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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 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.

What is urinary tract?

There are two kidneys - one on each side of the abdomen. They make urine which drains down the ureters into the bladder. Urine is stored in the bladder and is passed out through 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 bacteria (germs) 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 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.

Are urinary infections common?

About 3 in 100 men in there 60s, and about 1 in 10 men in there 80s, will have a urine infection.

Urine infection is much more common in women. This is because their urethra is shorter and opens nearer the 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 are some people prone to 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. Bacteria are more likely to multiply and cause infection in a stagnant pool of urine.

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.

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.

How does urinary infection present?

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 abdomen, your urine may become cloudy, bloody or offensive-smelling and you may have a fever (high temperature).

Infection in the kidneys may cause a pain in a loin (the side of the abdomen over your kidney), a high fever, feeling 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 being dehydrated. The confusion should pass when the infection has been treated.

Do you require any tests?

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 antibiotics, 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).

How do you treat urine infection in older people?

A course of an antibiotic 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 fever.

An underlying cause such as an enlarged prostate or constipation may be found and need treatment.

NB: If you have 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 dehydration.

What is the outlook?

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 then you may need an alternative antibiotic. This is because some bacteria are resistant to some types of antibiotics. This can be identified from tests done on your urine sample.

How can you 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, wiping from the front towards the back passage is best. If you start near the back passage, you may accidentally bring bacteria closer to the urethra and 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

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