Urinary Tract Infections (UTIs) are one of the most common diseases seen in women of all age groups. According to a recent survey, almost all women have experienced an attack of Urinary Tract Infection at least once in their entire lifetime.
Nena took her girl child Nyra, who is 12 years old, to a psychologist. The child was showing reluctance in going to school. Neena was fed up with the tantrums of Nyra of not going to school. She was finally fed up with all the emotional dramas including crying in a wide mouth. The worried mother decided to take the help of a psychologist to tackle the situation. After an individual discussion with Nyra, the Psychologist talked to Neena. “Your child might be suffering from a UTI”. Neena was surprised to hear a diagnosis that had not crossed her mind until then. “She doesn’t use the school toilet as it is not so tidy. She suppresses her urge of micturition. Nyra is also afraid to drink water because of the same. Currently, she often feels the urge of micturition, but it is really painful when she urinates. So, she tries to lie down in her bed most of the time. Don’t get tense Neena, it is just a matter of some medications. The rest of the mental support will be done by me. Don’t worry.” Said the Psychologist.
Though this story might seem silly, there are hundreds of cases being reported in hospitals where UTI plays a villain in destroying even the mental health of women. Why do women get recurrent UTIs? Compared to men, their urethra is very short with a length of only 4cm, whereas a male urethra has a length of 18-20cm, making the infections easily conquer the area. The proximity of the external urethral meatus to the areas contaminated heavily with bacteria like the vulva and the lower- third of the vagina makes it even more prone for UTI. Other factors like sexual intercourse and catheterization can also cause UTI. UTI usually is found more in pregnancy. This is because the gravid uterus exerts pressure on the bladder leading to stasis of urine. This leads to the multiplication of bacteria causing an influx of the infected urine into the ureters and renal pelvis. Post-menopausal women, who have hypo-oestrogenic states when defence of the urethral mucosa and bladder are diminished, also are prone to UTI. Immunological disorders like Diabetes mellitus and HIV can also act as culprits of the same.
There are three routes through which UTI can spread.
- Ascending infection
- Haematogenous infection
- Lymphatic infection
Ascending infections are the commonest route where the infection starts spreading from the ano – rectal region, vagina, and vulva and finally reaches the urethra, bladder, and kidneys.
Hematogenous infections are spread to the kidneys from the intestine, septic tonsils, or other septic foci.
Lymphatic spread is generally from the adjacent ascending colon or genital organs (cervicitis) finally reaching the kidneys.
The clinical presentations of UTI too have differences. There is a wide range of presentations including the asymptomatic one, called asymptomatic bacteriuria.
Another condition called Urethritis comes with painful voiding of urine, and increased frequency and urgency of micturition. If one is suffering from Urethral syndrome, the symptoms can include painful micturition, increased frequency of urination, nocturia (the patient has to get up at night regularly for urination), and urgency of micturition. In Cystitis, it usually produces painful micturition, especially at the end of the act. Sometimes the UTI can also be associated with pus in the urine depicting the intensity of the infection.
All these symptoms can take a toll on the mental health of the women too. Especially in the case of students, who need long hours of sitting, they often feel embarrassed in using the washroom in the fear of other students teasing them. In cases of pain and burning sensation during micturition, one can even find it difficult to concentrate on studies or plays.
Investigations include midstream urine examination which can reveal plenty of pus cells and red blood corpuscles. Through urine culture, we can always detect the organism responsible for the infection. Blood examination can show the levels of urea and creatinine which can often be raised. In chronic or recurrent UTIs, more sophisticated investigations like intravenous pyelography and cystoscopy are indicated.
Prevention of the infection to the lower urinary tract is always considered better than cure. Women should be advised to maintain proper perineal hygiene which includes cleansing of the vulvar region at least daily and wiping the rectum away from the urethra. It should be noted that after every sexual intercourse, urine should be evacuated which can prevent the UTI to a greater extent. While inserting the catheter, aseptic measures must be taken to prevent infections. Suppose the catheter is used for a long time. In that case, bacteriological monitoring of urine must be done periodically and after removal of the same to rule out any kinds of infections. Plenty of fluid intake is also encouraged for proper hydration.
Women, being the pillar of a family, often have the habit of neglecting their health. Suppressing the urge of micturition is one such act, which can lead to UTI. Though India is a developing country, the absence of toilets in our country in the required amount is also a reason for the increasing incidence of UTI. Proper awareness must be given to women about urination and the harmful effects of suppressing it. The team must also teach them about personal hygiene which can reduce the UTI.
In Ayurveda, often we correlate the condition as ‘Ushnavata’. Guduchyadi kashayam, Brihatyadi kashayam, Haritakyadi kashaya, Pathya Gokshurakadi kashaya, Brihatyadi kashaya, Nisamalaki choorna, Chandraprabha vati, Abhraka bhasma are the common medicines used in OPD. Yavakshara is highly useful in reducing burning micturition.
Some of the home remedies are also helpful in managing the condition. Gokshura (Tribulus terrestris) can be boiled in water, and it can be used for drinking throughout the day instead of normal water. This has got good results in clinical practice and has been prescribed widely by Ayurveda physicians. Tender coconut water is also considered beneficial in such conditions.
Though UTI is often neglected by females, it must be given its importance and should be treated at the earliest.
