UTI Defence Bundle

Urinary Tract Infections, Interstitial (non-bacterial) Cystitis, Bladder Pain Syndrome, Bladder Oversensitivity A urinary tract infection (UTI) is one of the most common infections in local primary care. Acute UTI affects 40% to 50% of women. Between 20% and 30% of women who have had a UTI will experience a recurrence, and around 25% will develop ongoing recurrent episodes with implications for individual well-being and healthcare costs. 1,2 Prophylactic antibiotics can prevent recurrent UTIs but there are growing concerns about microbial resistance, side effects from treatment and lack of long-term benefit. Herbal medicine has a recorded history of treating UTI symptoms and more recent research suggests a potential role in the management of recurrent UTIs. 

Research shows herbal formulations specifically formulated for recurrent UTIs were more effective in reducing infection incidence than the use of herbal formulations targeted for acute UTI. 1 Cystitis is inflammation of the bladder and is a UTI when an infection is involved or non-bacterial/interstitial cystitis if there is no infection. Women are more affected by UTIs and cystitis due to the shorter urethra (urine outflow tube) that allows bacteria to more easily move up the urethra from the outside of the body and into the bladder. UTI symptoms: • Urinary frequency • Urinary urgency • Passing small amounts of urine • Burning with urination • Urine discolouration • Pelvic pain Interstitial cystitis (IC) is a chronic condition that can present as very similar to a UTI but without an actual infection. The associated bladder pain ranges from mild discomfort to severe pain and is part of the disease group known as painful bladder syndrome (PBS). Interstitial (non-bacterial) cystitis (IC) symptoms: • Urinary frequency • Urinary urgency • Bladder pressure • Bladder pain • Pelvic pain (sometimes) The primary cause of UTI in up to 90% cases is the micro-organism Escherichia coli (E. coli) with other bacteria Proteus mirabilis, Staphylococcus saprophyticus, Enterococcus faecalis, Klebsiella pneumoniae, and Pseudomonas aeruginosa) involved in 10% or more cases. 3 Residual urine volume contributes as incomplete bladder emptying allows the bacteria to remain in the bladder and multiply instead of being flushed out with each urination. Medically, antibiotics are generally effective although antibiotic resistance is increasingly an issue in individuals with recurring UTIs. Recurring UTIs are defined as two or more UTIs in a six-month period or four or more within a year. Younger women tend to be affected by UTI (with sexual practices, poor hygiene, some birth control - diaphragm) as are menopausal (with declining estrogen) and older women (with urinary incontinence). The exact cause of interstitial cystitis (IC) is not known but many contributing factors are understood to be involved. A key theory is that a compromise of the protective lining (epithelium) of the bladder allows the lining to be more sensitive and easily irritated. Lowered immune defence, genetics or allergy are also thought to be involved. Repeated irritation of the lining as a result of UTIs is a known predisposing factor for IC. Recurrent UTI, Interstitial Cystitis and Bladder Oversensitivity Urinary tract infections (UTIs) are involved in the development of interstitial cystitis/painful bladder syndrome (IC/PBS). 4 Sufferers can often have UTI at the onset of IC/PBS and/or have a significant history of childhood recurrent UTIs. The UTIs resolve but the individual is left with symptoms similar to UTI (urinary urgency, frequency, pelvic discomfort etc.) but with no detectable infection. The significant and often unaddressed problem with UTIs is that they tend to be chronic in nature. One episode of a UTI results in a weakened urinary tract and an increased likelihood of a second UTI and then a third, etc. Commonly once a UTI clears, another UTI recurs within a short period. Research shows that women with recurrent UTIs suffer from bladder oversensitivity. 4 Even in the absence of an infection, they have reduced bladder holding capacity and mean voiding volume and an increase in urinary frequency. This bladder oversensitivity is often self-diagnosed or misdiagnosed as an infection and treated with unnecessary antibiotics which can also contribute to antibiotic resistance. There is no medical treatment for bladder oversensitivity. Simply using an antibacterial or bacterial-repelling approach with UTIs is short-sighted. UTIs (and IC, PBS and bladder oversensitivity) need comprehensive management that addresses the microbial infection, supports the epithelial membranes of the urinary tract, supports the bladder detrusor muscles for effective and complete bladder emptying (to resolve the residual urine that is a breeding ground for bacteria), addressed bladder accidents and urinary incontinence (that can allow bacteria to thrive in the external urinary area and encourage the development of UTIs) and supports the collagen and connective tissue underpinning the pelvic floor muscles for strong urinary sphincter control. Equisetum arvense (Horsetail) The Horsetail plant is one of the best herbal remedies for UTIs. Horsetail has astringent, diuretic and tissue healing properties that allow it to effectively fight a urinary tract infection. Horsetail has been used for ages by the ancient Romans, Greeks, and native North Americans for bladder problems and according to the British Herbal Pharmacopoeia, for UTI. 5 Horsetail promotes normal urinary flow end more complete bladder emptying. Horsetail essential oil has shown antimicrobial activity against a variety of pathogenic organisms, such as Staphylococcus aureus, E. coli and Candida albicans. 6,7 It is also able to reduce inflammation of the lower urinary tract while synergistically relieving pain and can increase urination by up to 30 percent. 7 Horsetail is traditionally indicated in cases of suppressed urination accompanied by blood and severe pain during urination (dysuria). 8 Horsetail has many pharmacological properties such as antioxidant and anti-inflammatory, diuretic activity, and anti-bacterial activity. 9-11 Traditional and scientific research shows the general antimicrobial effectiveness of Horsetail. 5, 14-16 As early as 2010, research was showing extracts of Horsetail were anti-bacterial towards bacterial pathogens of UTIs; E. coli (the cause of UTI in 80-90% of cases), K. pnuemoniae, P. mirabilis, P. aeruginosa, S. aureus, S. saprophyticus, Enterococcus faecalis. 17 A 2017 study assessed the antibacterial activity of ethanolic and aqueous extract of Horsetail against each of these urinary tract pathogens. Horsetail showed antibacterial activity against all the tested bacterial strains. 3 More recent research (2020) further supports the effectiveness of Horsetail against Escherichia coli. 18 When assessing the antibacterial effectiveness of a herb or drug, the minimum inhibitory concentration (MIC) for a given pathogen must be determined. The MIC is taken as the lowest concentration of a herb or drug that inhibits the growth of a pathogen after incubation. This study evaluated the MIC of Horsetail against urinary pathogens.18 All tests were done in triplicate and averaged to calculate the Horsetail MIC for each microorganism. The Horsetail extract showed MIC values comparable with standard antibiotics, which ranged from 0.78 to 3.12 mg/ml. Thus, the Horsetail extract was as potent as standard antibiotics in inhibiting the growth of microbial strains including E.coli. CratevoxTM (Crateva nurvala, Varuna) Crateva is well documented in traditional herbal literature for a wide range of uropathies including UTI, IC and bladder oversensitivity. Crateva stem bark was analyzed for in-vitro antibacterial activity against selected multi-drug resistant urinary isolates and MIC showed good antibacterial activity. Additional research shows Crateva is effective against multiple micro-organisms that cause UTIs including E. coli. 19,20,21 Crateva also protects against nephrotoxicity.21 Crateva shows good anti-bacterial properties against both gram-positive and negative microscopic organisms causing UTI. Other effects include mild diuretic, mucosal repair, nephroprotective and anti urolithic properties which further benefit in cases of UTI. 22 Urox® (Horsetail, CratevoxTM (Crateva) and Lindera aggregata pty blend) Urox® helps to resolve UTIs and prevent their recurrence via an anti-microbial effect against E.coli and other UTI micro-organisms. Urox® is unique in being able to improve symptoms of interstitial cystitis and bladder oversensitivity, soothing urinary discomfort, supporting a weakened urinary membrane defence and reducing urinary frequency and urgency. Urox® supports the bladder detrusor muscle function to address muscle spasms and promote complete bladder emptying. Urox® strengthens collagen and connective tissue to support the pelvic floor and external urinary sphincter. Urinary incontinence and bladder accidents are triggers for UTIs as urine and adult diapers can be a breeding ground for bacteria. Published placebo-controlled research shows that Urox® is effective in reducing urinary incontinence episodes and 75% of Urox® users reduced their diaper usage with 23% of users reporting normal continence/control by 8 weeks of use. 23 This research with urinary incontinence and overactive bladder (urinary urgency, frequency, nocturia and accidents) showed that by two months of treatment, Urox® resulted in: • 60% reduction in occasional urinary urgency • 56% reduction in occasional urgency urinary incontinence • 67% reduction in occasional stress urinary incontinence • Halving of nocturia • 84% users felt satisfied with Urox® Pilot research with Crateva and Horsetail evaluating effectiveness in 25 women with recurring UTIs showed Crateva and Horsetail reduced the frequency and severity of UTIs and cystitis over a 12-month period. 24 Results showed Crateva and Horsetail were effective in reducing the symptoms associated with cystitis and in the prevention of reoccurrence of cystitis. Results showed: • Decreased frequency of infection • Decreased duration and severity of infection • Many participants who felt a UTI starting to "come on" commented that the sensation went away within a short period (hours to less than a day) and were pleased that the cystitis sensation did not progress to an infection • Most participants comment that their symptoms felt milder with some chronic suffers being symptom-free throughout the study For decades, only the bacterial aspect of UTI has been considered. UTI and chronic UTI/IC is more than simply bacterial infection to be treated; it needs a holistic approach to support overall urinary health, protection and prevention. Clinically researched Urox® offers a next-generation, comprehensive UTI formula that addresses the infection, the bladder membrane defence, bladder and pelvic floor muscle function and collagen and connective tissue health. References 1. Flower A, Wang LQ, Lewith G, Liu JP, Li Q. Chinese herbal medicine for treating recurrent urinary tract infections in women. Cochrane Database Syst Rev. 2015 Jun 4;2015(6): CD010446. doi 10.1002/14651858.CD010446.pub2. PMID: 26040964; PMCID: PMC6481503. 2. Joseph J Carreno, Iris M Tam, Juliana L Meyers, Elizabeth Esterberg, Sean D Candrilli, Thomas P Lodise, Jr, Longitudinal, Nationwide, Cohort Study to Assess Incidence, Outcomes, and Costs Associated With Complicated Urinary Tract Infection, Open Forum Infectious Diseases, Volume 6, Issue 11, November 2019, ofz446, https://doi.org/10.1093/ofid/ofz446 3. Al-Snafi, AE. The Pharmacology of Equisetum arvense – A Review. IOSR Journal of Pharmacy, Feb 2017, 7, (2, V1): 31-42. 4. Arya LA, Northington GM, Asfaw T, Malykhina. Evidence of bladder oversensitivity in the absence of infection in premenopausal women with a history of recurrent urinary tract infections. BJU International, 110 (2) July 2012: 247-251. https://doi.org/10.1111/j.1464- 410X.2011.10766.x 5. Hyde, F.F. British Herbal Pharmacopoeia. British Herbal Medicine Assoc: West Yorks, England, 1983 6. Radulovic N1, Stojanovic G, Palic R. Composition and antimicrobial activity of Equisetum arvense L. essential oil. Phytotherapy Research, 2006 Jan;20(1):85-8. 7. Sandu NS et al. Equisetum Arvense: Pharmacology and Phytochemistry - A Review. Asian Journal of Pharmaceutical and Clinical Research, 3(3);146-150, 2010. 8. Grundemann C, Lengen K, Sauer B, Garcia-Kaufer M, Zehl M, et al. (2014) Equisetum arvense (common horsetail) modulates the function of inflammatory immunocompetent cells. BMC Complement Altern Med 14: 283. Link: https://bit.ly/3hfZ4DP 9. Geetha RV, Lakshmi T, Roy A (2011) In Vitro Evaluation Of Anti Bacterial Activity Of Equisetum Arvense On Urinary Tract Pathogens. Int J Phar Pharamc Sci 3: 323-325. Link: https://bit.ly/32BrKmm 10. Carneiro DM, Jardim TV, Araújo YCL, Arantes AC, de Sousa AC, et al. (2019) Equisetum arvense: New Evidences Supports Medical use in Daily Clinic. Pharmacogn Rev 13: 50-58. Link: https://bit.ly/3hg2yWD 11. Cetojevic-Simin DD, Canadanovic-Brunet JM, Bogdanovic GM, Djilas SM, Cetkovic GS, et al. (2010) Antioxidative and antiproliferative activities of different horsetail (Equisetum arvense L.) extracts. J Med Food 13: 452-459. Link: https://bit.ly/2Wugt3w 12. Velikij D, Cizauskaite U, Bernatonienee J, Pavilonis A, Petrikaite V. The 5th International Conference on Pharmaceutical Sciences and Pharmacy Practice. November 22, 2014, Kaunas, Lithuania. 13. Eslamiyan, F., Mehrabiyan, S., Majd, A. (2015). Evaluation of the antimicrobial activity of aqueous extract, ethanol, methanol and ashes two species ramosissimum and telmateia of Equisetum arvense on several bacterial species and Yeast. Report of Health Care, 1(4), 120- 123. 14. Martins Do Monte FH, Guilherme J, Russi M, Mariani V, Kalyne L and Matos de Andrade Cunha G. Antinociceptive and anti-inflammatory properties of the hydroalcoholic extract of stems from Equisetum arvense L. in mice. Pharmacological Research, March 2004, 49 (3): 239- 243. 15. Niko Radulovic, Gordana Stojanovic, Radosav Palic Composition and antimicrobial activity of Equisetum arvense L. essential oil Phytotherapy Research Volume 20, Issue 1, pages 85–88, January 2006 16. Garcia D, Garcia E, Ramos AJ, Sanchis V and Marin S. Mould growth and mycotoxin production as affected by Equisetum arvense and Stevia rebaudiana extracts. Food Control, August 2011, 22 (8): 1378 – 1388. 17. Cetojevic-Simin DD, Canadanovic-Brunet JM, Bogdanovic GM, Djilas SM, Gordana S, Cetkovic GS, Tumbas VT, Stojiljkovic BT. Antioxidative and Antiproliferative Activities of Different Horsetail (Equisetum arvense L.) Extracts. Journal of Medicinal Food. April 2010, 13(2): 452-459. doi:10.1089/jmf.2008.0159 18. Kacaniova M, Ziarovska J, Kunova S, Rovna K, Savitskaya T, Hrinshpan D, Valkova V, Galovicova L, Borotova P and Ivanisova E. (2020). Antimicrobial potential of different medicinal plants against food industry pathogens. Potravinarstvo Slovak Journal of Food Sciences, 14, 494–500. https://doi.org/10.5219/1387 19. Dholaria M. D., Desai P. V. Phytochemical Analysis and In-Vitro Antibacterial Activity of Some Medicinal Plants against Mult