Having a urine infection can be a common problem when you are older. There may be underlying health problems that are responsible. Urine infections are usually easily treated with a course of a medicine called an antibiotic. Once cleared with treatment, in most cases there are no long-term problems following a urine infection. There are some simple steps you can take to help prevent a urine infection.
Understanding the urinary tract
There are two kidneys - one on each side of the tummy (abdomen). They make urine which drains down tubes called ureters into the bladder. Urine is stored in the bladder and is passed out through a tube from the bladder (called the urethra) from time to time when we go to the toilet.
What is a urine infection and what causes it?
Most urine infections are caused by germs (bacteria) that come from your own bowel. They cause no harm in your bowel, but can cause infection if they get into other parts of your body. Some bacteria lie around your back passage (anus) after you pass a stool (faeces). These bacteria sometimes travel to your urethra (the tube from the bladder that passes out urine) and into your bladder. Some bacteria thrive in urine and multiply quickly to cause infection.
A urine infection is often called a urinary tract infection (UTI) by doctors. When the infection is just in the bladder and urethra, this is called a lower UTI. If it travels up to affect one or both kidneys as well then it is called an upper UTI This can be more serious than lower UTIs, as the kidneys can be damaged by the infection.
How common are urine infections?
About 3 in 100 men in their 60s, and about 1 in 10 men in their 80s, will have a urine infection.
Urine infection is much more common in women. This is because their urethra (the tube from the bladder that passes out urine) is shorter and opens nearer the back passage (anus) than in men. Infection also becomes more common as you get older. Half of all women will have a urine infection that needs treating in their lifetime.
Why do some people get urine infections?
In many cases the infection occurs for no apparent reason. There is no problem with the bladder, kidney, prostate, or defence (immune) system that can be identified. In some cases, an underlying problem can increase the risk of developing a urine infection.
In older women
- After the menopause the skin around your genital area may become more fragile. This is called atrophic vaginitis. It is associated with having more urine infections.
- A prolapse of the womb or vagina can also increase your risk of infection.
In older men
- An enlarged prostate may stop the bladder from emptying properly. Some urine may then pool in the bladder. Germs (bacteria) are more likely to multiply and cause infection in a stagnant pool of urine. (See separate leaflet called Prostate Gland Enlargement which discusses prostate enlargement in more detail.)
- Bladder or kidney problems may lead to infections being more likely. For example, kidney stones or conditions that cause urine to pool and not drain properly.
- Having a urinary catheter. A catheter is a thin, flexible, hollow tube.
- An underlying health condition may also be responsible. A poor immune system increases the risk of having any infection, including urine infections. For example, if you are having chemotherapy because of cancer. Diabetes can also increase your risk of having urine infections.
- Being constipated.
What are the symptoms of a urine infection?
- Infection in the bladder (cystitis) usually causes pain when you pass urine, and you pass urine more frequently. You may also have pain in your lower tummy (abdomen), your urine may become cloudy, bloody or offensive-smelling and you may have a high temperature (fever).
- Infection in the kidneys may cause a pain in a loin (the side of the abdomen over your kidney), a high fever, feeling sick (nausea), being sick (vomiting) and feeling generally unwell.
In some older people the only symptoms of the urine infection may be a recent onset of confusion or just feeling generally unwell. The confusion is caused by a combination of factors such as having a fever and having a lack of fluid in the body (dehydrated). The confusion should pass when the infection has been treated.
Are any tests needed?
A test on a urine sample can confirm the diagnosis and identify what is causing the infection. Further tests are not usually necessary if you are otherwise well and have a one-off infection. However, your doctor may advise tests of your kidney, prostate, or bladder if an underlying problem is suspected (such as an enlarged prostate or a kidney problem).
An underlying problem is more likely if the infection does not clear with antibiotic medication, or if you have:
- Symptoms that suggest a kidney is infected (and not just the bladder).
- Recurring urine infections. (For example, two or more episodes in a three-month period.)
- Had problems with your kidney in the past, such as kidney stones or a damaged kidney.
- Symptoms that suggest an obstruction to the flow of urine.
Tests may include a scan of your kidneys or bladder, and/or a look inside your bladder with a special telescope (cystoscopy).
What is the treatment for a urine infection in older people?
- A course of an antibiotic medicine will usually clear the infection quickly. You should see a doctor if your symptoms are not gone, or nearly gone, after a few days.
- Paracetamol or ibuprofen will usually ease any pain, discomfort, or high temperature (fever).
- An underlying cause such as an enlarged prostate or constipation may be found and need treatment.
NB: If you have an infection of your bladder (cystitis) then having plenty to drink is traditional advice to flush out the bladder. However, there is no proof that this is helpful when you have cystitis. Some doctors feel that it does not help, and drinking lots may just cause more (painful) toilet trips. Therefore, it is difficult to give confident advice on whether to drink lots or just to drink normally when you have mild symptoms of cystitis. However, if you have a fever and/or feel unwell, having plenty to drink helps to prevent having a lack of fluid in your body (dehydration).
What is the outlook (prognosis)?
Most people improve within a few days of starting treatment. See a doctor if you do not quickly improve. If your symptoms do not improve despite taking an antibiotic medicine then you may need an alternative antibiotic. This is because some germs (bacteria) are resistant to some types of antibiotics. This can be identified from tests done on your urine sample.
Can I prevent urine infections?
There are some general points that will lessen your risk of having a urine infection:
- When women wipe themselves after passing a stool (faeces), wiping from the front towards the back passage (anus) is best. If you start near the back passage, you may accidentally bring germs (bacteria) closer to the tube which drains urine from your bladder (the urethra) and your bladder opening. This increases your risk of having an infection.
- Older women with atrophic vaginitis may wish to consider hormone replacement creams or pessaries. These have been shown to help prevent urine infections.
- Try to eat lots of fruit and fibre and drink plenty of fluid. This is good for your bowel and will help you avoid being constipated. Being constipated prevents you emptying your bladder properly. This may increase your risk of having a urine infection. If you are having trouble with opening your bowels, let your doctor know. Sometimes your medication may be making the problem worse. Your doctor may be able to change it.
Further reading & references
- Management of suspected bacterial urinary tract infection in adults; Scottish Intercollegiate Guidelines Network - SIGN (updated guidelines 2012)
- Guidelines on Urological Infections; European Association of Urology (Mar 2013)
- Urinary tract infection (lower) - men, NICE CKS, January 2010
- Urinary tract infection (lower) - women; NICE CKS, October 2009
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Hayley Willacy
Dr Hayley Willacy
Dr Tim Kenny