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Urinary tract infections can be serious

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March 30th, 2017
Woman with a urinary tract infection.
Woman with a urinary tract infection.

 

According to the National Institute on Aging (NIA), urinary tract infections (UTIs) are the second most common type of infection in the body (behind respiratory infections). These infections of the kidneys, ureters, bladder, or urethra cause more than eight million visits to health care providers in the U.S.

Most UTIs affect the lower urinary tract—the bladder (cystitis) and urethra (urethritis). “UTIs are more common in women than men,” says R. Mark Ellerkmann, M.D., director of the urogynecology division at Mercy Medical Center’s Institute for Gynecologic Care in Baltimore, Md. “In women, the proximity of the anus to the vagina and the urethra make it easier for bacteria to enter the lower urinary tract.  Furthermore, given that the length of the urethra is shorter in women—approximately an inch long—harmful bacteria, known as uropathogens,  have an easier time of reaching the bladder.” 

UTIs can become very serious if they spread to the kidneys (pyelonephritis).

Signs and symptoms 

“You may feel an urgent need to urinate, and go more often,” Ellerkmann says. “Other common symptoms include pain or burning with urination, or urine that’s cloudy, discolored, or strong-smelling.” 

More severe infections (pyelonephritis or an infection that spreads to your blood) can produce fevers; chills; shakiness; abdominal pain; nausea; vomiting; or pain in the lower, middle, or upper back. 

Studies show that UTI symptoms in older adults can be absent or mistaken for other conditions, such as prostate enlargement in men or vaginal problems in women. “You may have a serious infection with very mild symptoms,” Ellerkmann says. “Your immune system is not as efficient as you age, and thus your body may not respond with typical warning signs and the infection may spread.”

In addition, detection of a UTI can be very difficult in seniors with cognitive impairment, as they may not be able to communicate symptoms.

Seniors at increased risk

Along with a reduced immune response, seniors can be susceptible to UTIs for a number of reasons. “Comorbidities such as renal disease, kidney stones, diabetes, or structural abnormalities of the urinary tract can predispose someone to UTIs,” Ellerkmann says. “In postmenopausal women, a reduction in estrogen levels causes the vaginal and urethral tissues to become thin.  This process, known as urogenital atrophy, predisposes many older women to a higher likelihood of developing a urinary tract infection.”

“Other risk factors can include incomplete bladder emptying or urinary retention, which is often seen in individuals who have suffered a spinal cord injury, a stroke, or who suffer from poorly controlled diabetes or bladder prolapse,” Ellerkmann adds. “Individuals with indwelling catheters are also at high risk.”

Treatment

Prompt treatment with antibiotics is essential to prevent complications. “The best treatment for many seniors with uncomplicated infections is a short course of antibiotics,” Ellerkmann says. “Current guidelines recommend certain antibiotics over others as first-line agents for uncomplicated urinary tract infections.” 

Your doctor may also prescribe an analgesic that can numb your bladder and urethra so it isn’t as painful when you pass urine. A common side effect of these drugs is orange or red urine.

The right treatment needs to be carefully considered for people who have repeated infections. “A recurrent infection is defined as three infections in the past 12 months or two in the past six months,” Ellerkmann explains. “Depending on the cause, some people may need long-term low-dose antibiotics to prevent flare-ups. Others may need to take only a single dose of an antibiotic around certain activity—like intercourse—to help prevent infections.”

“Someone with recurrent UTIs needs a medical evaluation to determine if there is a related underlying chronic condition,” says Brian Tremaine, M.D., medical director at Eagle’s Trace, an Erickson Living community in Houston, Tex. 

Serious UTIs may need to be treated at a hospital.

Reduce your risk

“A simple way to reduce your risk of UTIs is to drink sufficient amounts of fluids,” Ellerkmann says. It is also important to rule out other causes that might be predisposing someone to bladder infections—for example, kidney stones, an enlarged prostate in men, and vaginal atrophy and pelvic organ prolapse in women.”

Don’t wait until you are thirsty to drink liquids, and steer clear of beverages containing bladder irritants such as alcohol and caffeine. For many years, cranberry juice was considered an effective way to prevent, and in some instances even serve as an adjunct treatment for, UTIs. “Years of research have shown, however, that drinking cranberry juice makes no significant difference,” Tremaine says. 

Some researchers continue to study cranberry extracts and supplements for possible use, but so far results have not been conclusive. Regardless, cranberry juice is not harmful, but according to the Mayo Foundation for Medical Education and Research, people taking blood thinners, aspirin, or certain medications that affect the liver should talk to their doctor before drinking cranberry juice or taking any type of dietary supplement.

Proper hygiene is also essential for UTI prevention, but people who are unable to care for themselves need someone else to help. “UTIs can be a significant problem in long-term care facilities,” Tremaine says. “The staff have been taught how to care for patients, but nevertheless, incontinence and immobility contribute to an increased risk of UTIs in facilities.”

“More efforts are being directed toward the proper diagnosis and treatment of UTIs,” Tremaine says. “We are hoping to reduce the burden of these infections on patients and the health care system.”


Facts about UTIs

• UTIs are one of the most common infections among residents in long-term care settings.

• UTIs are associated with over $6 billion in health care costs worldwide.

• One in two women will have at least one UTI in their lifetime.

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