Urinary Tract Infection: Sign, Symptoms, and Treatment

Urinary Tract Infection (UTI) is one of the most frequently diagnosed infections in the elderly overall and is the most common infection in long-term care residents, responsible for over 30% of all nursing home associated infections.* While UTI can affect men, it is more common in women with about 10% of women older than 65 diagnosed each year. This increases with age to greater than 30% of women affected yearly by age 85.  Given this prevalence of UTI, it is important to be aware of a few important points.

Signs and Symptoms

Urinary Tract Infection can have both typical and atypical symptoms.  Some of the typical symptoms include:

• Burning or pain with urination
• Urinary urgency or increased frequency
• Foul-smelling urine
• Dark, cloudy, or bloody urine
• Pelvic pain or pressure

More severe infections can produce fever, shaking, chills, or night sweats.  However, there are also a few atypical ways that UTI can present, particularly in the elderly

• Agitation and other behavior changes
• Confusion
• Hallucination

Management & Treatment

In general, UTI is caused by bacteria and is treated with antibiotics, however, the management will depend on the severity of the infection and whether other health conditions are present.  Most cases can be treated with oral antibiotics at home, but more severe cases may require hospitalization.

At this point, it is important to address a common myth that causes a lot of confusion.  Some believe that the presence of bacteria in a urine sample is the same thing as a urinary tract infection.  However, without any of the symptoms listed above, bacteria in the urine, also known as asymptomatic bacteriuria, is actually quite different from a true urinary tract infection.  Asymptomatic bacteriuria has not been associated with any increase in adverse outcomes and treating it unnecessarily with antibiotics risks side-effects from antibiotics themselves.  In addition to antibiotic side effects like an allergic reaction, C. difficile colitis, etc, overtreating with antibiotics actually makes the bacteria more resistant to antibiotics and harder to treat over time.

Prevention

While urinary tract infection may not be completely preventable, these steps will help reduce your risk of infection.

• Use appropriate genital-urinal hygiene (e.g. women wipe front to back)
• Stay hydrated with sufficient fluid intake, if allowed by your physician
• Avoid feminine products which may be irritating (e.g. deodorant sprays, douches, powders in the genital area)
• Address any underlying urologic problems which could predispose to infection (e.g. urinary retention, large prostate in men, etc)

Other prevention methods are not definitely proven, but some claimed success by drinking cranberry juice or using pro-biotics to help prevent Urinary Tract Infection.  As always, discuss trying any of these methods with your physician first, as some individuals may have health conditions or use other medications that would limit some of these suggestions.

 

*Urinary tract infection in older adults.  Rowe, TA, Manisha, JM. Aging Health. Oct 2013.

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