In the catalog of age-related indignities, the humble urinary tract infection, or UTI, may not seem like a very big deal. But the truth is that, for women in particular, UTIs become much more problematic as we age. They’re easier to acquire, harder to identify, more challenging to cure and more dangerous if left untreated.
For all these reasons, according to Dr. Lindsey Kerr, director of the pelvic care and continenc e program at Eastern Maine Medical Center in Bangor, women approaching or past the age of menopause should be well informed about risk factors, subtle symptoms and preventive strategies. And for caregivers of elderly women who may not be able to communicate clearly or advocate for themselves, it’s essential to be on the lookout for subtle signs that indicate the possibility of a UTI.
“A UTI after 65 is a more complicated infection than it is in younger women,” Kerr said. That’s because risk factors that predispose older women to developing a UTI can be hard to manage, including the natural loss of estrogen that occurs with menopause. That change lowers the acidity of the vaginal canal and creates a more hospitable environment for invasive bacteria, which can then travel through the urethra to the bladder, kidneys and other structures of the urinary tract.
At the same time, lower estrogen levels diminish the strength and elasticity of tissues, making it easier for harmful bacteria to reproduce in the vagina and the urinary tract. But there are several other factors that predispose older women to UTIs, Kerr said — even those who live active, healthy lives.
Thanks to the unkind forces of gravity and childbirth, many women experience a dropping of their bladders and a weakening of the pelvic floor, which can cause leaking with exertion and related irritation of the tissues and also make it difficult to completely empty the bladder. In addition, the same forces can weaken the anal sphincter, so bits of bacteria-laden gas and stool come into contact with inflamed vaginal and urinary tract tissues.
“So then you have this pool of stagnant urine sitting in the bladder, growing bacteria,” she said. It’s a nasty set-up for a nasty infection that, though common, can be hard to detect and tough to treat.
It’s hard to detect, because many older women do not experience the classic symptoms of a UTI — urgency, frequency and pain with urination. Instead, their symptoms may be more subtle — intermittent cloudiness in the urine, an unpleasant odor and perhaps a persistent, low-grade fever. In elderly women, especially those who have trouble communicating, the observable symptoms may be as vague as a loss of appetite, a change of behavior, slurred speech or an uptick in confusion.
“If she has just a titch of dementia, a woman with a bladder infection can get very confused,” Kerr said. It’s important for family members, caregivers and medical providers to consider the possibility of a UTI early in the diagnostic process.
Most UTIs are identified with a dipstick test and can be quickly and easily cured with an oral antibiotic. For younger women, this is a relatively straightforward treatment that results in quick relief of symptoms and the killing off of harmful bacteria with a few days. But older women may not tolerate strong antibiotics well and are more likely to experience side effects such as nausea, diarrhea or constipation.
“I always prescribe the lowest effective dose for the shortest amount of time,” Kerr said. Sometimes, it takes some experimentation to effectively treat a UTI in an older woman. In rare instances, an infection can cross from the urinary tract into the bloodstream, a condition known as sepsis that may require hospitalization and even prove life-threatening.
Prevention is the best strategy
Given the challenge of diagnosing and treating UTIs in older women, Kerr said common-sense preventive strategies are important to adopt.
First she said, emphatically, “poop every day.” Women should ensure they experience a full bowel movement that empties their colon each day. Unevacuated stool can cause the colon to bulge and prevent the bladder from emptying effectively. And small amounts of leaking stool can be the direct cause of a urinary tract infection. Most American diets are low in dietary fiber and need supplementing with extra grains or greens or an over-the-counter fiber source, Kerr said.
It’s also important to drink plenty of water or other non-alcoholic beverages each day. Fluid keeps the kidneys and bladder flushing and also helps prevent constipation. Most sources recommend drinking a total of 8 cups of fluid per day.
Careful bathroom hygiene is essential. “Always wipe from front to back,” Kerr said. “Diaper wipes are good, or a small spray bottle of water, but stay away from harsh antibacterial soaps.” The goal is to wash bacteria off your bottom mechanically, she said, not to disable it chemically.
For older women who are sexually active, a spongebath of the genital area before bed is protective, and a good sexual lubricant is critical to avoid damaging sensitive tissues. “Buy a good personal lubricant product,” she said. “Don’t use coconut oil or Crisco or KY jelly. It needs to have a specific viscosity that mimics the body’s own fluids.” Stay away from any products that burn or irritate genital tissues, as the inflammation can open the way to infection.
Longer term, Kerr said exercises that strengthen the abdominal muscles and the pelvic floor can be effective at preventing urinary leakage. She recommends working with a professional coach to learn the exercises correctly and target them to the specific areas that need strengthening. “You would not use [YouTube] or paper instructions to learn tennis,” Kerr said. “Same goes for the pelvic muscle exercises.”
Cranberry and blueberry extract supplements contain a substance that appears to inhibit the ability of bacteria to attach to the lining of the urinary tract, but they cannot cure an existing UTI. By the time you know you have a UTI, Kerr said, a prescribed antibiotic is the only reliable cure.
Men do develop UTIs, Kerr noted, but the incidence is about nine times lower than in women primarily due to anatomical differences, including the length of the urethra. In almost all cases, older men’s infections are the result of prostate enlargement that constricts the urethra and causes incomplete emptying of the bladder. But, she added, men and women should be aware of the warning signs of a urinary tract infection and should not hesitate to contact a health provider for assistance.