En español | If you had urinary tract infections (UTIs) as a young woman — say, when you first became sexually active — you may have thought they were far back in the rearview mirror. Think again. UTIs strike many women again later in life: More than 10 percent of women over 65 — and nearly 30 percent of women over 85 — report having had one in the past 12 months.
"UTIs are extremely common in older women,” says Nicole De Nisco, assistant professor of biological sciences at the University of Texas at Dallas, who studies such infections. “They are one of the primary indications for prescriptions of antibiotics in older women. And older women are twice as likely to get recurrent UTIs as younger women.”
And sorry, guys, but you're not off the hook either: Though more unusual, UTIs — which can occur in any part of the urinary system, including the kidneys and bladder — occur in older men, too. Sometimes it's because an enlarged prostate keeps a man from emptying his bladder fully, but often the infection follows from catheter use. Doctors say anyone on a catheter — say, post-surgery — should be aware that its prolonged use can lead to UTIs.
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If you're diagnosed with a UTI, your doctor will prescribe a course of antibiotics (trimethoprim/sulfamethoxazole, fosfomycin, nitrofurantoin, cephalexin, or ceftriaxone), which will knock out the underlying infection. While treatment is fairly straightforward, the harder part can be simply realizing you have this particular infection in the first place. UTIs, says Howard Goldman, vice chairman of the Department of Urology at the Cleveland Clinic, sometimes go undiagnosed in older adults until more severe symptoms set in.
That's why it pays to know the list of symptoms below. If you are experiencing any, see your doctor, who will ask you to provide a urine sample. It will then be cultured to look for an overgrowth of bacteria (technically, 10,000 per milliliter in one specimen) before diagnosis.
Warning Signs to Know
As you look at the list below, ask yourself a key question: Is this symptom something new?
1. Painful urination (dysuria)
The cause? Bacteria — and 75 to 95 percent of the time, it's Escherichia coli, or E. coli, which invades the urinary system from outside the body, usually from the perineum, the area between the anus and the urethra.
Because excess bacteria cause inflammation, a UTI can cause you to feel burning or stinging while urinating. “For some [postmenopausal] women, lack of estrogen in the vaginal tissues means they have some chronic discomfort when they urinate. That's why it's important to note that the pain is acute or has increased in intensity lately,” says Summer Allen, assistant professor in the department of family medicine at the Mayo Clinic. (You can temporarily ease any new discomfort by avoiding caffeinated drinks, like coffee and sodas, and alcohol.)
2. Sudden, unexplained urge to urinate
Any woman who has ever had a UTI, even if it was decades ago, is painfully familiar with this feeling: As soon as you go to the bathroom, you feel the urge to urinate again, only nothing comes out no matter when you try again. As we age, some people already experience urgency or frequency, often due to the bladder muscle weakening — but if this urgency has developed suddenly or has gotten worse, you might have a UTI.
3. Pain in one of two areas
UTIs can cause newfound discomfort in two spots: either the lower pubic area near the bladder or the lower-to-mid back, technically called the costovertebral area, where the kidneys are located. (Your doctor might refer to this discomfort as “CVA tenderness.") Why pain? Because infections cause inflammation to surrounding tissues.
4. Cloudy or foul-smelling urine
Once again, the key here is urine that suddenly “smells funny” or doesn't look clear when you look at it in the toilet. To prevent UTIs from occurring in the first place, it helps to drink plenty of fluids — your urine should be light yellow to medium amber — and to empty your bladder regularly. Doing both “flushes out that bacteria trying to harbor in the bladder or the urethra,” says Allen. Women should also urinate right after sexual intercourse.
5. Blood in the urine
A UTI in a postmenopausal woman can cause another change in your urine: the presence of non-menstrual specks of blood. “The tissues in your bladder and urethra become so irritated and inflamed that they are basically bleeding a little bit,” says Allen. That blood is not always obvious, she says, but with “a gross hematuria, which means larger amounts of blood in the urine, the urine will either be bright red or have a pinkish or cola color."
Any infection, including a UTI, can cause a spike in temperature. Allen says to look for a fever of 100.4 degrees Fahrenheit or greater, adding: “Look for the fever in the context of some of the other symptoms. A fever alone does not indicate a UTI.” She recommends using a tympanic (ear), oral or axillary (armpit) thermometer to check your temperature. The fever may be accompanied by chills and even nausea.
7. Mental fog
Even if you don't have any of the above symptoms but suddenly feel mentally “off” (with no other apparent causes), talk to your physician. (Similarly, if you're the caregiver of a loved one who suddenly exhibits confusion or something like worsening dementia, call their doctor.) Lisa Corbin, professor of clinical practice, University of Colorado Anschutz Medical Campus, describes a female patient — “the healthiest 60-year-old you'll ever meet” — who was weaning off narcotics for chronic neck pain and started to feel sick and loopy. “She didn't have any urinary symptoms whatsoever, but by the time she saw me, she looked so bad I took her straight to the emergency room. She had gotten septic from a urinary tract infection.” Confusion, of course, can have other causes — like dehydration or depression — it's a sign you should check in with your doctor.
What's Menopause Got to Do With It?
A lot, when it comes to the causes of UTIs for older women. “One of the defenses against UTIs is well-estrogenized tissue,” says Corbin. “We all know that our vaginas have estrogen receptors, but the urethra does, too. So as you lose your estrogen, that whole area loses a line of defense because you don't have that moist, resistant mucosa any more. It dries and cracks and lets things in.” That's why when women get recurrent UTIs (defined as three or more within one year), their physicians often prescribe a topical estrogen cream, applied to the opening where they urinate. Researchers are even looking at treating older women with hormone replacement therapy combined with probiotics, De Nisco says.