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UTI in Paraplegia

What You Should Know

(Overview*)

A study from the Reeve Foundation estimates that more than 1.2 million Americans are living with paralysis resulting from spinal cord injuries. That is five times the previous commonly used estimate of 250,000.

They are most often referred to as paraplegics – individuals with injuries below the cervical level of the spine, called thoracic injury (more than 50 percent males) or – quadriplegics, individuals with cervical injuries, whose all four limbs are affected.

Unfortunately, urinary tract infections continue to be a problem throughout the life of most spinal-cord-injured individuals. They are due to a dysfunctional, neurogenic bladder (NGB) which is unstable or atonic with no muscle tone due to the spinal cord damage at the S2 to S4 level. Recurrent UTIs may result in further complications, such as renal failure.

Neurogenic bladder affects more than 90 percent of patients with spinal cord injury. It also affects people with multiple sclerosis (50-80 percent) and spina bifida (more than 90 percent).

It occurs frequently with many other neurological conditions such as after stroke, Parkinson’s disease and transverse myelitis (an inflammation of both sides of one section of the spinal cord).

Therefore, disabled people must work much harder to maintain their urinary bladder health.

*Based on various sources.

Dysfunctional Bladder

Healthy urinary system regularly rids the body of liquid waste by expansion of the bladder’s contents. Up to this point everything is controlled by chemical reactions and the autonomic nervous system that is normally not a part of our consciousness. As the bladder expands, the conscious mind becomes aware of the need to empty.

However, in disabled people, neurons tying urinary release messages and consciousness become impaired, thus preventing the normal bladder function, especially its regular emptying.

When a bladder is neurogenic and flaccid (hypotonic), the urine volume is large, pressure is low, and contractions are absent. This condition leads to

  • loss of feeling that the bladder is full,
  • urinary incontinence (unable to control urine),
  • small urine volume during voiding (a decreased output of urine, called oliguria, of less than 400 milliliters, or 13.5 ounces, over the course of 24 hours),
  • urinary frequency and urgency,
  • post-void dribbling (urine remaining in the urethra after voiding the bladder slowly leaks out after urination),
  • frequent urinary tract infections (UTIs),
  • bladder and/or kidney stones.

Chronic Bacteriuria

The constant presence of bacteria in the urine is a common occurrence among spinal cord injury patients who may develop symptoms of infection or remain asymptomatic (when symptoms do not result).

The latter creates a common medical dilemma: whether to treat asymptomatic patients who present with bacteria in their urine.

Escherichia coli is the most common organism found in patients with asymptomatic bacteriuria. Infecting organisms, however, are diverse. People with a catheter are more likely to have multi-drug–resistant polymicrobic flora, such as P. aeruginosa. Enterococcus species and gram-negative bacilli are common in men

However, treating asymptomatic bacteriuria with antibiotics in people with or without indwelling catheters, or people with spinal cord injuries has not been found to improve outcomes.

Each disability has its own unique dysfunctional characteristics. No two people with the same disability are exactly alike. Also, the likelihood of urinary tract infections is increased by the risk of developing of bladder stones in people with spinal cord injuries.

Unable to completely void, over time, the impaired bladder in its warm dark environment gives remaining bacteria, mainly E. coli, the opportunity – an excellent setting for their rapid growth leading to frequent urinary tract infections.

Uropathogenic E. coli (UPEC)

E. coli is a facultative anaerobe that is a member of the large family of gram-negative bacteria called Enterobacteriaceae, including most of the bacteria normally found in the gastrointestinal tract.

Strains of Uropathogenic E. coli (UPEC) colonize the large intestines of humans and are primarily selected for growth in the urinary tract. They are responsible for nearly all infections of the lower urinary infections.

If E. coli bacteria get into the bladder or the urethra, the body has ways of fighting them off. They include the obvious methods of simply flushing them out with the urine. But UPEC bacteria have evolved ways of anchoring themselves to the cells of the urinary tract.

The invading E. coli bacteria take advantage of receptors naturally found on the cells of the mucosal lining of the urinary tract. These receptors are like molecular “docking bays” for substances which the cells need for their normal growth and development.

E. coli use “grappling hooks”, called type I pili, to first hook on to these receptors, and then to invade the cell. These pathogenic “grappling hooks” are composed of long, fibrous chains of a molecular “glue” called adhesin.

Once inside the cell, E. coli can live and reproduce in safety, shielded from many of the body’s defensive immune responses. In fact, they are so sophisticated that when the body detects that cells have been infected and activates the cell suicide program to destroy the bacteria, E. coli can actually flee the dying host cell before it is flushed out, and look for new cells to invade!

Survival Rate of E. coli

E. coli return in as many as 30 percent of people apparently cured by antibiotics! They are able to survive an antibiotic treatment by reverting to an inactive state.

Within several days of antibiotic treatment, the number of bacteria reproducing can drop to zero. Not all the bacteria are killed, though. Even after a month of antibiotic exposure, about 10 million of the original 1 billion bacteria may remain.

Proteus mirabilis

Proteus species are also members of the family Enterobacteriaceae. The species associated with UTIs is Proteus mirabilis. It is the third most common cause of complicated urinary tract infection and the second most common cause of catheter-associated bacteriuria in patients catheterized long term.

Indwelling urinary catheters introduce Proteus spp. into the urinary tract. P. mirabilis strains tend to attach to catheters with a greater propensity than other gram-negative bacteria. They are capable of attaching to a number of catheter polymers.

Proteus bacilli are more commonly associated with UTIs in those individuals with structural or functional abnormalities, especially ascending infections in patients undergoing urinary catheterization.

Colonization of the intestinal tract allows Proteus to establish reservoirs for transmission into the urinary tract by intermittent colonization of the periurethral region. It can lead to the subsequent contamination of the catheter.

Proteus-associated UTIs are difficult to treat, and the bacterium persists due to complications associated with this type of infection, including bladder and kidney stone formation (urolithiasis) that can lead to the obstruction of catheters and the urinary tract.

Urinary Retention

Flushing of the urinary system minimizes the possibility of infection. Because you lose the sensation to urinate, your bladder can fill beyond typical capacity. But your bladder may not empty fully. This is called urinary retention and various symptoms may appear such as:

  • lower abdominal discomfort (pain or cramps),
  • cloudy or bloody urine,
  • frequent involuntary urination (incontinence),
  • cessation of urinary flow, the absence of urine (less than 50 milliliters, or 1.7 ounces, of urine in a 24-hour period is considered to be anuria).

This condition, especially for those who cannot experience pain, may lead autonomic dysreflexia. This syndrome characterized by such symptoms as:

  • a sudden onset of increased blood pressure (called secondary hypertension),
  • heavy, profuse, excessive sweating (as a warning sign of infection),
  • rapid heart rate (greater than 100 beats per minute, a condition called tachycardia),
  • emotional panic (a panic attack – a short burst of intense fear often marked by increased heart rate, brief chest pain or shortness of breath, lasting fewer than 30 minutes),
  • other possible life-threatening symptoms.

Autonomic dysreflexia is more common in people with spinal cord injury that involves the thoracic nerves of the spine or above (T6 or above).

Bladder Emptying Procedures

The constant flushing of the urinary bladder is imperative for all people with spinal cord injuries. There are many medical management procedures to empty bladder contents and avoid urinary tract infections.

Urinary Catheterization

Indwelling urinary catheters are standard medical devices utilized to relieve urinary retention and urinary incontinence. Of the almost 100 million catheters that are sold annually worldwide, one-quarter of them are sold in the United States.

The most common urinary catheter in use is the Foley indwelling urethral catheter, a closed sterile system that is comprised of a tube inserted through the urethra and held in place by an inflatable balloon to allow urinary drainage of the bladder.

Although these devices were originally designed for short-term use in patients, indwelling catheter use is now commonplace in the long-term setting. Some people learn to catheterize themselves periodically throughout the day.

However, foreign bacteria may not always be controlled, even with antibiotics, making this procedure ineffective. As a result, catheterization often increases the risk of the urinary tract injuries and, therefore, recurrent bladder infections.

Exposed to repeated or long-term courses of antibiotics, in time, many people with spinal cord injuries also develop resistance to these drugs what makes maintaining healthy urinary tract for them even more difficult.

Catheter-associated UTIs

Catheter-associated urinary tract infections (CAUTIs) are a major health concern due to the complications and frequent recurrence of the infections. They are often caused by Escherichia coli and Proteus mirabilis.

The insertion of a catheter into the bladder increases the susceptibility to UTIs, as these devices serve as the initiation site of infection by introducing opportunistic organisms into the urinary tract.

The majority of these uropathogens are fecal contaminants or skin residents from your own native or transitory microflora that colonize the periurethral area. Bacterial entry into the bladder can occur at the time of catheter insertion, through the catheter lumen, or along the catheter-urethral interface.

The preferred mechanism of bladder entry is extraluminal (outside the lumen), where organisms ascend from the urethral meatus along the catheter urethral interface.

Organisms can also enter the bladder intraluminally (within the lumen), where the bacteria migrate into the bladder as a result of manipulation of the catheter system.

Upon insertion, urinary catheters may also damage the protective uroepithelial mucosa. Lastly, the presence of the indwelling catheter in the urinary tract disrupts normal host mechanical defenses, resulting in an overdistension of the bladder and incomplete voiding that leaves residual urine for microbial growth.

Urinary Sphincterotomy

This approach employs a relatively simple surgery that cuts the muscle that controls urination. This often necessitates the use of an external condom catheter and collection leg-bag since bladder retention is compromised. Still others use an indwelling, or Foley, catheter with leg bag.

Complete Medical Check-ups

Regular check-ups are necessary at least once a year. They should include a urological exam (urinalysis and a physical exam), along with a renal scan or ultrasound to know that the kidneys are working properly. The exam may include a kidney, ureter, and bladder (KUB) X-ray, if a kidney or bladder stones are suspected.

Standard Management

Unfortunately, neurogenic bladder cannot be cured. It can only be managed. The medical management for hypotonic bladder is as the following:

Intermittent catheterization Program (ICP): Catheters are inserted through the urethra to drain the bladder on a set schedule (every four to six hours is common). You can catheterize yourself, or someone can do it for you,2 using either a disposable catheter or a reusable one that you wash and dry each time. (See the Catheter-associated UTIs above).

Prescription drugs: These include anticholinergic prescription medications. They block the action of a neurotransmitter, called acetylcholine, from causing involuntary muscle movements in the urinary tract – in case of an overactive bladder and incontinence.

Injections of botulinum A toxin (Botox®): It is injected into the bladder or urinary sphincters; this powerful drug acts to temporarily paralyze muscles when it is locally injected. It is commonly used as the treatment of overactive bladder that often leads to the involuntary loss of urine (urge incontinence). Not free from side effects, or adverse effects, the Botox therapy lasts for six to eight months and then is re-injected.

Bladder augmentation (augmentation cystoplasty): This is a surgery in which segments of the intestine (sigmoid colon) are removed and attached to the walls of the bladder. This reduces the bladder’s internal pressure and increases its ability to store urine.

Ileal conduit: Part of the small bowel is used to make a urine stoma (an opening on the belly). This stoma drains to a bag attached to the outside of the body.

Antibiotic Drawbacks

Although routinely used, antibiotic treatments have many drawbacks. Here’re the most common ones:

  • They kill both the unwanted micro-organisms and wanted micro-organisms. (Research has shown that a single course of ciproflaxin can disrupt a third of the microbe species naturally present in the gut, and other work has suggested that in some people, the microbiome might never really recover.)
  • When used long-term or repeatedly they lead to major disturbances both in normal body microflora and in overall health.
  • They may cause stomach upset, rash, and allergic reactions.
  • They may cause nasty yeast infections.

Also, all antibiotic therapies carry with them the risks of developing:

  • antibiotic-resistant bacteria,
  • gastrointestinal problems,
  • adverse effects, especially on the liver and kidneys.

Therefore, due to all these hazards, especially of prolonged antibiotic therapy, the use of antibiotics should be reduced to the absoluteminimum.

Necessary Lifestyle Changes

Recommended lifestyle changes include:

  • Drinking the proper amount of water (it can help with washing bacteria and other waste materials from the bladder).
  • Avoiding certain bladder irritants, mainly foods and drinks, such as: caffeinated drinks like coffee, tea, cola drinks, carbonated beverages, sweet drinks, alcohol, spicy foods, and citrus fruit.
  • Quitting smoking (as it may irritate the bladder).
  • Avoiding constipation.
  • Losing weight (to ease stress on the bladder).
  • Delayed voiding (a behavioral treatment helping with urine control).
  • Washing your pubic area with a mild soap (to avoid deodorant soaps or soaps with heavy perfumes).
  • Absorbent undergarments, pads, panty shields, panty liners, and adult diapers (to help prevent wetness and odors while protecting skin and clothing).
  • Bed pads (to protect sheets and mattresses).

Alternative Prevention Measures

Until the 1950s, urinary tract infection was the leading cause of death after paralysis. Nowadays, bladder infections can be prevented and remedied both pharmaceutically and naturally.

For people with a dysfunctional bladder, a matter of the utmost importance is meticulous hygiene and proper handling of urinary care supplies – catheters, leg bags, tubings, connectors, urinary and incontinence supplies.

As the sediment in the urine tends to be collected in tubing and connectors, they should be kept clean and well maintained. This can make it harder for bacteria to spread. Clean skin is also an important step in preventing infection.

Supplemental D-Mannose

When faced with a pathogenic germ like E. coli, conventional, pharmaceutically-based medicine typically confronts the problem by throwing antibiotics – the most potent poisons it can find at the bugs.

While there is nothing essentially wrong with killing disease-causing bacteria, this approach does have some very serious drawbacks. Fortunately, taking antibiotics is not the only way to attack uropathogens.

Supplemental D-Mannose is ideally suited for people with spinal cord injuries. Within two to three days, and with no adverse side effects of any kind, it can cure up to 80-90 percent of pathogenic strains of E. coli.

Even more remarkably, it accomplishes this feat without killing a single bacterium. And, it does that with none of the unwanted side effects of antibiotics, such as gastrointestinal problems, yeast infections and resistant bacteria.

As for the E. coli infections, in most cases, supplemental D-mannose is just as effective as standard antibiotics.

Supplemental Probiotics

We all know, more or less, what antibiotics are, but we still don’t know exactly what probiotics are, when they should be used, and who needs them. Let’s clear up a little bit of the confusion.

The term “probiotic” is used to describe the beneficial bacteria that inhabit the human intestinal tract. The word is derived from Greek and literally means “for life.”

Probiotics are found in fermented foods such as yogurt, sauerkraut, and kefir. Many of these foods rich in probiotics are still of great importance to the diets of most of the people in the world.

Scientists, however, have found a way to freeze-dry these beneficial bacteria and put them in capsules. The specific microorganisms found in these capsules are usually lactobacilli and bifidobacteria, which are the major probiotics found in the human intestinal tract.

According to clinical research, probiotics promote proper “gut flora” and stimulate the gastrointestinal tract and systemic immunity. Therefore, they offer many health benefits.

One of the best-documented applications of probiotic supplements is in the prevention and treatment of recurrent urinary tract infections.

As the efficacy of probiotic supplements is based solely on the number of live organisms present, successful results are attained by taking the minimum of 50 billion viable bacteria per day.

People with SCI Write to Us

(Testimonials)

Contrary to a popular belief and common medical practice, people with spinal cord injuries do not have to suffer from chronic bacteriuria and be exposed to countless rounds of vicious antibiotics.

With the help of antibacterial and anti-inflammatory herbs, nutrients and phytonutrients, it is possible to get through both acute and chronic infections by:

  • disinfecting the urinary tract,
  • inhibiting and preventing inflammation,
  • enhancing the growth of some forms of beneficial bacteria within the body such as Bifidobacteria bifidus and Lactobacillus acidophilus,
  • destroying some forms of detrimental fungi such as Candida albicans and Candida krusei.

Compared to standard medical treatments (read: antibiotics), the natural, non-pharmacological approach to urinary tract infection is clearly a superior option – much safer and without side effects.

It is our working experience that those who use catheters can successfully control, and most importantly, prevent repeated bladder infections with the help of natural formulations.

Therefore, you, or someone you know or hold dear, who suffers from spinal cord injury, should give this approach a serious consideration.

URIBIOTIC FORMULA

What Our Customers Say

Andrew,

I want to thank you for developing the product Uribiotic.

Due to a fall which caused a spinal cord injury about 1 1/2 years ago, I have had a Pseudomonas urinary tract infection repeatedly.

I purchased your product about two months ago and took the full dosage. The next urinalysis culture showed no Pseudomonas!

I dropped back to three capsules of your Uribiotic per day for precautionary maintenance and have not had a urinary tract infection sense.

After pic lines and liquid antibiotic injections and hospital stays off and on for over a year, which did not work for me, I have to thank you for this product which does work.

Stephen

Dublin, California, USA

Andrew,

I have been purchasing the Uribiotic Formula for my father on behalf of my Mom for the past several months. So far, the results are amazing.

My father has a catheter and because of this has suffered numerous hospitalizations with urinary tract and bladder infections. Due to the numerous prescriptions of antibiotics, he had developed a resistance to most.

For the past few years, he has been in and out of the hospital and rehabilitation centers. This has taken a tremendous toll on him and the whole family, not to mention the financial burden.

I am happy to report that the Uribiotic Formula has been working. It’s so nice to visit him and see him in good spirits.

I am so thankful to have found Uribiotic.

Theresa P.

Gilroy, CA

Dear Andrew,

My daughter, now 9, was born with multiple complications which had led to many surgeries and a lifetime of having to catheterize to urinate.

Because of the catheterizing, she was plagued for about 3 years with UTIs which involved being on a daily antibiotic and huge doses of very strong antibiotics about every 2-3 months…

It was a downward spiral which just kept getting worse.

I have always looked for alternatives from Western medications to heal the body and bring it back to homeostasis. In my long and desperate search I found Uribiotic Formula.

I knew this would help my daughter, so I told her urologist about what I was putting her on. They were very happy to help out.

Since her infections were so huge and she had been on daily antibiotics for so long it has taken about 9 months of working very diligently with Andrew at Full of Health.

Now, my daughter’s urologist says that she is antibiotic-free!

She has been off daily antibiotics for 2 months now and without a full blown infection requiring high dose antibiotics for 4 months.

This is so amazing and such a benefit for her future!

This is one more huge piece of the puzzle for bringing my daughter into optimal health throughout her life.

Thank you, Andrew, from the bottom of my heart for creating Uribiotic Formula!

Jenny B.

La Mesa, California, USA

Andrew,

I wanted to share some news with you, but first I would like to reiterate my story as to maybe help some other folks who undoubtedly have the same dilemma I have had.

I have been a quadriplegic since June of 1986, over 26 years. Almost since my acute injury, I have been burdened with troublesome reoccurring urinary tract infections. These infections for years were treated repeatedly with oral antibiotics by several different doctors: Bactrim, Amoxicillin, Macrobid, Cipro, Levaquin, etc. I have been on all of them numerous times. In the past, these infections were always treated aggressively with antibiotics.

Opinions have changed and now doctors are more cautious treating their spinal cord patients with antibiotics unless they are symptomatic. The view now is that spinal cord patients can live effectively with colonized bladders (!).

Eventually, I reached the point where the Pseudomonas bacterium I was colonized (high greater than 100,000 colonization) with was resistant to all oral antibiotics. They made it very hard for me to function and live life. They affected my energy level and lowered my blood pressure to levels that a productive life of any kind was impossible. Periodically, I would become septic. This would result in IV antibiotic therapy, typically two or three different drugs, and weeks, sometimes months, in the hospital.

Because of the ineffectiveness of oral antibiotics, over the last couple years I have been directed by numerous doctors to do a bladder irrigation several times a week. This would consist of 1 g of Gentamicin mixed with 50 mL of normal Saline, and then via catheter put directly into the bladder, clamped off for 30 to 60 min. and then expelled from the bladder.

I must admit, I have experienced some benefit from this therapy. But it didn’t take long until the Pseudomonas was resistant to Gentamicin. Then I was directed by doctors to substitute Tobramycin for the Gentamicin, and again the same protocol. When the Pseudomonas became resistant to the Tobramycin, I was directed by doctors to substitute Amikacin for the Tobramycin. Eventually, even these bladder lavages lost their effectiveness.

Early this spring, I ended up in my local emergency room very, very sick with urosepsis [a systemic inflammatory response of the body to infection – A.M.] – high fever and very low blood pressure. I was in serious trouble. Urine cultures showed a resistant Pseudomonas sensitive to only two drugs: Amikacin and Fortaz. The colony count was well over 100,000. My white blood count was 19. I had to have a PIC line put in and was given IV Fortaz every eight hours for 12 days. I went through this same scenario again twice this summer. Two more trips to the emergency room dangerously ill.

During these last two episodes, I was given IV Fortaz 1 g every eight hours for 14 days, while at the same time irrigating my bladder with 1 g of Amikacin/50 mL normal saline. Both of these treatments continued for 14 days. When the dual therapy was finished, my doctor ordered a repeat urine test. Even after these two therapies, I still had greater than 50,000 colonies of resistant Pseudomonas.

At this point, I began an exhaustive search to find something, anything that could help the situation.

I went to no fewer than six Infectious Disease Doctors at four different hospitals. None of them seem to have any answers. I spent days and weeks searching the Internet and different blogs for something that could help.

Eventually, I stumbled across your website. I went over the website thoroughly, and truth be told, was very skeptical.

On it there was a special link for spinal cord injured people. I read the testimonials. Although still skeptical, I purchased three bottles of Andrew’s Uribiotic Formula.

I began taking the product on August 10th. I also had a doctor’s appointment that day to see my urologist. I brought in my urine for culture. Sure enough, there were greater than 100,000 colonies of resistant Pseudomonas, and Enterococcus.

On August 21st, I had another doctor’s appointment. I again brought a urine sample. This time there were 10,000 colonies of Pseudomonas.

That’s 90% of the colonization gone in 11 days. Remarkable!

I find this simply amazing and hard to believe after all I have gone through.

Thank you, Andrew, for providing such a simple remedy to a problem that has been so troublesome for over 25 years.

Daniel C.

Massachusetts, USA

I have been quadriplegic for 15 years. About seven years ago, I started to suffer recurrent urinary tract infections to the point where most of the bacteria had become multiresistant.

My urologist pointed out to me that kidney failure is the biggest killer of people with spinal cord injuries as a result of repeated urinary tract infections which became untreatable as a result of repetitive use of antibiotics.

About two years ago I developed an infection, the bacteria being pseudomonas. Antibiotics did not work and the decision was made to not use any more, live with it and hope it didn’t get into my bloodstream.

I couldn’t accept this, so I researched the Internet once again until I finally found out about oil of oregano and Uribiotic. I ordered some, showed my GP who confirmed that there was nothing in it that could possibly cause any harm and to give it a go, which I did.

Within a few weeks the urinary tract infection cleared up.

I have barely had any symptoms since, and when I do I just use the Uribiotic for a couple of days and symptoms clear up. No side effects and no worries about the tablets not working.

I am a skeptic and honestly didn’t think this would work when I tried it, but it does. If I didn’t find out about it, I hate to think where I would be now.

I just wish I knew about it sooner.

Janine P.

Western Australia

I have lived with quadriplegia for decades. Together with oregano oil, Uribiotic has proven a fast ‘killer’ combination for any UTI’s, including a multi-resistant Pseudomonas aeruginosa infection.

This has been a great relief to me. Thank you!

Now, my daughter’s urologist says that she is antibiotic-free!

Erik L.

Perth, Western Australia

Thanks, Andrew, for your advice and support with my Pseudomonas [aeruginosa] bladder infection with your amazing product Uribiotic which stopped the infection and kept it away.

I’ve suffered from UTIs for 18 years since my spinal cord injury and now I’m infection free.

Jason C.

Great Britain

As a paraplegic for almost 14 years, I was almost constantly on antibiotics due to chronic bladder infection. However, being afraid of possible side effects, for many years I was reluctant to consider any natural alternatives.

I was afraid of getting diarrhea or constipation. These are the worst – a real disaster! But after successful experience with D-Mannose, I started looking for other natural means to solve my problem.

And I was pleasantly surprised by lack of any adverse reactions to URIBIOTIC, which I introduced to my system very cautiously.

Two weeks later, my urine culture showed NO E. coli. Burning went away in a few days. I’m pleased to report such great results.

Barret D.

Minnesota, USA

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