Lesser used homoeopathic medicines for urinary tract infections

Dr Pragya Sharma

ABSTRACT
Urinary tract infection (UTI) is one of the common condition clinical practice encountered nowadays. It is caused by the Escherichia coli (E. coli) bacteria, most commonly. It severity varies from simple urethritis and cystitis to acute pyelonephritis with septicaemia. There are many homeopathic medicines that have been found to be very effective in the management of urinary tract infections. This article aims at describing the indications of some lesser used as well as commonly used homoeopathic medicines which can be useful in treating cases of urinary tract infections.

KEYWORDS:  Urinary tract infections, Urinary tract diseases, Homoeopathy

INTRODUCTION
Urinary tract infections (UTI) affect about 20% women during their lifetime. It occurs more commonly in females than in males, although men above 50 years of age have an increase incidence of UTI caused due to obstruction from prostatic hypertrophy.^{(1, 3)}

The term urinary tract infection consists of various clinical entities: cystitis, pyelonephritis, prostatitis, and asymptomatic bacteriuria (ABU). About 4% females suffer from asymptomatic bacteriuria and the incidence rises to 10% during pregnancy.^{(1, 3)}

The commonest causative organism is Escherichia coli (80-90%) and others are Pseudomonas, Klebsiella, Proteus, Enterococci, Staphylococcus, etc. Risk factor includes frequent sexual intercourse, a history of UTI, catheterization, Immunocompromising diseases like diabetes mellitus and HIV.⁽³⁾

UTI is associated with multiplication of organisms in urinary tract and the term Significant bacteriuria is used when there is presence of more than 10 organisms/ml in the midstream sample of urine (MSU). The cases of UTI are usually ignored when minor manifestations are present. In cases of asymptomatic bacteriuria, the infection remains in the urinary tract for a long period of time which flares up to produce pyelonephritis. Hence, attention should be paid even in asymptomatic patients having significant bacteriuria.^{(2, 3)}

CLINICAL MANIFESTATIONS  

• Asymptomatic bacteriuria is diagnosed when the patient has no symptoms related to the urinary tract but a urine culture found to contain bacteria which has been performed for a reason unrelated to the genitourinary tract.⁽¹⁾
• Features of cystitis and urethritis include: increased frequency of micturition, pain in the urethra during micturition (dysuria), Suprapubic pain during and after urination, constant urge to pass urine after micturition (urgency), Unpleasant odour of urine with cloudiness and Microscopic or visible haematuria.⁽¹⁾
• Pyelonephritis presents as fever, lower back pain, nausea, and vomiting. Bacteraemia may be present.⁽⁴⁾
• Symptoms of Prostatitis presents as dysuria, urinary frequency, fever, chills, symptoms of bladder outlet obstruction, and pain in the prostatic, pelvic, or perineal area. Non-infectious prostatitis is more common.⁽¹⁾

DIAGNOSIS
The clinical history itself helps in diagnosing urinary tract infections. Gold standard diagnostic test for UTI is urine culture which detects bacteria in urine (>10² bacteria/ml). Midstream urine examination reveals pus cells and red blood corpuscles. A urine dipstick test positive for nitrite or leukocyte esterase can confirm the diagnosis of uncomplicated cystitis. Intravenous pyelography and cystoscopy is indicated in cases of chronic or recurrent urinary tract infections.^{(1, 3)}

PREVENTION 

• Plenty of fluid intake.
• Proper perineal hygiene should be maintained.
• Urine should be immediately voided after coitus. This is helpful in women who have history of postcoitus infection.
• Alkalization of urine should be done by citrus fruits intake etc.
• Regular complete bladder emptying.^(2,3)

HOMOEOPATHIC MEDICINES

 Following are some Lesser used Homoeopathic medicines which can be effectively used in cases of urinary tract infections –

ARISTOLOCHIA SERPENTARIA:  It is a useful remedy when there is irritation of urinary and genital organs. There is violent desire to urinate with passage of increased quantity of urine. The patient also presents with frequent desire to pass urine but passes a little quantity of brownish urine.⁽⁷⁾ 

BAROSMA CRENULATUM: It is useful in cases of urinary tract infections when there is presence of muco-purulent discharge from genito-urinary organs. Irritability of bladder with vesical catarrh.^(6,7)

COPAIVA OFFICINALIS: The patient presents with retention of urine with painful urination. Patient has constant desire to urinate and urine has odour of violets.^(6,7)

DORYPHORA DECEMLINEATA: This remedy is useful in urethritis in children from local irritation and gleet. Urination is difficult with excruciating pain in urethra while urinating. Severe pain in back and loins is associated with urinary symptoms.^(6,7)

FERRUM IODATUM: It’s indications are sensation as if something crawling in urethra and rectum. Incontinence of urine in anaemic children. Dark urine with sweet smell.^(6,7)

HELONIAS DIOCA: It is indicated when urinary symptoms are associated with Diabetes mellitus.^(6,7)

NAPHTHALINUM: This remedy is indicated when there is irritation of urinary organs with irresistible desire to urinate. Black urine of offensive odour with pain in bladder region.^(6,7)

POPULUS TREMULOIDES: It is a useful remedy in vesical troubles after operations and in pregnancy. It is also indicated in old people with dyspepsia and catarrh of the bladder. Urine is scalding and contains mucus and pus. Pain at the end of urination behind pubis.^(6,7)

RHUS AROMATICA: It is indicated in patients who are suffering from diabetes and who are having pale, albuminous, constantly dribbling urine and passes large quantity of urine with low specific gravity. Also indicated in children who have severe pain before urination.^(6,7)

VESPA CARBO: It is indicated in patients with burning urination with itching.^(6,7)

Following are the commonly indicated Homoeopathic medicines which can be effectively used in cases of urinary tract infections –

ACONITE NAPELLUS: It is indicated when symptoms come very suddenly, often after a fright or exposure to cold. Urine is scanty, red, hot and painful. The patient has tenesmus and burning at neck of bladder and burning in urethra. Retention of urine may also be present. Anxiety is present always on beginning to urinate.⁽⁶⁾

APIS MELLIFICA: The patient presents with incontinence of urine, with great irritation of parts. Patient can hardly retain the urine a moment and scalds severely when passed. Burning and smarting of last drops of urine. Scanty and high-coloured urine. Cold application ameliorates the complaints.^{(5, 6)}

CANTHARIS: This remedy is a wonderful remedy for cases of UTI in patients having complaints of constant urging to urinate, passing a few drops at a time. Key points of cantharis are intolerable urging, before, during and after urination with burning, cutting pains in urethra during micturition.⁽⁵⁾

CANNABIS SATIVA: This is also one of the useful remedy in cases of urinary tract infections. Its indications are scalding urine with burning and painful urging while urinating. Urethra is very sensitive to touch or pressure and the patient cannot walk with legs close together because it hurts the urethra. Stream of urine splits during micturition.^(5,6)

 CHIMAPHILA UMBELLATA: This can be particularly useful in cases where UTI is associated with prostatitis. Urine is scanty with ropy, mucopurulent sediment. Burning and scalding during micturition and patient must strain before urine flow comes. The patient has a feeling of ball in the perineum. The patient is unable to urinate without standing with feet wide apart and body inclined forward. Complaints are aggravated while sitting and relieved by walking about.^(6,7)

EQUISETUM HYEMALE: It is indicated when there is constant desire to urinate and passing large quantity of clear, watery urine without any relief. There is sharp, cutting, burning pain in urethra while urinating. Frequent and intolerable urge to pass urine with severe pain at close of urination. The patient feels dull pain in the bladder as from distension which is not relieved after urinating.⁽⁵⁾

MERCURIUS: It is a very useful remedy for urinary tract infections when the quantity of urine voided is larger than amount of water drunk. Urine is dark, scanty and bloody with burning in urethra on beginning to urinate and frequent urging to urinate. All complaints worse at night.^(5,6)

NUX VOMICA: Nux vomica is chiefly successful with persons of an ardent character, irritable, impatient temperament who are disposed to anger. Irritable bladder with ineffectual urging, spasmodic pain and strangury. The patient may complaint of itching in urethra & pain in neck of bladder while urinating.^(5,6)

STAPHYSAGRIA: It’s useful in patients when cystitis develops after sexual intercourse, especially in newly married women and in females after difficult labor. Burning in urethra even when patient is not urinating. Old men with prostatic troubles presenting with urging and pain after urination.⁽⁵⁾

PULSATILLA: The disposition and mental state are the principal guiding symptoms to the selection of pulsatilla. Mild, gentle, yielding and weeping disposition with changeability of symptoms are the keynote of this remedy. There’s increased desire for urination which is worse on lying down. Burning in urethra during and after micturition. Spasmodic pain in bladder after urination. Involuntary urination while coughing or passing flatus may also present. Symptoms of patient are better in open air and from consolation.⁽⁶⁾

PAREIRA BRAVA: It is indicated in cases of urethritis with prostatic troubles. Violent itching in urethra with scalding during micturition and pain in thighs while urination. Urine is black, bloody and contains thick, white mucus. Patient can pass urine only when he goes on his knees and hands pressing his head firmly against the floor.^(6,7)

TEREBINTHINIAE OLEUM: It is indicated when the urine is scanty, bloody and has the odour of violets. The patient has violent cutting and burning pain in the bladder with tenesmus and strangury. Cystitis and spasmodic retention of urine. Urethritis with painful erections.^(5,6)

UVA URSI: It is one of the wonderful remedy for urinary tract infections and the indications are painful micturition with burning sensation and frequent urging with severe spasms of bladder. Urine is bloody with pus and mucus. Symptoms are better when lying on the back.^(6,7)

CONCLUSION
There are many more remedies for Urinary tract infections in Homoeopathy. Many drugs which are mentioned in this article are rarely used and very less known. These remedies can be very useful in cases of UTI. With selection of similar remedy based on totality of symptoms we can successfully manage such cases. Hence, proper case taking according to Homoeopathic principles is required for treating the patient as a whole.

REFERENCES

1. Kasper D.L, Fauci A.S, Hauser S.L, Longo D.L, Jameson J.L, Loscalzo J. Harrison’s manual of medicine, 19th ed. : McGraw-Hill Education; 2016.
2. Mathew G.K, Aggarwal P. Medicine Prep manual for undergraduates, 5th ed. New Delhi: Elsevier; 2015.
3. Dutta D.C. Textbook of Gynecology, Enlarged & Revised Reprint of 6^th New Delhi: Jaypee brothers medical publishers (P) Ltd; 2013.
4. Davidson’s principles and practice of medicine, 23rd ed. : Elsevier; 2018.
5. Allen H.C. Allen’s Keynotes rearranged and classified with leading remedies of materia medica and bowel nosodes, 10th ed. New Delhi: B. Jain. Publishers (P) LTD; 2005.
6. Boericke W. Boericke’s new manual of homoeopathic materia medica with repertory: Including Indian Drugs, Nosodes, Uncommon Rare Remedies, Mother Tinctures, Relationships, Sides of the Body, Drug Affinities & List of Abbreviations, 3rd Revised and augmented edition based on 9^th New Delhi: B. Jain Publishers (P) LTD; 2018.
7. J.H. A Dictionary of Practical Materia Medica. Reprint ed. New Delhi: B. Jain Publishers (P) Ltd; 2000.

Dr. Pragya Sharma
MD Scholar, Department of Homoeopathic Materia Medica
Bakson Homoeopathic medical college and Hospital, Greater Noida, Uttar Pradesh