\19
LYCOPODIUM- 9\18
ZINC. MET - 9\15
OPIUM- 7\13
CANTHARIS 3\9
PRESCRIPTION:-

Causticum 200] 4 dose

4-4 glob. BD 2days
Phytum 200] 1/2 dm
4-4 glob BD 3 DAYS
18/7/13
Slightly better in dysuria.
Remain all compt.
Rx
Repeat
25/7/13
-Pain in knee jnts
-Relief in frequent and Rx
painful micturition .
Causticum1m]3dose
4-4
glob OD.-

Rubrum]1dm
4-4
glob BD 7 days
3/8/13
relief in knee jnts pain
 BASIS FOR THE SELECTION OF
POTENCY

1) The problem is not so chronic in

nature so the potency will be
medium to high.
2) As selected remedy is on the basis
of constitution so high potency will
also be prescribed.
 REFERENCE & Bibliography

-Golwala & Davidson Practice of Medicine

- Dutta Gynecology
- Allens Keynotes - H.C.Allen
-Homeopathic Materia Medica and Repertory- W.
Boericke
-Kent's repertory.
-www.similia.com
-www.google.com