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Urinary - Lower urinary tract infections

by Stansbury, Jill

Medical Herbalism 03-31-97 9(1): 1, 5-11

Bladder infections or simple cystitis are frequently seen in a general family practice and are fairly easy to diagnose and treat. The complaint occurs mostly in women. The presenting symptoms of frequent urination, discomfort with urination or in the pelvis, and an abnormal urinalysis make them impossible to miss. Following is a therapeutic overview of the treatment of cystitis for simple and more difficult cases.

General considerations in cystitis therapy

Simple cystitis responds best to herbal teas rather than tinctures. Mucilaginous substances dissolved in the water can soothe pain, reduce inflammation, and promote mucosal repair. Mucilaginous herbs, such as althea (marshmallow) can sometimes reduce symptoms so effectively that people feel the complaint is entirely resolved and discontinue treatment before the infection is completely resolved. Antimicrobial herbs are usually needed for at least three to five days, often longer, while mucilaginous herbs offer quick symptomatic relief. Anti-infective constituents, such as phenolic compounds in the Heath (Ericacea) family members Arctostaphylos uva ursi and Chimaphila umbellatum can provide a germicidal effect in the tea form. Other herbs that may be specific to the case or individual may be added, and three or more cups of such teas can be consumed daily for five to ten days. This may be all that is needed for a young, otherwise healthy person with a single or rare occurrence of cystitis. There should be some positive response within twenty-four hours. If there is no change in a day, or two at the most, additional therapies should be promptly sought.

For tenacious or chronic cases, or urinary infections in debilitated persons, consider using systemic immune support as well as a tea. A tincture or an encapsulated immune formula containing echinacea, Panax ginseng, Astragalus, Glycyrrhiza, reishi mushroom or other immune polysaccharide-containing botanicals may be added. Allium cepa (onion) may also be supplemented for additional antimicrobial support. High volatile oil compounds that are filtered by the kidneys will also have a local disinfectant action and stimulate debilitated, hypotonic tissues. Volatile oils that are filtered by the urinary system include those in urinary tract herbs such as barosma (buchu), juniper, thuja, and sandalwood. These compounds are stimulating and may be irritating to the urinary passages. They should be avoided or at least used with caution in acute inflammations and recent acute infections. Immune supportive nutrients, such as vitamin C, beta-carotene, and vitamin A may be supplemented and homeopathic remedies are also very useful in cystitis, both acute and chronic. The homeopathics most commonly indicated are apis, cantharis, berberis vulgaris, equisetum, and chimaphila

Underlying diabetes or a high sugar intake can contribute to repetitive urinary infections, and should be ruled out through medical testing. Allergic individuals such as those with asthma, hay fever, chemical sensitivity, and multiple food intolerances may suffer as allergens inflame the hypersensitive bladder. Those with constipation, poor diets, and bowel toxemia can develop chronic cystitis as the kidneys attempts to assist the bowels in their eliminative function. When one organ of elimination is weak, such as the bowels, the other organs of elimination, such as the skin and urinary system will be taxed in an effort to compensate. Those with immune deficiency, chronic fatigue, fibromyalgia, and candidal overgrowth can also experience frequent cystitis as part of the condition.
Copyright 2001 Paul Bergner    393


    Medical Herbalism: Clinical Articles and Case Studies

When choosing botanicals or therapies for cystitis it is beneficial to discern any underlying pathologies of constitutional tendencies. Is this an allergic individual with a hot, fiery, inflammation? Or is this a cold, immune deficient patient with weakness and loss of pelvic tone? Is there circulatory stagnation, poor perfusion to the kidneys, and reduced glomerular filtration? Or is there a high sugar, low fiber, and nutrient-poor diet, with constipation and sparse fluid intake. All of these cases would indicate slightly different approaches. By simple taking a thorough history, an underlying factor leading to the development of the condition can often be identified or suspected.

Case one

Marian was a lovely gentle woman in her late sixties who came in for acute cystitis. She had never had cystitis before and was experiencing pelvic discomfort, constant sensation of the need to urinate, with the passage of only scant amounts of urine. Urinalysis confirmed bacterial cystitis. She was prescribed the herbs in formula one.

The tea may be sweetened by adding licorice to the blend if necessary. All sugars are discouraged during a bout of cystitis. The althea was included in the tea as a soothing demulcent. Calendula and chamomile are both antimicrobial and antiinflammatory, while the chimaphila and uva ursi contain phenolic disinfectants specific for urinary complaints. Marian was to consume three to five cups of this blend over the day and call back in the morning. She phoned the following day and reported that the discomfort was more than fifty percent subsided.

She continued the tea for the next week, while the symptoms were relieved in several days. A follow-up visit and urinalysis ten days later showed the complaint to be completely resolved.

Case two

Samantha was a fast-talking, dramatic, and animated woman of thirty-eight years, who came in complaining of frequent urination and constant burning in her pelvis. The pain was relieved by drinking copious amounts of water and cranberry juice, but the high fluid intake further promoted frequent urination. Samantha had suffered occasional bladder infections over the last eight years, but they had become more frequent in the last several years, and she had been treated with antibiotics repeatedly. When she did not consume large amounts of fluid, her urine appeared thick and cloudy. She came in during her third infection in the last five months with pelvic pain, frequency, dysuria, and a characteristically abnormal urinalysis. She was prescribed tea described in formula two.
Copyright 2001 Paul Bergner    394


    Medical Herbalism: Clinical Articles and Case Studies    

As in the previous case, althea, uva ursi, and calendula were included in the tea. Agrimonia is specific for thick cloudy urine and for chronic urinary symptoms. Gallium was added as a nourishing immune tonic that stimulates lymphatic flow and filtration by the kidney. Eclectic physicians have classified it as a renal depurant, a type of renal alterative that assists the kidneys in removing waste from the body. She was to steep one Tbls per cup of water and drink three or more cups per day. She was also prescribed a commercial encapsulated immune-support formula containing echinacea, Allium sativa (garlic), Vitamin C, Beta-carotene and zinc. I suggested that she intake. I also suggested she take a break from the impressive fluid consumption for a least a week while using these medicines.

Samantha returned in one week reporting that the symptoms were dramatically reduced. She was urinating less often, had less suprapubic discomfort, and the pain with urination had gradually diminished over the week. We continued to work on here diet and stress management, and began homeopathic Nux vomica. The chronicity and tenacity of the infections improved over the next few months. She was further treated for occasional urinary symptoms over several years time, using the tea only as needed. No antibiotics have been required in the last eight years.

Case three, interstitial cystitis

Barbara was a quirky forty-eight year-old woman who presented in a state of severe debility and hypersensitivity. She reported a thirty-year history of bladder infections beginning after her marriage at a young age. The condition was aggravated by intercourse and she shared that the condition had interfered with her sex life for her entire thirty year marriage. She was presently experiencing a constant sensation of needing to urinate, a urethral discharge of a watery to mucous discharge, urinary incontinence with sneezing and straining, and vague pelvic discomfort that was aggravated by many foods. Most of her discomfort was quite external indicating urethritis as well as cystitis. A review of her entire health history revealed multiple hypersensitivities including hay fever, hives, irritable bowel and multiple drug, vitamin, and food allergies. She reported an intolerance to all orange and yellow fruits and vegetables, and most of the vitamins, herbs, and supplements ever tried on her own or prescribed by other physicians. Barbara consumed a high meat and fat food high white flour diet, with too many sweets and very sparse fruits and vegetables. She had been worked up elsewhere numerous times, but had always left treatment due to intolerance to the pharmaceuticals prescribed. While bacteria could sometimes be found or cultured, just as frequently no bacteria were found. A cystoscopy six months prior had shown a mild but diffuse inflammation of the cystic mucosa.

Barbara was pale, awkward, had a small weak pulse and trembled slightly. A urinalysis revealed high number of squamous cells and debris, and many white blood cells without significant bacteria. I tried to obtain a blood sample, but had to abandon the procedure when she became faint and ill. A CBC and Chemscreen including a thyroid panel and a urine culture run six months previously was normal. Although Barbara was in dire need, I was reluctant to give her anything too strong or complex given her extreme chemical sensitivity. Strong herbs were out of the question, as were mucosal nutrients such as zinc, beta-carotene, bioflavonoids or other nutrients, as she reported not tolerating any supplements. I started with a simple tea of althea and glycyrrhiza (licorice), and homeopathic Equisetum 6c.
Copyright 2001 Paul Bergner    395


    Medical Herbalism: Clinical Articles and Case Studies

She returned in one week having reacted poorly to the tea and feeling no better. She also disliked the homeopathic saying that it made her feel unwell and sleepy. She had used both for one day only. She calmly shared with me her religious melancholy and sexual frustration over her symptoms and life in general.

We switched her therapy to an herbal tincture of equal parts chimaphila, equisetum, and uva ursi. This was dispensed at an extremely low dosage of only five drops in water to be taken hourly, and gradually increasing if tolerated. At this dilute a dosage we wouldnít really expect a significant pharmacologic activity. These botanicals are all used in homeopathic medicine as remedies for the urinary tract, and these botanicals were noted to have specific indications fitting her symptoms. I was hoping to start here and build up to more pharmacologic doses once I found something she could tolerate.

She returned in another week reporting some improvements as she was having some good days. We continued on the tincture encouraging her to continue trying to increase the dosage. She was not taking the diluted tincture hourly, only a few times a day. We also added flax oil for her multiple allergies and hypersensitivities. She was referred for food intolerance testing, which showed reactivity to numerous foods, including orange foods such as carrots, squash, peaches, papaya, mangos, and all citrus, just as she had suspected, as well as dairy, wheat, sugar, red meat, and numerous other substances. We discussed her diet at length and devised a dietary plan.

She returned in two weeks with slight further improvements. However, she was not increasing the dosage of the tincture, and had, in fact, been taking it less. When she felt symptoms coming on, she would take a few drops in water, and the symptoms would subside, remaining at bay for a few hours to a day or more. When asked why she didnít take the tincture more often she sighed and reported that she didnít think it would really help her. I wanted to use higher dosages and further therapies, but Fate once again turned the conversation to melancholy over her situation. She brought up her grief over her daughterís divorce, and her resulting interrupted involvement with her grandchildren. Her symptoms had worsened at the time of the divorce, and had never improved. Homeopathic ignatia 200c, a remedy for physical symptoms related to grief and sadness was prescribed. She was to take a single dose. I also added another tincture of Panax ginseng for her severe debility and mental and physical weakness. Since she was tolerating the few drops of urinary tincture in water reasonably well, I suggested she add the Panax to this and take them both hourly as originally prescribed.

Barbara returned in two weeks reporting that the homeopathic had made her extremely nervous within hours after taking it, and that this progressed into a near state of panic. She had not taken the panax as she felt it was useless, and felt there was no hope of ever getting better. This visit was spent motivating and encouraging. We discussed her many emotional obstacles and emphasized that action and effort would likely help. We just had to persist and get enough therapy (whatever type) in her to do some good. She agreed to take the tinctures more often, and we also added hot epsom salt soaks in her bathtub, writing in a journal, and yet another homeopathic medicine, Phosphorus 6c for weak, nervous, trembling debility, with hypersensitivity.
Copyright 2001 Paul Bergner    396


    Medical Herbalism: Clinical Articles and Case Studies    

She returned in two weeks doing better. She was more comfortable in the bladder and a bit more optimistic. I kept up the motivation and emotional support and encouraged her to continue increasing the amount of tincture for another two weeks.

She returned for another follow-up and reported tolerating larger dosages of the tinctures, working on improving her diet, and having brief periods or relative comfort that would last a half day or more. The urinalysis was finally improving with lower content of white blood cells and debris.

I continued to work with Barbara over the next year, during which time she has continued to improve in terms of the constancy of the urinary symptoms. We continue to work on the emotional weakness and general sensitivity and debility, and the more occasional urinary flare at the present time. {Picture 3}

Case four; mixed infectious and interstitial cystitis

Betty was a hardworking forty-five year-old woman with a pleasant, friendly demeanor who came in describing a six-year history of recurrent cystitis that had become worse over the last several years. She had been working for several years with a urologist who had performed several cystoscopies showing the bladder mucosa to be inflamed, exuding blood and pus in several locations, and scarred in several other places. The urologist had rinsed the bladder with silver nitrate and manually stretched the organ on several occasions. She had experienced four or five months of improvement the first time this procedure was done, but the effects were shorter and less noticeable subsequently.

Betty described a constant burning sensation and discomfort in the pelvis. At its worst it built to a tight cramping and squeezing sensation that was extremely uncomfortable causing her to leave work for the day. Many foods would promote these bladder spasms and she was very restricted in what she could eat. She reacted to some foods so strongly that she would develop bleeding from the urethra within several hours after ingestion. Betty was chemically sensitive, and intolerant of many drugs, perfumes, soaps, and environmental substances. She had an excellent diet of mainly organic fruits, vegetables, and whole grains, and seemed to know herself, her symptoms, and her optimal diet very well. She was well-educated and informed and had started taking essential fatty acids, quercitin, and antioxidants on her own over the last six months, These supplements had improved her symptoms, but she was till in a lot of discomfort. At present she was experiencing pelvic burning and tension with a vague squeezing sensation.

I prescribed a tea in formula three.

The herbs were separated since the licorice root and kava are best decocted, adding the rest afterward to be infused. Since, like the previous case, she was chemically sensitive, I could begin with just the licorice and kava for the immediate discomfort, and add the other herbs if the first were tolerated. The licorice was included not only for flavor, but also for antiinflammatory activity and immune support. Kava is specific for spasms in the urinary passages (as it is for skeletal muscle spasms) and works reliably and impressively for spasms in the bladder and sometimes even severe renal colic. Calendula, althea, and chamomile were added because of their soothing, antiinflammatory vulnerary actions, and their general tolerance by sensitive individuals. She was to consume at least three cups of tea per day.
Copyright 2001 Paul Bergner    397


    Medical Herbalism: Clinical Articles and Case Studies

Betty returned in two weeks with continued improvement. The infused herbs were tolerated and she was enjoying the tea, drinking three to five cups a day. Optimistic after her improvements, she consumed some of the foods known to aggravate her and she had a rapid flare-up causing her to leave party and go home. Once home, several cups of the tea relieved her symptoms. I added a zinc supplement and advised her to increase her flax oil and antioxidants she had been taking and scheduled a follow-up for another two weeks.

Further improvements were noted at this third appointment. Betty had no urethral discharge for more than three weeks, and the burning and tightness in the bladder occurred less than once a day, lasting only a few hours rather than constantly. She was advised to decrease the tea to several cups a day, taking a day or a weekend off now and then, and to maintain the supplements.

Betty returned in three months. Improvements were holding and she was tolerating more diverse foods. Iíve followed Bettyís progress for more than two years now. She presently has only occasional pelvic and bladder pain, mainly with fatigue and allergen overexposure.

Case five: post-streptococcal nephritis

Six year-old Trevor came in with his mother who reported that he was limping around the house yesterday and today, but had not had any sort of injury she was aware of. He complained of hip pain and his leg would hurt so much that he refused to move it and would barely move for hours, then feel a bit better and would hobble around saying his leg hurt, and then would feel fine for a while and run around. There were no known illnesses, injuries, or accompanying symptoms reported, and the pain had been waxing and waning over the last forty-eight hours.

Trevorís right hip was held in antalgia and displayed a decreased range of motion. He was afebrile, alert, and in minor discomfort. I wanted to rule out renal pain being referred to the hip, but found the right costralvertebral angle was mildly tender and a urinalysis revealed hematuria (blood in the urine), red blood cell granular casts, renal epithelium, and large conglomerations of urate-type crystalline debris. After further questioning, it was ascertained that Trevor actually had experienced a severe sore throat about six weeks previously. I suspected post streptococcal glomerular nephritis and obtained a blood sample, which, when returned the next day, showed a very slight elevation in eosinophils and the ESR, indicating an inflammatory reaction, with all else within normal limits. An elevated antibody titer to streptococcus was also confirmed. He was prescribed a tea of althea, chamomile, and licorice, and referred to a specialist for further evaluation. The tea rapidly improved the symptoms, and by the time he consulted the urologist, all was resolved and he needed no further therapy.
Copyright 2001 Paul Bergner    398