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Dr. Andre A. Kulisz
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| Infections in incontinent populations | ||
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Dr. Kulisz's view on infections in incontinent populations
| A note from the author: | The following information is based on my experiences with incontinent patients - Dr. Andre Alexander Kulisz |
I beg to differ.
As much as it may be true to some extend, UTI needs to be approached by education (what to do to prevent it or to limit it), and by including old, pre-antibiotic medications that did not cause bacterial resistance and were doing well for our parents and grandparents. Let’s leave antibiotics to cases that don’t respond to anything else. Since a substantial part of UTIs is of nosocomial origin, it would be beneficial that hospitals and clinics get cleaned (literally and figuratively).Patients need to take more (sometimes much more) responsibility for their own health. They must actively participate in the treatment process. Unless there are some special circumstances, they must always, always finish their prescription. If we can’t prevent infections, we can surely limit them. Non discriminate use of antibiotics and patients noncompliance with therapeutical requirements are substantially harmful. Let’s get back to basics. It will be also a more responsible and more affordable medicine.
I mentioned education at the beginning of the previous paragraph. My word to the patients is: don’t wait until a nurse or a doctor hands you over some fliers. Go to the library, search the net. Do whatever it is that you need to learn more about your affliction. No matter what you think, you are primarily responsible for your health. Not your doctor, not your parents, children, friends, etc... You are. Active and informed participation is the key. It will be good for you and your doctor. Give the treatment a chance. Stay educated and informed. Improve your odds.
Urinary infections can be as serious as they are unpleasant. Some of them seem to be specifically associated with the life style of incontinent people. Some, with anatomical conditions that cause voiding dysfunction. The two primary ones are probably poor hydration (not drinking enough of the water) and not knowing how to properly take care of the hygiene of urogenital area. The other causes may be attributed to the anatomy. In incontinent women urethras are short and their closure is poor. This condition may allow bacteria to migrate to the bladder and cause an infection. (In the retentive patients, not voiding frequently enough causes that the bladder is not flushed and bacteria retained in the remaining urine grows and causes infection.) Interestingly enough, symptoms of urinary infection can’t be specifically attributed to the number of bacteria. It is generally accepted that a number of colony forming units (CFU) lower than 100,000 is considered non-infection, while a CFU larger than 100,000 is considered infection. However, different people react differently to the same bacteria. Some may show the symptoms of infection well below 100,000 CFU, while the others may not show any well above 100,000 CFU.
It is normal in many people to have bacteria in the bladder. In many of us it is a symbiotic condition. We and bacteria coexist as a part of the natural environment. We have bacteria in our mouth, stomach, digestive tract, vagina, rectum, on our skin and on the surface of our eyes. Bacteria is literally everywhere. There are many species that inhibit our bodies. And all of them, most of the time, keep each other "in check". If the situation arises that one of the species becomes more prominent than the other, infection may occur. That is why, in the case of infection, doctors want to know what species we have in our urine and what medications they are sensitive to. This allows them to select a medication, that eradicates the bacteria and, in effect, ends the infection. Ending an infection may be all that is needed to improve or even end incontinence. Take care of yourself. You are worth it.
For personal telephone consultation with Dr. Kulisz click here.
Things that we can do to help prevent infections.
Universal Precautions:
There are very few things that need to be done to effectively limit or prevent bladder infections:
- Maintain proper hygiene of the urogenital area (prevents bacterial growth and spread from rectum to vagina to urethra.)
- Perform regular vaginal/pelvic floor exercises to close the urethra and prevent bacteria from migrating to the bladder (that's why continent women have lot less UTIs than incontinent ones)
- Drink eight to 12 glasses of water daily to dilute the urine and flush bladder frequently. This effectively prevents bacteria from reaching numbers sufficient to infect the bladder.
- Drink a glass to two of cranberry juice. It contains alpha-D-mannopyranoside, a substance preventing bacteria from attaching to the bladder wall. It also acidifies the urine making it inhospitable for bacterial growth.
- Strengthen your immune system. Nourish yourself properly, take food supplements if needed. Exercise daily. Nothing boosts health better than proper nourishment and daily vigorous general exercises.
The following chart shows more specifically things we need to do to prevent UTIs:
Cause of infection |
Method of prevention |
| Short urethra, possibly open bladder neck, open passage to the bladder | Kegel exercises to strengthen pelvic floor, pessary, surgery -- bladder neck suspension that closes the urethral passage. Drink 8 to 12 glasses of clean water to flush the bladder frequently and at least 8 oz. (250 ml.) of pure cranberry juice to acidify the urine and prevents bacteria from attaching to the cells lining the bladder. (Cranberry juice contains alpha D mannopyranoside, a derivative of the D-mannose that prevents bacteria from attaching to the bladder wall.) |
| Bladder prolapse preventing complete voiding | Kegel exercises to strengthen pelvic floor and improve tonus of anterior vaginal wall, pessary, surgery. Modifying voiding position by leaning forward while voiding may help empty the bladder completely. An ultrasound scan may be beneficial to see how much (if any) of the post voiding residual (PVR) is left in the bladder. Try to avoid checking PVR by inserting urinary catheter. This procedure may actually introduce infection. That is why patients after catheterization get an antibiotic prophylactically. |
| Fecal contamination | Clean (wipe) yourself after defecation rearwardly. Do not clean after defecation forwardly as it will always bring some feces to the urethral meatus and cause infection. Enterococus feacalis is a typical specie that may be introduced by feces. Always, if only possible, wash your urogenital and rectal area after defecation with copious amounts of soap and water. I know, it may be a substantial inconvenience, but it’s well worth it. Always wash you hands before and after a visit to the toilet. |
| Improper or insufficient hygiene of urogenital area | Wash your labias,
meatus, rectum and all the area around them with copious amounts of soap and water after
you are done with showering and rinse yourself with shower again. You may also consider
voiding you bladder after intercourse, if you can’t take a shower. Wash your hands
well, before you wash you urogenital area. If the urine culture shows staph epidermis, it
may be from your hands. If you are prone to UTI try the following rinse after washing: boil two-four tea bags (use tea bags AFTER you used them to make tea) for 10 min in small amount of water (about eight ounces -- 250 milliliters). Remove tea bags and cool water until it is luke warm. Rinse your vagina and whole urovaginal area. Do it once a day. You may be surprised with results. Make fresh every day. If you can make it an early morning and evening (before going to bed) the better. The process of the boiling extracts tannins from tea leafs. Tannins will help you firm up the most external tissue layers of your urovaginal area and help retain their cleanliness. In the industry tannins are used in tanning, dyeing, photography and as clarifying compounds for beer and wine. (Tannins are complex nonuniform constituents that occur in many plants i.e. oak bark and other Fagaceae. They also occur in tea leafs) |
| Dehydration | Incontinent people don’t drink. This is probably one of the most prominent enhancers of the urinary infections. Concentrated urine is an excellent growth medium for bacteria. Drinking dilutes the urine and reduces its alkalic properties (reduces pH value) which also helps. Drinking is essential to processes that make us live and function. Never, no matter what, deprive yourself of water. Water is indispensable to maintain proper hydration. Coke, coffee, concentrated tea and beer (or any alcohol for that matter) are not hydrators. They are in fact diuretics. Unless you are taking prescription diuretics, drink two to three liters (quarts) of water a day. Your urine should have a light-straw color. You must replenish your fluids regularly and steadily. You will feel better, you will get UTIs not as often or they may end completely, and as a premium, in addition to these two obvious benefits, you complection will markedly improve. |
| Highly alkalic urine | Alkalic (pH>7.0) urine is promoting bacterial growth. To change it drink water. Process of dilution alone will make it less alkalic. Additionally, drink one to two glasses of pure cranberry juice or take 2 cranberry juice gelcaps. You may also supplement your diet with 2000 to 3000 mg. of vitamin C. You may not know if your urine is alkalic or acidic and to what extend. Just make it a habit to drink a glass or two of cranberry juice (make sure that it is not a juice cocktail and that it is not sweetened). Cranberry juice, also, prevents bacteria from attaching to the bladder walls. |
| Weak immune system | A lot of infections happen to us because our immune system is too weak to fend them off. Regular exercise and proper nourishment is the best way to regain fitness and strengthen our immune system. Urinary infections, like any other infections are triggering immune responses. Fever is a good example of such responses. Strong immunity stops infections before they start. My advice is: stay fit, nourish yourself properly. You may take some food supplements if you or your doctor feel you need them. Check yourself for vitamin and mineral deficiency. Staying fit may be the simplest way not to get infected again (hopefully). |
For personal telephone consultation with Dr. Kulisz click here.
Prevalence of urinary tract infections
A summary compiled from BiblioMed©/Urology Reference Library, American Urological Association, Office of Education. Medline Subset, 4th Quarter, 1995. Compilation © Dr. Andre Alexander Kulisz, 1995
Compilation method and results: The BiblioMed/Medline Search for this compilation has been performed using three ANDed key words:
- "Urinary" - 8899 publications, and
- "Infection" - 16303 publications, and
- "Women" - 14622 publications
Three additional relevant publications were found using search category "urinary incontinence/complications" (2) and "urinary catheterization/adverse effects" (1).
The combined search yielded 116 publications of which 10 pertained directly to the subject matter and provided quantified data, and two publications that pertained directly to the subject matter and provided substantially indicative statement as to the prevalence of urinary tract infections (UTI)
N - number of patients, ns - not stated
Title, Author, Source, Date, Issue #, Medline Ref # |
N |
Male/Female | Infection Rate % | Remarks |
N/Male/Female |
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| Clean intermittent catheterization..., Waller et al, JUrol, 1995, Feb, 153(2):345-8, # 95115167 | 30 | ns/ns | 60.0/ns/ns | CIC patients |
| Urinary incontinence and bacteriuria in women, Esteban, Arch Esp Urol, 1994, Jul-Aug, 47(6):591-6, # 95031288 | 103 | 0/103 | 25.2/0/25.2 | Incontinent patients |
| Risk factors and consequences of bacteriuria in non-catheterized nursing home residents..., Eberle..., JGerontol, 1993, Nov, 48(6):M266-7, # 94044470 | 195 | ns/ns | 43.0/35.0/47.0 | 18 month study |
| Does asymptomatic bacteriuria predicts mortality and does antimicrobial treatment reduce mortality in elderly women..., Arbutyn..., Ann Intern Med, 1994, May 15, 120(10): 827-33 # 94205766 | 1491 | ns/ns | 21.0/ns/ns (counts > 10^5 only) | Nursing home residents |
| Urinary tract infection with low and high colony counts in young women..., Arav-Boger..., Arch Intern Med, 1994, Feb 14, 154(3):300-4 # 94127911 | 146 | 0/146 | 60.0/0/60.0 | Dysuria patients |
| Ciprofloxacin as prophylaxis for urinary tract infection..., Biering..., JUrol, 1994, Jan, 151(1):105-8, # 94076470 | 21 | 18/3 | ns/ns/ns | 18 patients with multiple infections per year (mean 5.8) |
| A reassessment of the importance of "low count" bacteriuria in young women..., Kunin..., Ann Intern Med, 1993, Sep 15, 119(6):454-60, # 93362808 | ns | 0/ns | 29.8/0/29.8 | Women under gynecological care |
| Prophylaxis of UTI in persons..., Gribble..., Am J Med, 1993, Aug, 95(2):141-52, # 93362666 | 60 | 52/8 | ns/34.6/ns | "similar numbers in women... differences did not reach statistical significance... number of females was small" |
| Physical complications in patients treated with clean intermittent catheterization..., Bakke, A., Scan JUrol Neph, 1993, 27(1):55-61, # 93262364 | 302 | ns/ns | 75.5/ns/ns -- assumed -- "24.5% had no signs of infection" | CIC patients |
| Acute urinary tract infections in women..., Elder, NC, Postgrad Med, 1992, Nov 1, 92(6):159-62 # 93065816 | **** | **** | ***** | "Urinary tract infection continue to be a major health problem for women" |
| Psychological factors in recurrent uncomplicated UTI, Hunt..., Br JUrol, 1992, May, 69(5):460-4, # 92323344 | **** | **** | **** | "Recurrent urinary tract infections (UTI) is a very common medical complaint among women" |
For personal telephone consultation with Dr. Kulisz click here.