SHRI GUJARATI SAMAJ, INDORE

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

Guided by:
Dr. S. P Singh sir
Dr. Anjali Nigam Mam

20132014

Submitted By:
Priti Bhatewara
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

The lower urethra is colonized with

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

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
factors

to

detect

underlying

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 aspirationAny 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 examinationWBC- 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
Disease/Condition
Overactive bladder

Differentiating
Signs/Symptoms

Differentiating Tests

Urinary urgency and

Negative urine dipstick,
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.

Noninfectious urethritis

Foreign body in bladder

Dysuria, possibly with

irritative voiding
symptoms, in the absence
of a UTI.

Negative urine dipstick,

microscopic urinalysis, and
urine culture.

Recurrent or unresolved
UTI.

Foreign body (e.g., stone,

stitch from prior pelvic
surgery) visualized on
imaging or cystoscopy.

Pelvic organ prolapse

Urethral cancer

May present with pelvic

fullness or pressure
and/or voiding
dysfunction.

No evidence of infection
in urine studies.

A urethral mass can be

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

Hx of pelvic radiation.
Radiation cystitis

Diagnosis is clinical.

May have voiding

symptoms and/or
hematuria.

Findings on cystoscopy
include diffuse erythema,
edema, vascularity,
petechiae, and patches of
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 bearingdown 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
Husbands name-Mr. Akhilesh Sharma
Add- Palasia
Occupation-H.W.
Date- 23/7/13

Age -45

C/O - Burning micturition, since 1 week.

- Itching over vulva.
- Increased frequency and urgency of urine.
- urine-hot.

sex-f

- 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
1.Loquacity
2.Company,desire for
3.Clothing,loosening,amel
4.Burning,urination,during
5.Itching,vulva
6.Tingling,hand,left

CHAPTER
mind
mind
gens
urethra
genitalia-female
Extremities

PAGE
63
12
1348
675
720
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.
Stool with mucus.
Lachesis 200]4dose
Heaviness in abdomen.
BD 2 days
Continuous talking.
12/8/13
Phytum 200]1/2dm
Better
Sac.Lac.
OD 530]1dm
days

Rx

BD 7 days.

Rx-

CASE-PRESENTATION- 2
Regd no. -25435
Name Mrs. Manorama Bhatt
Sex-f
Add-7/2 South Tukoganj
Occupation-H.W.
Date-10/7/13

Age -63

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
PAGE NO
1.Pain ,urination, during
673
2.Religious affections
71
3.Reserved
72
4.Mildness

CHAPTER
Urethra
Mind
Mind
Mind

8. Pain, knee
1072

Extremities

9.Winter, in
1422

Generalities

10.Desire, highly seasoned

485
food.

Stomach

11.Aversion, Sweets
482

Stomach

12. Constipation
606

Rectum

Repertorial analysis
CAUSTICUM10\22
PHOSPHORUS- 10\19
LYCOPODIUM- 9\18
ZINC. MET 9\15
OPIUM7\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
painful micturition .
Causticum1m]3dose

Rx

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