Cystitis

This is an inflammation of the wall and lining of the urinary bladder
that may be due to bacterial infection or to mechanical abrasion from microcrystals
of calcium phosphate in urine. Symptoms of cystitis include frequency, dysuria,
cloudy or bloody urine, with pain and tenderness in the lower abdomen. The
urine itself may be cloudy because it contains pus or blood and it may also
have an unpleasant smell. These symptoms must be distinguished from those
caused by vaginitis, sexually transmitted diseases and irritations of the
urethra.

Acute urinary tract infections are very common, involving at least 15% of
females at some point in their lives. It can occur at any age and is about
twenty times more common in women than men. This is because the urethra
is much shorter in women than in men, so allowing infective organisms easier
access to the bladder. Such ascending infections are usually
announced by discomfort at the urethral opening and as the condition progresses,
the irritation travels upwards. These infections are usually caused by the
rod-shaped bacterium called Escherichia coli. This is a normal bacterium
found in the bowel, and after a bowel movement they can be wiped on to the
urethral opening. Less commonly, infection from the blood-stream and the
kidneys descends into the bladder. These descending infections
are usually associated with back-ache, headache, tiredness, and pains in
the abdomen.

Many women have bacteriuria (bacteria in the urine), and pyuria in the absence
of symptoms, whilst others experience symptoms without clinical signs. Women
with no clinical sign of cystitis who complained of recurrent symptoms were
diagnosed as having urethral syndrome in the past. Urologists
have recognized a variety of cystitis, interstitial cystitis, comprising
a group of urethral/bladder disorders in which the mucosa of the bladder
has become eroded resulting in ongoing symptoms in the absence of bacteriuria.

Etiological factors:

• Sex: The female urethra is prone to colonization due to its proximity
  to the anus, its short length (about 4 cm), and its termination inside the
  labia. Friction during intercourse may cause minor inflammation of the urethra
  predisposing to infection, and organisms may even be moved into the urethra.

• Pregnancy: Pregnant women may be more susceptible to infection
  because of hormonal change resulting in dilation and reduction in tone of
  the ureters. Pressure of the uterus on the bladder and local venous congestion
  and pressure may also be factors in precipitating cystitis in pregnancy.

• Diabetes: Diabetics and those with high consumption of sugars
  are predisposed to cystitis.

• Chemical Factors: Antibacterial soaps, sprays, douches, feminine
  deodorants, contraceptive jellies and creams alter the vaginal environment
  and may cause irritation that makes the tissue susceptible to infection.
  In addition, barrier contraceptive devices like the diaphragm may cause
  mechanical irritation of the urethra. Some forms of interstitial cystitis
  may be caused by food contaminated with pesticides.

• Retention of Urine: Anatomical deviations, such as uterine malpositions,
  that result in retention of urine potentiate infection.

• Hormonal Changes: Oral contraceptives may initiate infection
  in some individuals.

• Antibiotics: Overuse of these potentially life-saving drugs will
  select for resistant bacteria, often leading to cystitis.

• Stress:Stress results in the production of hormones such
  as ACTH, glucocorticoids and aldosterone, all of which reduce circulating
  white blood cell counts and contribute to the susceptibility for infection.
  Many who experience recurrent infection can relate stress (chemical, physical,
  emotional) to the onset of symptoms.
  

Actions indicated for the processes behind this disease:

Anti-microbials will help the body control and then clear
bacterial infection. However, many of the well known anti-microbial remedies
(such as Echinacea) do not fulfill the herbalists expectation of
them in the case of cystitis. It is important to use plants that are specifically
active in the urinary tract. Thus anti-microbials with terpene essential
oils are indicated here as the oil is excreted from the body via the kidney,
thus directing to the site of infection in the bladder.

Anti-inflammatories will soothe the pain and discomfort. Avoid overemphasizing
them in the prescription. The symptomatic relief they produce must be applied
in the context of removing the infection that causes the inflammation.

Astringents may be called for if there is any hematuria.

Diuretics will help flush the whole of the tract. Of course it is
best to select diuretics that possess the actions mentioned above.

Anti-spasmodics may be necessary if there is much pain.

System Support :

The specifics will depend upon careful diagnosis. If the cystitis is clearly
associated with the following conditions, use the tonics suggested:

pregnancy : use the appropriate uterine tonics (refer to the
section on pregnancy).

hormonal changes (menopausal or due to the contraceptive pill) : Vitex
plus appropriate uterine tonics (refer to the sections in the next chapter).

diabetes : endocrine support with bitters (refer to the section on diabetes).

immune system weakness : both deep and surface immune support (refer to
the section on the immune system).

stress : adaptogens and appropriate nervines.

Specific Remedies :

Many plants have a local reputation as being effective in the treatment
of cystitis. Often their efficacy will vary from fresh to dried samples,
time of year they were picked, etc.etc.. In Wales, freshly picked Yarrow,
preferable from sea cliffs, had a dramatic effect even for intransigent
cases. Unfortunately tincture or infusion made from the same plants dried
did not replicate such results.

Plants containing an anti-microbial volatile oil have most to offer. Primary
examples are:

Arctostaphylos uva-ursi (Bearberry) Barosma betulina (Buchu)

One possible prescription for cystitis

Zea mays — — — 2 parts

Arctostaphylos uva-ursi — — — 2 parts

Barosma betulina — — — 1 part

5ml. of tincture taken 3 times a day.

This combination supplies the following actions :

• diuretic (Arctostaphylos uva-ursi, Barosma betulina, Zea mays)

• demulcent (Zea mays)

• antimicrobial (Arctostaphylos uva-ursi, Barosma betulina)
  

One possible prescription for cystitis associated with pain & discomfort

Zea mays — — — 2 parts

Arctostaphylos uva-ursi — — — 2 parts

Viburnum prunifolium — — — 1 part

Valeriana officinalis — — — 1 part 5ml. of tincture taken 3
times a day.

infusion of Achillea millefolium (preferably fresh) drunk often

This combination supplies the following actions :

diuretic (Arctostaphylos uva-ursi, Barosma betulina,
Zea mays)

demulcent (Zea mays)

antimicrobial (Arctostaphylos uva-ursi, Barosma betulina)

antispasmodic (Valeriana officinalis, Viburnum prunifolium)

Infusion : one example

Hot infusions will ease to symptoms dramatically. As an example consider
a combination recommended by British Medical Herbalist Annie McIntyre. Combine
the following dried herbs:

Althaea officinalis rad. — — — 2 parts

Zea Mays — — — 2 parts

Agropyron repens — — — 2 parts

Equisetum arvensis — — — 2 parts

Arctostaphylos uva-ursi — — — 2 parts

Barosma betulina — — — 1 part

Broader Context of Treatment :

• avoid internal tampons, as they contain additives which can injure the
  lining of the vagina.

• Discontinue use of diaphragm, oral contraceptives & other chemicals
  used around the vagina.

• Discontinue use of `deodorant soaps’ such as Lifebouy, Irish Spring,
  Safeguard. These soaps are irritating to skin and are responsible for killing
  off normal external bacteria which are then replaced by more virulent, less
  easily killed pathogens.
  

Dietary advice:

• Increase intake of water to at least 8-12 glasses per day. This will
  help to flush out the bacteria, and will often reduce dysuria.

• Acidify the urine. Decrease foods that are alkaline forming such as
  dairy products, citrus juices, sodas.

• Eat a light diet consisting of grains, some vegetables, and specific
  acidifying juices.

• Eliminate bladder irritants such as coffee, black tea, alcohol.

• Discontinue all intake of foods high in sugar including sweet vegetables
  and fruits, sugar, honey. Chocolate is a bladder irritant.

• Do not eat: chicken liver, canned figs, brewers yeast, raisins, avocados,
  soy sauce, grapes, fava beans, corned beef, nuts, hard cheeses, chocolate,
  apples, peaches, pineapple, cantaloupe, citrus, pickled herring bananas
  yogurt beer wine vinegar mayonnaise sour cream guavas/nectarines
  

Supplements:

• Vitamin C- new studies show that ascorbic acid irritates the bladder,
  thus C must be obtained in the form of Calcium ascorbate, which is relatively
  buffered. Avoid vitamins containing aspartate, as it is a bladder irritant.

• Vitamin E- 400 to 600 IU/day Vitamin B6- 300 mg/day.