Articles

Recurrent Cystitis

Womens Health and Beauty web md from mature women and beautiful women to cancer foods and medical abbreviations -
Cystitis is an inflammation of the urinary bladder, with 75% of cases of cystitis caused by the bacterium E coli.

Cystitis often reoccurs therefore part of the herbal approach is based on prevention. The conventional approach of administering antibiotics is effective for acute episodes, however they do not impact on the bacteria adhered to the bladder wall and therefore the colonies causing the infection are not effectively dealt with, leaving the patient susceptible to re-infection. (Yarnell, 1997)

Herbal remedies have much to offer and treatment consists of anti-bacterials, alteratives, diuretics, demulcents, immunomodulators and antiseptics. This approach relieves the discomfort and pain experienced, while at the same time deals with the underlying cause of the infection, and gives support the enable the bodies immune system fight the possibility of reinfection. Much research conducted has shown positive results in treating cystitis with herbal therapies.

Pathophsyiology
The most common form of urinary tract infection is cystitis, which is inflammation of the urinary bladder. Cystitis is not always a result of infection, with other causes including metabolic disorders, chemotherapy or radiation. The most common cause of the inflammation is infection caused by bacteria. The mucosa of the bladder becomes reddened with the possibility of puss formation and diffuse haemorrhage. The normally sterile urinary tract can be infected by pathogens in two ways. Most commonly the pathogens ascend from the mucous membranes of the perineal area into the lower urinary tract, or the pathogens enter from the blood. The most common cause of infection is from Escherichia coli, however other gram negative bacteria including Proteus, Klebsiella, Enterobacter, and Pseudomonas can also be responsible.

Gram positive bacteria such as Staphlococcus, and other forms of fungus are found to cause infections in less frequent cases. Some people have a predisposition to urinary tract infections with urinary tract obstruction, chronic disease such as diabetes and bowel incontinence some of the contributing factors.(P Lemone & K Burke, 2000) Women tend to suffer from cystitis more than men due to having a shorter urethra, meaning bacteria have a shorter distance to travel to enter the bladder. As people age they also become more susceptible to urinary infections as a result of incomplete emptying of the bladder. Post menopausal women can also become more susceptible to cystitis due to the decrease in oestrogen causing thinning of the tissue around the bladder, increasing the likliehood of infection. (Parsons, 2003)

Symptoms of cystitis include frequent and painful urination, urgency, cloudy and strong smelling urine, flank pain and fever. (Parsons, 2003)

Conventional medical treatments currently available Cystitis is commonly treated with antibiotics to eliminate or control the bacterial infection. The most often used antibiotics include:
• Nitrofurantoin
• Sulfa drugs (sulfonamides) such as trimethoprim-sulfamethoxazole (Bactrim)
• Amoxicillin
• Cephalosporins
• Ciprofloxacin or levofloxacin
• Doxycycline

The symptoms of burning and irritation can be relieved with a medication called pyridium. Vitamin C is also recommended to acidify the urine.(Parsons, 2003)

Review of herbal treatment
In keeping with herbal therapy philosophy the patient should be treated holistically, considering the underlying cause of the condition, while at the same time relieving the symptoms and reducing the discomfort experienced by the patient.

The three main types of herbs appropriate for the treatment of cystitis are urinary diuretics, urinary demulcents and urinary antiseptics. These herbs broadly address the problems involved with the condition, then other herbs can be added to the formula to individualise the treatment for a particular person.

It has been shown that the use of antibiotics disrupt the balance of healthy intestinal flora, which can then lead to recurrent urinary tract infections. The problems of antibiotic resistant bacteria, is also becoming a major issue. (Reid & Burton, 2002) It is also important to not only treat the actual episode of cystitis, but also look at treatment that will reduce the likelihood of recurrent infections.

Treatment objectives
Maintain fluid intake – studies have shown inadequate fluid intake increased the risk of urinary tract infection. A high intake of fluids aids in flushing the pathogen out of the urinary system. (Haarst, Andel, Heldeweg, Schlatmann, & Horst, 2001)

Eliminate the pathogens – the most common pathogen found in urinary tract infection is E coli with this bacteria found the causative agent of infection in 75-85% of cases. (Nicolle, 2002) It is important to identify the pathogen responsible for the infection to enable the correct treatment approach to be taken. This can be done with urinalysis, collecting a specimen of mid stream urine and identifying the presence of bacteria. A bacterial count of more than 105 per mililitre suggests an infection is present.(Priscilla Lemone & Karen Burke, 2000)

Soothe inflammation – acts to protect and heal inflamed urinary membranes and relieve pain and discomfort.

Balance gut flora and improve digestion - this is vital to overall health. The use of a probiotic is important to establish a healthy balance and lessen the dominance of pathogenic bacteria.

Enhance immunity – as the infection can often reoccur it is important the body has the defence mechanisms to fight the pathogens. (Nicolle, 2002)

Improve circulation – overall vitality is improved or maintained, similar to the approach used in the Thomsonian treatment. The use of a circulatory stimulant also potentiates the effects of the other herbs.

Take preventative measures to reduce the likliehood of reinfection or spread of infection into the upper urinary tract.

Botanical treatment

With these treatment objectives in mind the following classes of herbs would be appropriate for the treatment of recurrent cystitis.

? Antimicrobials
? Diuretics
? Antiseptics
? Alteratives
? Demulcents
? Anti-inflammatories
? Astringents
? Immunomodulators
? Circulatory stimulants

Formula
Hydrastis Canadensis 10%
Galium aparine 25%
Zea mays 30%
Echinacea purpurea 25%
Cinnamomum verum 10%

Dosage - 5ml TDS . Formula rationale
Hydrastis Canadensis - contains isoquinoline alkaloids including hydrastine, berberine and canadine, resin and polyphenolic acids. (Wren, 1988) Hydrastis has a long history of use as an antimicrobial. (Cystitis, 2003) The actions are listed as antibacterial, alterative, tonic and anti-inflammatory. (Wren, 1988) Studies have supported the traditional use of Hydrastis as an antibacterial, showing it to be effective against E coli and other bacterias. (Scazzocchio, Cometa, Tomassini, & Palmery, 2001)

Galium aparine – contains iridoids, polyphenolic acids, anthraquinone derivatives, tannins and coumarins. Actions include diuretic, tonic, alterative and mild astringent. (Wren, 1988)

Zea mays – contains saponins, allantion, sterols and vitamin C and K. The actions are demulcent and diuretic. (Wren, 1988)

Echinacea purpurea – contains isobutyl amides, polysaccharides and polyacetylenes. Actions include antibacterial, alterative and immune stimulant. (Wren, 1988)

Cinnamomum verum – essential oil, tannins, cinnzelanin and cinnzelanol and coumarin. The actions are astringent, stimulant, spasmolytic, increases peripheral blood flow and anti-inflammatory. (Wren, 1988)

Additional herbal supplements
Vaccinium macrocarpon- Cranberry fruit contain anthocyanins, flavonoids, tannins, organis acids and mannose. Proanthocyanidins are found to interfere with type P fimbrial adherence of uropathogenic E. coli. The this reason cranberry taken on a regular basis can be used as a preventative to stop the infection developing, as the bacteria are unable to adhere to the bladder wall. (Kemper, 2003)

Probiotics - including Lactobacilli help in the prevention of urinary tract infections by competitively excluding pathogenic bacteria. (Hoepelman, Meiland, & Geerlings, 2003)

Vitamin C – to acidify the urine.

Conclusion
Countless other herbs, which have not been mentioned have a long tradition for use in the treatment of cystitis. With an estimated 80 to 90% of women experiencing at least one episode of cystitis during their lifetimes, and as many as 10 to 20% of women experiencing urinary infections each year the importance of providing effective treatment is undeniable. (Nicolle, 2002) The fact that herbs can effectively treat and relieve the unpleasant symptoms of cystitis, without upsetting the delicate balance of gut flora, is extremely beneficial. The inclusion of immunomodulators allows for the individual to resist recurrent infections, which a common problem in cystitis. With the continuing problem of antibiotic resistance, the use of herbal therapies for the treatment of this condition is likely to become a preferential option for many who might not have considered this option in the past.