Like many women, Katherine Trent (name has been changed) of Austin, Texas, had to deal with an occasional urinary tract infection (UTI) when she was younger. Symptoms were obvious (pain, burning, and a persistent need to urinate) and easy enough to clear up with antibiotics. But once Trent entered her late 60s, the sporadic UTIs of her earlier years suddenly returned—and wouldn’t go away. Within a few days of one infection easing, another round of symptoms would start. This cycle continued, getting progressively worse over the course of five years. “I could tell when one was coming on. My bladder would feel irritated. I went to the bathroom frequently, and it was painful. If I couldn’t get to a doctor or a walk-in clinic within 24 hours, I would sometimes see blood in my urine,” Trent recalls.
We tend to think of UTIs as a young women’s problem, but many women—and men—who have never or rarely been troubled can become prone at midlife. Understanding how your age changes your risk and the best approaches to treatment can bring life-changing relief.
Surprise UTI Sufferers: Men
UTIs are extremely uncommon in young males. So it can come as a nasty surprise when men get one for the first time in their 50s, often because of an enlarged prostate.
“The prostate surrounds the urethra—the tube from the bladder through the penis—like a doughnut,” says Neil Baum, MD, an associate clinical professor of urology at Tulane University School of Medicine in Louisiana. A growing prostate compresses the urethra, causing a weak urine stream, the need to pee frequently, and a dribble after a void. If the bladder doesn’t completely empty, the reservoir of urine can become infected.
Some 5 to 10 percent of men who have an enlarged prostate experience repeat UTIs, says Dr. Baum. Medication can relax muscles in the gland or shrink it so urine can pass easily. Minimally invasive procedures to relieve blockage or pressure can also help.
Why Women’s UTIs Get Worse
While blocked pipes can cause an upswing in UTIs in men, weakened pipe linings—a result of menopause—contribute to women’s increased risk of UTIs. This was a factor in Katherine Trent’s repeated infections.
Prior to menopause, estrogen keeps the lining of the urinary tract thick and healthy, producing germ-killing compounds and limiting the ability of infection-causing microbes to invade tissues. As estrogen levels decrease during menopause, the germ-fighting capability and physical barrier of the urinary tract weaken and the mix of bacteria in the vagina changes—all of which can increase the odds of developing UTIs.
Antibiotics treat acute infections, but other treatments may be necessary to prevent recurrences. In 2013, Swedish researchers reported that a few weeks of topical estrogen treatment in postmenopausal women strengthened the urinary tract wall, making it less prone to infection.
Trent’s urologist suggested that she apply a prescription estrogen cream to the vaginal area every day for a few weeks and then follow a less frequent regimen. The urologist also supported Trent’s idea to use vaginal suppositories containing probiotics. Trent hasn’t had a UTI in 18 months, and last summer she spent a month in London—a vacation she would not have been able to fully enjoy while UTIs were controlling her life.
If you start experiencing UTIs out of nowhere, your doctor will want to rule out other issues. “If standard treatments fail, we check for stones in the bladder or kidneys,” says Elizabeth Mobley, MD, of the Urology Team in Austin, Texas. If you have poorly controlled diabetes, UTIs hang around longer, since bacteria feed off sugars that spill into the urine.
The Scariest UTI Symptom: Delirium
Two years ago, when Meredith Channing made her daily phone call from Hawaii to her elderly mom in the Midwest, she knew something had gone dramatically wrong.
“One day, she was happy; the next, she was nasty, paranoid, and totally off her rocker,” Channing says. “She was telling me that the neighbors were stealing from her and something had entered her apartment and moved her sewing machine.”
Others in Channing’s shoes might have panicked and suspected dementia, but Channing knew better. While she was caring for her mother-in-law several years earlier, the older woman had developed two UTIs and become confused and suspicious during both infections. “You can really mistake the symptoms for insanity or dementia and think that it’s time to ramp up the home care or consider a nursing home. The most wonderful thing about resolving a UTI is that the person can become herself again,” says Channing.
Channing asked for her mom to be tested even though she had no typical symptoms. Sure enough, she had an infection. With treatment, she was back to normal in two days.
Seniors may be more likely to become delirious when they fight a condition such as a UTI or pneumonia because of changes in the immune system, explains Timothy Girard, MD, an assistant professor of medicine at Vanderbilt University in Nashville, Tennessee. Many older adults don’t have the usual symptoms. If you suspect a loved one might have a UTI because of changes in her behavior, get her tested, urges Dr. Girard. “Prompt treatment can help avoid delirium, sepsis, and kidney failure,” he says.
Hospitals: A Danger Zone
Up to 25 percent of all hospitalized patients receive a urinary catheter, significantly raising the risk of a UTI—which sufferers very commonly acquire at a health-care facility. Germs can enter this slim tube, which drains fluid from the bladder, if the device is inserted incorrectly, not kept clean, or left in too long.
If you’re hospitalized, ask every day whether you still need a catheter. If the medical staff says yes, ask why. Making care more convenient isn’t a good enough reason if there are other options, such as using a bedside commode. Walk around as soon as possible after surgery to speed recovery and shorten your catheter time.
“Speak up if anyone starts to adjust the catheter without first washing his hands or if you see that the tubing is kinked or the bag is positioned above the patient’s abdomen. Keeping it low helps prevent urine from backing up,” says Lona Mody, MD, a professor of internal medicine at the University of Michigan in Ann Arbor. This advice is also important if a loved one has been transferred to a nursing home, where patients with a catheter are at double the risk of developing a UTI.
5 Ways to Cut Your UTI Infection Risk
1. Boost good bacteria. Small studies have found that women with repeat UTIs are less likely to get another if they use vaginal suppositories with the probiotic lactobacillus, which balances good and bad bacteria.
2. Drink cranberry juice. In a 2012 meta-analysis, cranberry juice and supplements reduced repeat UTIs.
3. Wipe the way Mom taught you. The most common UTI-causing germs are E. coli bacteria from the gastrointestinal tract, so wipe from front to back to avoid moving the bugs closer to your urinary tract.
4. Excuse yourself after intercourse. Peeing after sex gives bacteria less chance to enter the urinary tract.
5. Drink lots of water. When you urinate, bacteria are flushed from the urinary tract, so drink enough to go regularly, especially if you have incontinence. Those prone to leakage often restrict fluids to prevent accidents, but this is a recipe for infection.