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I spy a UTI

It’s not the easiest of subjects, but understanding the symptoms of a Urinary Tract Infection is crucial to keeping healthy, especially as we age.

A Urinary Tract Infection (UTI) is a growth of bacteria somewhere in the urinary tract, which travels along the urethra where the urine comes out, to the kidneys where the urine is formed. Generally speaking, it’s the result of an infection in the bladder and, if left untreated, can do some serious damage.

Not to be taken lightly, a UTI could lead to urosepsis, a potentially life-threatening infection of the bloodstream, or acute or chronic kidney infections, which are capable of permanently damaging these vital organs or cause kidney failure.

“A UTI can be very common particularly in older people, both men and women, because they don’t always empty their bladder fully each time they pass urine. Urine is a great breeding ground for organisms,” explains Professor Susan Kurrle, a geriatrician based in Sydney.

Some other conditions that make older individuals more susceptible to UTIs include:

  • Diabetes
  • Urine retention
  • Use of a urinary catheter
  • Bowel incontinence
  • Urinary incontinence
  • Enlarged prostate
  • Immobility
  • Surgery around the bladder
  • Kidney stones

Even a weak immune system or
a lack of strength in the bladder muscles and pelvic floor can place seniors at risk of infection. What’s more, some do not or cannot express their discomfort to their caregivers, so the more serious symptoms, such as delirium, are often mistaken for the early stages of dementia, Alzheimer’s disease, or stroke.

Putting the pieces together

With that in mind, diagnosing a UTI in seniors isn’t always a straightforward process, says Dr John Obeid a geriatrician from the Specialist Services Medical Group at Norwest Private Hospital.

“A urinary tract infection is more than just the finding of bugs in the urine. Older people often have an overgrowth of bacteria in the bladder to begin with, so to diagnose a UTI

it has to be accompanied by other symptoms. Whether the symptoms are the ‘classic’ UTI indicators, such as burning as one passes urine, frequency and urgency of urination and a new onset of urinary incontinence, or whether they’re other types

of symptoms that are more commonly associated with frailty,” explains Dr Obeid.

“If someone has, for example, dementia or Parkinson’s Disease, or other disorders of the brain, they might not have the ‘classic’ symptoms. They might present instead with acute delirium or confusion, hallucinations, reduced level of consciousness or with a fall.”

Professor Kurrle agrees, adding that the most common symptom of a bladder infection, in older women particularly, is confusion, the second being falling.

“Anyone who’s had a bladder infection will know the burning and the frequency of urination is really significant. You can’t miss it. But
in older people you don’t see those symptoms as much,” she says.

“This is because as we age, we
lose our ability to adapt and we become more vulnerable to any insult, it’s called homeostasis. A high temperature will immediately make an older person delirious, whereas a young person might respond with a drop or rise in blood pressure.”

While these types of severe symptoms (such as delirium or falls) can, of course, be associated with other illnesses, such as pneumonia or even dehydration, it’s important to also identify the classic UTI symptoms (if present) in order
to make a diagnosis. Failure to recognise a UTI, says Obeid, could in fact put your life at risk.

“You can die from a UTI. So make sure either yourself, or your caregiver, raises all your symptoms with your health professional to put you in the best position possible for an accurate diagnosis.”

Once a patient presents with a variety of UTI symptoms, typical next steps include an examination of the abdomen, looking for any tenderness present, followed by sending a urine culture off to the laboratory to look for any bacteria growth and to identify the bug, which is most commonly E. coli. If all the pieces put together point to an infection in the bladder, then you could confidently diagnose a UTI.

Where to from here?

Treatment depends on the level of severity of the UTI, as well as the general wellbeing of the patient.

Typically, if delirium is present you’d be admitted to hospital to help manage the symptoms and antibiotics are administered intravenously over three to seven days. However, it’s important to note this can also be conducted at home as long as there’s a carer present, to avoid drawn out hospital stays where possible.

Otherwise, more often than not antibiotics taken orally at home will do the trick.

“But if the bugs manage to break out of the bladder and begin circulating around the blood system, that’s when a person can become extremely unwell and the condition can become life threatening,” says Obeid.

The best thing you can do is take steps to prevent a UTI from arising in the first place. Simple things like increasing your level of hydration to increase the urine flow and help naturally flush out the bacteria could be all that’s needed to keep it at bay. Otherwise, both Obeid and Kurrle recommend using over-the-counter medications, such as Ural, to help reduce the irritation caused by a UTI.

“Hydration really is key, and that’s a constant problem with older people because they lose their sense of thirst and are relatively dehydrated a lot of the time as a result. They doubly won’t drink because they think it will make them have to urinate more, when in actual fact if you have plenty of dilute urine in the bladder you can actually hold more because it doesn’t irritate the bladder in the same way until it stretches to a larger amount,” says Kurrle.

“In men, sometimes UTIs are indicative of prostate problems, so any man who does experience these symptoms regularly should see their GP to check for signs of prostate disease,” adds Obeid.

What are the symptoms?

Typical UTI symptoms include:

  • Dark or cloudy urine
  • Bloody urine
  • Strong or foul-smelling urine
  • Feeling pain or a burning sensation during urination
  • Needing to urinate frequently or urgently
  • Pressure in the lower pelvis
  • Low-grade fever
  • Night sweats or chills

Some lesser-known symptoms include:

  • Confusion or delirium 

    • High-grade fever
    • Agitation
    • Hallucinations
    • Poor motor skills or loss of coordination
    • Dizziness
    • Falling

Remember, these are often the only symptoms that present in older people, so it’s crucial to keep an eye out for any sudden changes in behaviour and mental state.

How to prevent UTIs

Urinary Tract Infections are more than a nuisance – they can lead to serious health problems. Reduce your risk of infection by following these simple preventative steps:

  • Drink water, and plenty of it – up to two to four litres a day. (People with heart problems should seek advice from their doctor about whether it is safe to drink this amount of water).
  • Drink cranberry juice or use cranberry tablets – but this isn’t recommended if you have a personal or family history of kidney stones.
  • Caffeine and alcohol can irritate the bladder, avoid or limit your intake where possible.
  • When bathing, don’t douche or use other feminine hygiene products.
  • Change your underwear at least once a day, and stick to breathable cotton if possible.