Unrecognized and untreated urinary tract infections (UTIs) can quickly turn into more serious conditions. Among young and middle-aged adults, UTIs are more likely to strike women than men. But UTIs also occur often in older men. In both older men and women, the symptoms of a UTI may not be so obvious as they are in young women.
UTI causesUTIs commonly occur when bacteria from the rectum (such as Escherichia coli) infect the skin around the opening of the urethra (the tube leading to the bladder) and then ascend to the bladder. Because a woman's urethra is much shorter than a man's, it is easier for bacteria to get up into the bladder and cause a UTI.
UTIs may also occur when urine flow is blocked and the urine pools in the bladder, creating an ideal setting for the growth of bacteria. In older men, enlarged prostate glands often partially block the outflow of urine. In older women, bladders that have descended (prolapsed) can cause incomplete emptying of the bladder. Also, a lack of estrogen in older women encourages the growth of bacteria near the urethra. Finally, kidney stones can lead to UTIs in both men and women.
A urinary tract infection (UTI) occurs when bacteria travel up a woman's urethra and into the bladder, ureters, and/or kidneys. Most UTIs are caused by bowel bacteria, such as E. coli.
Symptoms and risksThe most common UTI symptoms include burning with urination, frequent urination, a sense of urgency to urinate, and pain in the area of the bladder. But symptoms don't always appear in older adults. "It's not unusual to see a patient in her upper 70s or older who gets infections without symptoms," says Dr. George Flesh, director of urogynecology and pelvic reconstructive surgery for Harvard Vanguard Medical Associates. Some experts think that is because the symptoms of a UTI are actually caused by the immune system's fight against the infection, and the immune systems of older people may not fight as fiercely.
Dr. Suzanne Salamon, a geriatrician and instructor at Harvard Medical School, says the lack of symptoms in men and women also can be related to conditions such as stroke, Parkinson's disease, and dementia. "Anything that affects the brain may affect the ability to feel, localize, or describe pain," she explains.
A lack of symptoms may result in a UTI going untreated and then spreading to the kidneys, and then the bloodstreamâa potentially fatal condition.
But UTIs produce more subtle signs even when common symptoms don't emerge. "In older adults, there may be a sudden change in mental status or behavior, such as confusion or agitation, fatigue, and loss of appetite," says Dr. Salamon. But she cautions against assuming there's a UTI just because someone becomes agitated, saying that approach can lead to unnecessary treatment with antibiotics. It's better, she says, to consider additional signs such as cloudy and foul-smelling urine, abnormal urine color, blood in the urine, and back painâa sign the infection has spread to the kidneys.
Diagnosis and treatmentNo matter how many symptoms there are, it's important to do a thorough diagnosis for a suspected UTI. This may require a physical exam, urine analysis, and urine culture. "If it's caught in time, treatment is a short course of antiÂbiotics," says Dr. Fleshâfor example, with nitrofurantoin (Macrodantin). This should improve or eliminate symptoms within two to three days. If a UTI is not caught in time and turns into a more serious condition, it may require a hospital stay and stronger courses of antibiotics given intravenously.
What you can doBoth Dr. Flesh and Dr. Salamon recommend drinking more fluids to help prevent UTIs. "Older people have a tendency to drink less fluid so they don't have to go to the bathroom as often, but urine stagnates. It's important to drink more of anything so it washes away the bacteria," says Dr. Salamon. Other suggestions include emptying the bladder after sex to flush out bacteria.
For women with recurrent UTIs, Dr. Flesh recommends vaginal estrogen cream. "It is the most effective preventive treatment, resulting in 70% to 90% fewer infections," he says. If recurrent UTIs occur following sexual intercourse, a single dose of antibiotics at the time of intercourse can reduce the risk of recurrences. Finally, a low daily dose of certain antibiotics for several months can reduce future recurrences.