I have only ever had one urinary tract infection in my life. I was in college. I was busy studying for an organic chemistry exam and I did not have time for this. So I waited. And eventually, over the course of 48 hours, the inconvenient urinary frequency and urgency turned into lower back pain and low energy. The night before the exam, as I was trying to cram every last morsel of information into my already swollen mind, I was blessed with profound hematuria (blood in the urine) and every dribble felt like razor blades. Ok. Enough was enough. I ended up in the emergency room in Worcester, Massachusetts. And I missed my exam.
So the moral of that story is to never ignore urinary symptoms. Ok, got it. But here’s the thing. As we get older, the way in which a urinary tract infection presents can sometimes change. And what if, because of the way certain anatomical structures change over time, we always have some degree of urinary discomfort?
So traditionally, when it comes to urinary tract infections, we think of urgency, frequency and burning mixed with a little back pain, general “crappy” feeling and if it progresses, maybe nausea and a fever. That’s what it looks like at 20, 30, 40.
But let’s fast forward about 40+ years from my ER visit in Worcester, MA. Maybe I am 60ish. I certainly am not taking an organic chemistry exam, but maybe I have something else important to do in the upcoming days. I start to feel “not quite right”–can’t put my finger on it but I am more tired than usual, have a little nausea and my cognitive processes are just ever so slightly diminished (not firing on all cylinders…a little “fuzzy”) I let it go, take an extra B12 vitamin (because B vitamins are miracle workers), take a nap, and go on with my days. And all of a sudden, at some outrageously inconvenient time of the night, I develop nausea, I am very confused, there are people coming out of my walls, and I end up in the emergency room because my daughter has recognized that “Mom is not right.” The ER doc asks for a urine sample, and wow is it concentrated and foul smelling. And that, my friends, is how a urinary tract infection often presents in an older individual–not always, but more often than not. So watch out for foul smelling urine, confusion, nausea, abdominal discomfort, lightheadedness, general feeling of unwellness in addition to (or instead of) the classic symptoms.
So why are UTIs in older individuals such a big deal and worth blogging about? Well, you might not know this, but the prevalence of UTIs is high. In fact, UTIs are one of the most common bacterial infections among older adults. Approximately 20% of women and 10% of men over the age of 65 experience at least one UTI episode annually. Yikes. And because they are so prevalent, UTIs are a leading cause of hospitalizations among older adults. It’s estimated that UTIs contribute to over 1 million hospital visits each year in the United States alone. And this is super important because UTIs in the elderly population are associated with an increased risk of mortality, especially if left untreated or if complications arise. Studies have shown that older adults with UTIs have a higher mortality rate compared to those without UTIs. And when we increase our risk for complications, we DECREASE our ability to remain independent at home. Older adults also are more prone to recurrent UTIs. Research suggests that up to 30% of older adults who experience a UTI will have a recurrence within six months.
So with all that in mind, let’s dive deeper…why are older individuals more susceptible to UTIs? First and foremost, reduced immune function in aging can weaken the immune system, making seniors more susceptible to infections. Bacteria that our bodies used to fight with ease have now figured out how to circumvent our defenses, and our defenses are also much weaker than they once were. Incomplete emptying of the bladder also occurs due to anatomical changes over time. For men, an enlarged prostate certainly impacts bladder emptying. For women, weakened bladder muscles or, rather, a weakened pelvic floor (thanks to pregnancy and childbirth) may lead to incomplete emptying of the bladder, creating an environment for bacterial growth. Certain pelvic organs have shifted, or maybe are no longer there, as in after a hysterectomy.
Urinary Retention: Seniors may experience difficulties fully emptying their bladders, allowing bacteria to multiply. This often happens as a result of anatomical changes as noted above, or other factors. For example, many of the medications we utilize without difficulty when we are younger, may cause certain side effects when we are older. Think back to my earlier blog post about decluttering your pillbox—a major side effect of many of the meds we use…..URINARY RETENTION. Good old benadryl—urinary retention. Detrol LA for overactive bladder? URINARY RETENTION. Oxycodone for pain? URINARY RETENTION. All the good stuff comes at a price! And it usually, in some way, involves the bladder. 🙄
In the long term care and skilled rehab setting, the presence of Urinary Catheters adds a whole new element of susceptibility. Those who require catheters are at a higher risk of UTIs due to the increased likelihood of bacterial entry. A catheter is like a direct line to the bladder. Bacteria get so excited–they don’t have to work nearly as hard to gain access. Now catheters are not just in the nursing home. Many individuals living independently use this type of equipment to assist in bladder emptying due to other underlying health conditions, and those individuals are at just as much risk.
And one cannot forget that the more chronic conditions you have that are uncontrolled, the more risk you carry in terms of developing a UTI. Conditions such as diabetes, obesity, vascular disease causing strokes (resulting in damage to the nerves that control the bladder and bowels), autoimmune disorders that require chronic immunosuppressants (think inflammatory Bowel Disease, Rheumatoid Arthritis, etc), cancer patients on chemotherapy. The list could go on….
So thankfully, treating a urinary tract infection is a fairly simple task in medicine. (Well, simple compared to other things we deal with.) Here is how it goes: Patient (you or me) presents with a urine sample positive for the following: Leukocytes, blood, nitrites (the big 3). You feel a bit crummy, they send your sample to the lab for a culture that takes about 24 hours and the lab sends back a report with the specific pathogen (bacteria) that is wreaking havoc on your body. Along with this report comes something called the SUSCEPTIBILITY PROFILE and this is perhaps THE most important part of the evaluation. This is a report of which antibiotics the lab has tested that will absolutely kill the bacteria in your urine and a list of the ones that will not. This allows for appropriate targeted treatment and, we hope, cuts down on the risk for resistant pathogens. This is particularly important because as UTIs take on a more recurrent pattern in someone, the risk for repetitive antibiotic use and therefore the development of RESISTANT strains of bacteria increases. The goal is to solve the problem with the least amount of interventions. So leave that to us. We got you.
The best treatment plan for this problem I can think of is actually PREVENTION and developing healthy urinary habits early on. Kinda like dental habits, but in the southern hemisphere (below the waist) and without flossing 😬
Shocking…the same things our parents told us when we were kids apply here–hygiene, hydration, regular bathroom breaks. It’s literally that simple. Oh, and managing underlying conditions that can increase susceptibility.
So here we go. Good personal hygiene is paramount. We learned this when we were two, and it still holds true when we are 65+! It’s almost more important given the anatomical changes that have occurred since we were two. So go on and keep (or start) wiping front to back.
Breathable clothing is an important part of the mix. Wearing 100% cotton underwear keeps your nether regions fairly dry, wicking away moisture. Nobody likes to admit this but we all sweat. Wearing anything but cotton down under just invites issues.
Adequate hydration is also super important. Less concentrated urine means the environment in the bladder is less appealing to bacteria and yeast. Hydrate with 6-8 glasses of water daily (providing you are not on a legitimate fluid restriction for any reason).
Putting yourself on a toileting schedule and having regular bathroom breaks avoids prolonged periods of bladder distention–try making a trip to the toilet every 2-4 hours.
Managing chronic conditions is also incredibly important.
For example, someone who is a poorly controlled diabetic with glucose levels consistently above 200 likely has significant glucose in their urine, creating an environment within the bladder conducive to bacterial and yeast overgrowth. Think about when you are baking and you feed the yeast starter….with sugar. It multiplies, right? Same thing if diabetes is uncontrolled.
Urinary incontinence is another chronic condition that bears managing as it can also lead to an increased risk of UTIs. Future dedicated blog post on that. (It’s a pretty big topic)
For women, the loss of estrogen post menopause can lead to atrophy of the tissues surrounding the urethra leading to increased exposure of the urethral opening. This decrease in estrogen also happens to cause changes to the natural microbial environment of the vaginal and vulvar region–less beneficial bacteria and more opportunity for other strains of bacteria to colonize and create an issue. Some remedies for this issue include high quality cranberry extract (supplement) and topical estrogens for the vaginal region–helps plump the tissues and recreates the right environment for beneficial microbes.
For men, an enlarged prostate creates a physical barrier to urinating and therefore can lead to retention and increase the risk for UTIs. (More on this later as well)
And the list goes on…..the bottom line is that if you have chronic conditions that you manage, make sure you are actually managing them.
So there you have it. More information than you ever needed to know about urinary tract infections and how they affect us as we age. But to be fair, knowledge is power and it may just help us stay home and stay independent. Recognizing the symptoms of UTIs, understanding the underlying causes, and implementing preventive measures are crucial steps in managing this common yet often overlooked health concern. And as always, establishing a strong relationship with your healthcare provider is essential in this journey. I know it’s not easy in this current medical landscape, but so worth it in the end. Good luck! Take care of each other. Take care of you!
