Why are urinary tract infections in elderly women so common?

10 answers | Last updated: Dec 16, 2016
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Why are urinary tract infections in elderly women so common?

Expert Answers

Jennifer Serafin, N.P. is a registered nurse and geriatric nurse practitioner at the Jewish Homes for the Aged in San Francisco.

This is a complicated question, and a good one. I'll to simplify the answer. There are several reasons why women are at a higher risk of urinary tract infections (UTI) as they age.

Urine retention or incomplete bladder emptying: As women get older their bladders may not empty as efficiently, leaving urine behind. This urine can become contaminated with bacteria, which leads to infection. Many things can contribute to urine retention. These include: Gynecological problems (organ prolapse, surgeries), urethral stricture, severe constipation, medication side effects, and neurological diseases like strokes and Parkinson’s disease. In particular, bladder medications used to treat incontinence can cause urine retention. What helps? Talk to a doctor or pharmacist about changing medications. Treat constipation.

Decreased ability to fight infection: After menopause, changes can occur in normal vaginal bacteria. For example, lactobacillus, a healthy and protective bacterium decreases. This decrease allows the more troublesome fecal bacteria to over-grow, which can cause infection. What helps? Check with a gynecologist and good hygiene.

Female anatomy: With women, the urethra (where urine comes from) is only a couple of inches from the rectum (where fecal infection-causing bacteria come from), so it's easy for baceria to spread. As some women age, they lose the ability to toilet efficiently. If someone is incontinent and wears diapers, it's more challenging. What helps? Women should always wipe from the front to the back. Frequent diaper changes and cleaning.

Dietary changes: Many elders do not drink enough, as they're afraid of urine accidents, can't access beverages independently, or can't express or feel "thirst" as clearly as before (especially true for women with dementia). What helps? Drinking at least eight glasses of water or clear fluid daily. Cranberry juice may also help, though the research on this is inconclusive. I's recommend trying one 8 oz. glass of 100% cranberry juice twice daily. If the frequent UTIs continue, then I'd stop.

If you know a woman who gets frequent urinary tract infections, she should see her doctor who can check for and address these issues.

Community Answers

Twstr2u answered...

Over the last six months or so; I too have been afflicted with urinary tract infection. My doctor put me back on HTR (Harmone Therapy Replacement) but at half dosage. So far, this seems to be doing the trick. That is until now. All of a sudden, it is back again. I was wondering if I should increase the dosage to a full dose until it is back under control again. I am also wondering (after it's back under control) if I should take half of BOTH pills as they go together for the htr. I take Estradiol 1 MG Tab and Medroxyprogest 5 MG. I've been taking 1/2 of the Estradiol but a whole pill on the Medroxyprogest. Should I halve the Medroxyprogest as well? Thank you for any help you can give me.


Ladydawn answered...

In response to the cranberry juice aspect only, I'd skip the juice and go straight to the best canberry capusles you can find. Taken with a glass of water (you certainly don't want to dehydrate) you can take 2 capsules 4X a day for an infection and once or twice a day if you suspect.

The juice unless not mixed with anythin else for palatability is going to have more sugar than you want or need. The last thing you want is a yeast infection.

Have you talked to your doctor about natural HRT? There are some decent herbal-type blends for Hot Flash.

Are you kegeling? That will help regain some strength in the pelvic region where it is needed to aid complete emptying of the bladder. You can even do them in bed before you get up in the morning.

Yamajoybot answered...

l went to see a doctor for vaginal discharges and after lab result everything was alright but sometime l still smell odour from my vaginal which l know is not normal. What may be the cause of this?

A fellow caregiver answered...

yamajoybot I just had a bout with Bacterial Vagninosis. This causes a fishy oder and some discharge. Need to see a doctor, and get treatment. They gave me Metronidazole. Seems to have worked. It can also cause pressure feeling and urgency.

Ca-claire answered...

OK, so I used to get a lot of kidney infections (skipped my bladder completely). I used to keep myself dehydrated all the time (drank tea or soda rather than plain water). I have used cranberry capsules, and have used plain cranberry juice mixed with orange juice.

As for the question about the HRT, dosages and such to take, talk to your Physician. There's a lot of hooey (crap) out there on the internet about bioidenticals, OTC's, Canadian stuff, Mexican stuff, etc - all with only anecdotal (non-research based) 'evidence' as to it's efficacy - your physician or pharmacist are the only ones with enough knowledge to guide you on HRT.

For the lack of lactobacillus, and vaginal odors, be sure to eat some yogurt, kefir, or Acidofillus milk to up the prevalence of the 'good' bacteria to keep your perineal area healthy. Only wipe front to back from birth to the end of the line!

Jwyck answered...

I was shocked to see this in a 2014 article on the JAMA Network site (Journal of the American Medical Association) and to see it repeated on other reputable medical sites: "Asymptomatic bacteriuria in older women should not be treated." This means doctors have determined (and are instructing other doctors) that urinary tract infections where bacteria is clearly present but where symptoms are not recognized or not reported should not be treated. Yet, we know that UTI symptoms in the elderly are often subjective and missed by caregivers. The result of this approach simply has to be that UTIs wait until the situation becomes a serious medical problem. As a 75-year old otherwise healthy woman, living independently, I too have a UTI. I wonder what my health care will be like in future in regard to UTIs. Do we women need to unite? Now? Before we are in our 80s and 90s and are subjected to this kind of care?

A fellow caregiver answered...

Jwyck...YES!! You are SO right. I am caretaker for my 93 yr old Mom...and I have had to fight and INSIST that additional Urine samples be taken after treatment ends...usu. 48 - 72 hrs. "We just don't do that if there are no symptoms" I've been told ad nauseum...and I explain that she does not even usually show symptoms...and it's harder to tell by behavior as dementia progresses. The bacteria may not be treated immediately, but usually, when she faints or gets the shakes -- when we KNOW there is bacteria and infection, it is usually severe. And THEN you have to wait for the sample ...and then the culture to come back. More precious days lost.

So I INSIST on another urine sample CULTURE...so I KNOW what bacteria are there --- even colonized --- which they love to spout ( and for good reason often)...so that I can act immediately. Now, I am trying more natural treatments(so very important to know which bacteria are lurking there) of d-mannose and wild oregano oil, and of course, a good probiotic (30-50 BILLION active strains of at least 8 - 10 different strains) to see if THIS will work, since antibiotics are making her weaker, and she is on her third bout of antibiotics, moving directly into ESBL...and after THAT treatment into VRE (both serious antibiotic resistant bacteria) ...with only ONE antibiotic left to treat it. Cranberry tabs(which contain d-mannose - rather than cranberry juice - which has sugar --- NOT something that any UTI victim should have!!) and several supplements are also being used. I have used the d-mannose and wild oregano oil along with the antibiotics...(lots of research done...some clinical trials and lots of anecdotal evidence of efficacy. I will NOT put my mom at risk--and have consulted her doctors. as well..none knows much..(don't have naturopaths around here)....but one has ok'd the usage and said he could see no harm that could be done with the naturopathics. I just need to watch her blood INR as she is on warfarin..(since wild oregano oil can thin blood) but her clinic is not concerned...we just watch it more often. There is lots of info out there...and poo=pooing anecdotal evidence is far too common. People are different..nothing works for everyone...but drug companies don't want scientific evidence...so we must search for ourselves...give heavy doses of caution to what is read online...weigh all drugs and treatments and condition of our loved ones...and proceed slowly. I am confident that this will only help my Mom...I am ready to accept it may not work...but it is certainly worth a try.And if not, I will try other natural antibiotics like Uva Ursi and garlic oil extracts, etc. And likely will rotate some of these, even if something works to avoid her body getting 'used' to anything in particular.

And the last nine days of treatment...not even giving a full dose shows improvement in her overall demeanor...so I am hopeful...but still hoping.

The REAL dangers of antibiotic overuse ..and the use of it in our soils and food chain is SO worrisome. We need to look beyond ..back to mother nature...from whence all drugs have come...But we must also be aware and careful that quality products and companies are utilized or things could be worse. Not all natural treatments are necessarily safe ...and can interact with drugs and even foods you eat. But mother nature packs her natural medications with more compounds that the body uses well...whereas drugs, including antibiotics, are simple components that superbugs find easy to 'outwit' and mutate beyond into even more harmful entities.

A fellow caregiver answered...

I am a woman of 65 years old and I have had UTI and a terrible pelvis pain in the last 4 years, It has been a very sad and very painful time for me , I have scanns fo the lower and upper Urinary system and other type of exams and apparently all Ok. What has helped me are the antibiotics that have been taking two daily doses of 500mg Cephlexin. and it works perfectly but I am worry about the long-term effects of the antibiotics. During this time I also used Ovestin 2 applications X week.

The urologist-gynecologist prescribed me Uvaxom for 6 months and only take 1 daily antibiotic and it was expected that after those 6 months everything would be fine but it was not so. Consulted my doctor and he recommended to use the Ovestin daily for 3 weeks and after that time come back to the application of 2 times per week. He did not told me but it's my body and I have to take care therefore after two weeks you get the Ovestin every day I stopped taking the antibiotics. I have 10 days now of not taking antibiotic and I'm completely fine. Could you tell me if Ovestin continuous use may increase the risk of cancer?

A fellow caregiver answered...

Having aging parents I want what is best for them.

My mom has been having reoccurring bladder infections. After several doctor visits, 2x failed antibiotic attempts, I decided to look more into over factors that cold cause this.

My mom & dad has been taking statins for several years now. They are having odd similar symptoms. In regards to this post, I have growing concerns that her recurring bladder infections may be a side effect of statin medicines.

Statins may increase risk of future diabetes. UTI can be a precursor sign of diabetes starting.

I told my mom to go to doctor and check her blood sugar levels on a more continual basis to rule that out. Waiting on results.

Info founded to support thesis: "Predisposition to urinary tract infections (UTIs) in diabetes mellitus results from several factors. Susceptibility increases with longer duration and greater severity of diabetes. [1] High urine glucose content and defective host immune factors predispose to infection. Hyperglycemia causes neutrophil dysfunction by increasing intracellular calcium levels and interfering with actin and, thus, diapedesis and phagocytosis. Vaginal candidiasis and vascular disease also play a role in recurrent infections."

In Taiwan study, " statins have immunomodulatory capabilities. Some studies have found that statins increase expressions of proinflammatory cytokines in immune cells, such as dendritic cells and macrophages. “Therefore, statin use may induce chronic inflammation in the bladder urothelium.”

Taiwan Longitudinal Health Insurance Database (LHID), Li-Hsuan Wang, MD, and colleagues at Taipei Medical University compared 815 female patients with BPS/IC and 4,075 randomly selected female controls. After adjusting for numerous co-morbidities and other confounders, regular and irregular statin use were associated with a significant 58% and 53% increased odds of BPS/IC, respectively, the researchers reported in Urologia Internationalis (2015;95:227-232).

Pharmaceuticals make a lot of money selling medicines. Their studies are often self funded. So, they can be bias. The doctors are doing their best to help, however it takes time for the side effects to show up years later to come to the realization it was the medicine causing more problems.

So, when taking any medicine be careful. Read the side effects before taking. Keep a daily self health journal for several months of any new symptoms or changes that may occur. No matter if it is a small symptom or not. If you start having more weird symptoms after taking a medicine then suspect it may be the medicine and your body is reacting.

Be your own advocate & take control of what you ingest. Study what you take. Read studies and learn why some elderly have no symptoms in other countries. What medicines do they take or not. What foods do they eat or not. It's worth your health to take the time to research.

Eat well. Check your ph levels. Avoid sugars which cause inflammation. Stay positive.