Treating Uncomplicated Infections of the Lower Urinary Tract (Urocystitis) from the Point of View of Anthroposophic Medicine

Recommendations of an international panel of doctors, nurses and therapists

Introduction

This article describes the treatment of uncomplicated urinary tract infections (UTI) without anatomical pathology (vesicoureteral reflux, malformations, etc.) from the point of view of integrative Anthroposophic Medicine, for the age of three years and up. This therapy concept is based on clinical experience and an international consensus of experts.

Simple urinary tract infections are common. Up to 20% of all women are affected at least once during their lifetime. Urinary tract infections account for about 1% of all outpatient visits to the doctor. Most of them are still being treated with antibiotics (1, 2, 3, 4, 5). Nevertheless, spontaneous improvement of symptoms without antibiotic therapy seems to be high (6). The worldwide emerging problem of antibacterial resistance is well known. As a result, new guidelines recommend that acute uncomplicated UTI should not initially be treated with antibiotics. Recognizing methods that make it possible to avoid or reduce antibiotic use is therefore of great interest (7, 8, 9, 10).

Definition and leading symptoms of uncomplicated urocystitis

Urocystitis is defined as the presence of pathogenic germs (> 105 per ml) in the urinary bladder (11) with inflammatory reaction of the bladder mucosa, and accompanying symptoms of dysuria, pollakiuria and bad smelling urine. The most common pathogens of uncomplicated urinary tract infections are E. coli and Enterococcus faecalis, which are both native to the intestinal flora. Other rarer pathogens are Streptococcus saprophyticus, Klebsiella pneumoniae, Staphylococcus epidermidis, Pseudomonas aeruginosa, Proteus mirabilis, viruses and fungi (Candida albicans) (12).

Causes, triggers

  • Hypothermia of the lower extremities (often cold feet) and the pelvis (acute or constitutional),
  • wet-cold swimsuit,
  • previous infections: airways, gastrointestinal tract,
  • dysbiosis, e.g., due to previous antibiotic therapy, excessive sugar consumption and malnutrition, not drinking enough, constipation,
  • “honeymoon UTI” in women with a new sexual contact,
  • spermicide-coated condoms (diaphragm or condoms) (13),
  • women with postmenopausal atrophy of the vaginal mucosa,
  • urinary voiding disorders: phimosis, cellular adhesion, morbid obesity,
  • hygiene (e.g., wiping in the wrong direction with toilet paper),
  • excessive mental stress.

The causes are commonly rooted in insufficient self-awareness and warming of the lower half of the body (with a correspondingly weakened immune defense) as well as excessive irritation in the bladder area (14).
Diagnosis

1. Case history

  • Ask about the main symptoms, duration, fever, triggers, predisposing factors. 

2. Examination

  • Physical examination, incl. examination of the state of warmth in the extremities, sensitivity of the kidneys and the bladder area.
  • Urine analysis (strip test or microscopy/sediment): bacteria, leukocyte esterase, possibly nitrite, erythrocytes, if necessary.
  • A urine culture from clean catch midstream urine, with antibiotic sensitivity, indicates type of bacterial infection (15).
  • Ultrasonic imaging, if required.

A urine test is useful for non-antibiotic therapy. Further imaging procedures are only indicated for complications or recurrences.
This does not apply to infants and young children under the age of three.

3. Differential diagnosis

  • Asymptomatic bacteriuria: permanent colonization with a low bacterial count can protect against virulent germs, but can also lead to the multiplication and invasion of pathogenic germs in an increasingly disturbed guest-host relationship.
  • urinary frequency in the setting of sterile urine and/or dysuria, understood as an “oversensitivity of the bladder”, e.g., with mental overload, hypothermia, after urinary tract infections (16).
  • Vaginitis (including thrush, chlamydia), urethritis, asymptomatic/subclinical pyelonephritis.

Treatment

1. Principles of sustainable integrative therapy

  • Pain relief,
  • Stimulation of the person’s own warmth (local and systemic) and thus
  • Stimulation of the immune system,
  • Stimulation of the excretion activity of the kidney-bladder region,
  • Stimulation of self-perception.

2. Elements of therapy

Local

  • Chamomile steam sitz baths have proven to be the most important basic therapy from the age of 6. They are both analgesic and antispasmodic. (17).
    For instructions, see: http://www.pflege-vademecum.de/kamillen-dampfsitzbad.php
    They can be used several times a day at the beginning, as they directly alleviate pain and provide deep warmth, thereby promoting better immune defense and self-perception in the pelvic area.
    Daily use is recommended for at least seven days after resolution of symptoms.
    Chamomile steam sitz baths are also suitable for prevention of urinary tract infections, e.g., when certain inducing factors (see above) are present.

  • For toddlers, an alternative can be warm sitz baths with thyme tea, chamomile tea, or sage tea.
    Duration 8 min. each, 1–2 x daily, also to prevent a relapse (see below).
    For instructions, see: http://www.pflege-vademecum.de/sitzbad_kinder.php
    Steam baths are generally preferable from the age of 6.

  • Steam baths can be supplemented with increasingly warm, knee-high foot baths, with 2–3 tbsp. salt or 3 tbsp. ginger powder in 10 l water.
    For instructions, see: http://www.pflege-vademecum.de/ingwerfussbad.php

  • As a bladder compress, Eucalyptus Oleum aeth. 10% WALA, 15–20 drops. Use eucalyptus 10% oil for adults, 5% oil for 6–12-year-olds, 2% oil for infants and toddlers. This application has a strongly relaxing, warming and immune-stimulating effect.
    For instructions, see: http://www.pflege-vademecum.de/blasenwickel_eucalytptusoel.php.

  • To stimulate warmth generation in the legs: rub the outer sides of the thighs (trochanter to knee) and the feet with
    Cuprum metallicum praeparatum 0.4% ointment WELEDA or
    Red Copper Ointment WALA (also available as Kupfersalbe rot) or mallow oil WALA. Copper sole insert.

  • A more complex, but effective measure is a pelvic floor bladder compress with juniper.
    For instructions, see: http://www.pflege-vademecum.de/bbb-oelw-w.php

  • Warm clothing made of cotton or wool and avoidance of cold gaps in the clothing.

Systemic

Anthroposophic medications

  • Pain-relieving, anti-inflammatory:
    Cantharis bladder pillules (available as Cantharis Blasen Globuli velati WALA, Cantharis solution for injection (available as Cantharis Blasen Inject WALA) and/or
    Berberis/Apis comp. pill. WALA, Berberis/Apis comp. amp. WALA,
    initially alternating, 5–10 pill. hourly, later 5–10 pill. 3x/d, for young women possibly 1 amp. s.c., 1–2 x daily
    (lower abdomen, thighs). A single evening dose of Cantharis bladder pill.
    (available as Cantharis Blasen Globuli velati WALA) promotes prophylaxis of recurrent UTI.

  • To stimulate immunity:
    Argentum nitricum comp. pill. WALA, 5–10 pill. 3–5x/d, or
    Thuja comp. N trit. WELEDA 1 saltsp. (~¼ tsp.) 3–5x/d for 14 days, if there is a tendency to relapse.

    The composition of the German medicinal products mentioned: Cantharis Blasen pill
    .: Achillea millefolium ferm 33d dil. D2, Cantharis ex animale toto Gl dil. D5, Equisetum arvense ex herba ferm 35b dil. D2, Vesica urinaria bovis Gl dil. D7. Berberis/Apis comp.: Apis mellifica ex animale toto Gl dil. D7, Atropa belladonna ex herba ferm 33a dil. D3, Berberis vulgaris e radice ferm 33d dil. D2, Terebinthina laricina trit. D2. Argentum nitricum comp.: Argentum nitricum dil. D19, Chlorophyceae ferm 33e dil. D2, Echinacea pallida e planta tota ferm 33c dil. D1, Eucalyptus globulus e foliis ferm 33d, Thuja occidentalis e summitatibus ferm 33e dil. D2. Thuja comp. N: Argentum metallicum trit. D3, Mercurius vivus trit. D6, Thuja occidentalis trit. D6.

Phytotherapeutic medications

  • Angocin® (in Germany, Switzerland) (nasturtium leaf powder + horseradish root powder), for adults 4 tabs. 4x/d after meals,
    for children – because of possible abdominal pain – only 1–2 tabs. 4x/d.

  • Cranberry fruit extract (Cranberry-Saft/Trockenextrakt) (e.g., Urovit® caps. in Germany, Switzerland) is milder, 1 caps. 2x/d to 2 caps. 2x/d for school-aged children. For smaller children: juice in individual dosages.

  • Solidagoren® N drops (in Germany), 5–20 drops 3x/d or Ceres Solidago comp. drops (in Switzerland), 5 drops 3x/d.

  • Warm horsetail or birch leaf teas, up to 1 liter/day to stimulate excretions. 

Anthroposophic therapeutic speech

Therapeutic speech formation works on human physiology via the therapeutic effect of spoken, thoroughly exhaled sounds, among other things.

In cases of acute cystitis, this means releasing the contraction of the abdominal muscles and bringing back the flow of congested processes in the pelvis with the help of the sounds “L”, “S” and “CH”, which are sounded while sitting on a stool or gymnastic ball and rotating the pelvis (the sounds are embedded in various words or word sequences in exercise phrases). This can help the patient gradually recover a feeling of well-being in the pelvic area. The sound “CH” has proven to have an antispasmodic and calming effect, the sounds “G” and “B” have a formative effect on inflammatory processes. Patients also find helpful the shielding effect of the lip sound “B” against the influences and demands of the outside world, as it promotes self-perception and the formation of boundaries.

Diet

  • Increase liquid quantities to 1 liter/day for children and 2 liters/day for adults. (18).
  • Drink warm fluids.
  • Drink alkaline liquids or mineral water for a few days (pH above 8.5) and give preference to alkaline plant nutrition (19, 20).
  • Avoid the consumption of sweets.

Urinary tract infections from the perspective of Anthroposophic Medicine

The urinary tract is a kind of hollowing out of the inner portion of the body.
The bladder is controlled by the sympathetic and parasympathetic nervous systems. Only at the age of 2 or 3 does a child learn to consciously control bladder emptying as a higher function of the ‘I’. Due to the sympathetic and parasympathetic nervous systems, the bladder remains sensitive to psychological influences, such as stress and tension.
The constitutional predisposition described above and most of the triggering factors contribute to a tendency to hypothermia. The causes of the infection are thus rooted in insufficient self-awareness and warming of the lower half of the body (with a correspondingly weakened immune defense) as well as excessive irritation in the bladder area (14). This favors colonization by foreign organisms. This is the thinking underlying the therapy concept presented here, which has been successfully applied in many cases.

Relapse prophylaxis

Lifestyle

  • Warmth
  • Outer warmth: see local warmth treatments above, sauna, clothing
  • Inner warmth: enthusiasm, finding meaning
  • Rhythm: regular emptying of the bladder, warm meals, sufficient time for regeneration, relaxation, and sleep
  • Exercise: work up a sweat at least 2–3 x per week
  • Nutrition: e.g., Mediterranean-alkaline diet
  • Reconsider habits (sexual and toilet hygiene)
  • discontinue hormonal contraceptives, if necessary, since the tendency to urinary tract infections can increase significantly (14)

Medications

  • Argentum nitricum comp. pillules WALA, 5–10 pill. 1–2x/d and
  • Cantharis bladder pillules WALA (available as Cantharis Blasen Globuli velati WALA), 5–10 pill. 1–2×/d, e.g., Argentum nitricum comp. pill. in the mornings and Cantharis in the evenings
  • Lien comp. pillules WALA, 5–10 pill. 1x/d

The composition of the German medicinal products mentioned: Argentum nitricum comp.: Argentum nitr. dil. D19, Chlorophyceae ferm 33e dil. D2, Echinacea pall. e planta tota ferm 33c dil. D1, Eucalyptus glob. e fol. ferm 33d, Thuja occ. e sum. ferm 33e dil. D2. Cantharis Blasen pill.: Achillea millefolium ferm 33d dil. D2, Cantharis ex animale toto Gl dil. D5, Equisetum arvense ex herba ferm 35b dil. D2, Vesica urinaria bovis Gl dil. D7. Lien comp.: Cichorium intybus e planta tota ferm 33c dil. D14, Equisetum arvense ex herba ferm 35b dil. D14, Lien bovis Gl dil. D5, Mesenchym bovis Gl dil. D5, Renes bovis Gl dil. D5.

Symbiosis management

  • e.g., with Colibiogen®, Uro-Vaxom® (21, 22), D-Mannose, 2g per day (23).

Artistic therapies for the soul  

Psychosomatic orientation: psychotherapy, biography work, painting therapy

Somatopsychic orientation:

  • Oil dispersion baths: stinging nettle oil (Urtica dioica ex herba W 5% Oleum WALA) strengthens the excretion activity of the kidneys and the urinary tract, horsetail oil (Equisetum ex herba W 5% WALA) is used more for men, yarrow oil (yarrow in olive 5% oil Dr. Heberer) more for women.

  • Eurythmy therapy: suitable exercises include the sound exercises “L”, “B” and “F”, as well as “M” and “SZ”, learned under guidance and then regularly practiced at home.

  • Rhythmical massage therapy 

  • Relaxation exercises

  • Anthroposophic therapeutic speech: in case of recurrent cystitis, we must support warming in the bladder region, because the repeated inflammations indicate that the body is attempting over and over again to counter a state of permanent hypothermia by stimulating warmth in the bladder region. The sounds “K”, “H” and “F” are particularly suitable for this (to be practiced during non-acute phases), embedded in sentences, such as, “I have halted” (“Ich habe Halt”). They should not be used in case of diarrhea or during menstruation! The exercises should be learned from a trained speech formation specialist. Biographical aspects can be included in the selection and execution of the exercises.

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