Urinary tract infections, or UTIs, are more than a painful medical condition. Left untreated, these infections can spread through the body. The leading cause of sepsis, an untreated UTI can ultimately result in death. For caregivers of elderly patients, learning how to recognize a UTI can be tricky as the symptoms are varied. Fortunately, there are three easy ways to avoid the onset of the infection to begin with.

What is a UTI?

A urinary tract infection (UTI) is the most common type of infection in older adults, and it occurs when bacteria are able to get into the urethra and travel to the bladder. Anywhere along this path, bacteria can grow and cause a series of health issues, including pain and possibly dementia symptoms. An infection can occur in any part of the urinary tract, and is detectable by testing urine for trace amounts of protein and blood that could be harboring bacteria. UTIs are very common- it is estimated that 60% of adult women will have a UTI at some point. Unfortunately, up to a third of these women will have more UTIs in the future. Luckily, there are steps one can take to help our bodies fight and prevent UTIs.

What Causes a UTI?

A UTI occurs when bacteria, usually from either the anus, kidney stones, or from backed-up urine, is trapped in the urethra and allowed to grow. Research tells us that there are various causes for UTIs and urinary infections (UI), and causes tend to change as we grow older. For example, in older women, a decrease in estrogen can lead to UTIs. Other factors that contribute to UTIs and UIs include:

• Living in an environment with someone that has a yeast infection or UTI

• Wearing incontinence supplies for an extended time

• Sexual activity, especially unprotected sex that can expose you to bacteria and STDs

• Kidney stones or other issues affecting the urethra, trapping urine and bacteria

UTI Symptoms

A UTI has many symptoms, but the most common indication of a bladder infection is pain in the genital region, especially burning type sensations during urination, in addition to a more frequent need to use the bathroom. Less obvious symptoms include:

• Lower back pain

• Feeling the urge to pee but being unable to

• Impaired ability to complete one’s own daily tasks like getting dressed alone and bathing

• Weakened memory and ability to reason, or worsening dementia symptoms leading to delirium

• Loss of appetite

• Changes in sleeping pattern, an indication that the brain is being affected by the UTI

• Blood in the urine

• Cloudy or foul-smelling urine

In older age, symptoms of a UTI may not be so evident, especially in the case of those living with cognitive decline such as in the case of Alzheimer’s disease. Cognitive impairments can lead to an inability to notice certain symptoms, such as pain, agitation, and appetite loss, or one may attribute these symptoms to dementia itself. When dementia is already present, a person’s symptoms can quickly escalate, causing extreme confusion and a state of delirium. Caregivers of those with dementia need to be aware that worsening symptoms of confusion and disorientation can indicate a UTI.

It is more common, however, for a UTI to be over-diagnosed than under-diagnosed, and research shows that it is increasingly common for an STD to be misdiagnosed as and treated as a UTI. Elderly women often remain sexually active, and are at risk for a UTI through sexual contact with somebody with an STD, as well as the act of having sex which can introduce a variety of other UTI-causing bacteria into the urethra.

3 Ways to Prevent a UTI

Antibiotics and natural medicines are available to help clear up UTIs, but there are preventative measures you can take to help ensure your body is able to stave off infections that tend to occur through the normal course of life. Read on to see three ways we’ve discovered through careful research to help prevent urinary tract infections in older women.

Estrogen Replacement

One of the most widely known symptoms of aging in women is menopause, where the hormones in other body shift and estrogen is no longer created as it was before. According to researchers, around half of menopausal women will have symptoms of lowered estrogen in the genital region, including dryness and irritation. Not only is this incredibly uncomfortable, but UTIs are able to take advantage of the vulnerable area and take hold as a result of this irritation. The good news is, there are a few ways to combat lowered estrogen in menopause. 

Estrogen cream has been shown through extensive studies to promote a healthy environment that is not preferable for e. Coli to grow and cause a UTI. Estrogen supplements are also available to help regulate post-menopausal hormones, available in pill form, as a plant-based supplement, a long-term estrogen releasing ring (Estring) that is placed in the vagina, and in vaginal suppository form. Research has shown these supplements to be effective, but they can increase the risk of cardiac events as well as certain cancers, so be sure to speak with your doctor about all the possible side effects and risks of taking estrogen.

Natural estrogen sources, called phytoestrogens, are forms of the hormone found in certain plants. These are a weaker version of estrogen supplements you would get from the doctor, but it is still advised to speak with your healthcare team before taking any supplements. An excess in estrogen can cause an ailment called estrogen toxicity. 

 Common foods that are high in estrogen include:

• Soybeans have the highest amount of phytoestrogen out of this list, so use with caution- too much soy can easily build up and cause estrogen toxicity and increased cancer risk

• Flax, which is also high in fiber and a great addition to any diet, is shown to have similar levels of estrogen as soybeans

• Garlic contains a moderate amount of phytoestrogen as well as helpful antioxidants and has been recorded to contain antibacterial, antimicrobial, and antifungal properties, helping destroy many forms of UTI-causing germs. A word of caution about garlic- extensive use of raw garlic juice can be very harmful to skin tissue, and can cause burns.

• Alfalfa sprouts contain high levels of phytoestrogen, as well as UTI-fighting vitamin C

• Hummus is made from chickpeas, which are rich in phytoestrogen

Careful Cleaning

When caring for an elderly patient, be sure that the perineal area is being cleansed properly. Women should always wipe themselves from the front to the back. If you are tending to perineal care, take steps to ensure that you always wipe your patient starting in front of the urethra and wiping towards the anus. Before wiping the area again, fold the rag to a clean section. 

The idea is that residue from the anus should never be dragged toward or against the urethra. Patients that wear adult diapers, or briefs, should be changed on a regular basis. They should be checked every two hours or so and they should never be allowed to sit in dirty briefs for prolonged periods. Your patient should also be wiped and cleansed after every brief change and bowel movement. Douches should never be used, as they are far more likely to spread around and push bacteria further into the body than to remove any bacteria from the area.

Stay Hydrated

The kidneys and the bladder are organs that are highly sensitive to the fluids we consume, and one of the best preventative measures we can take to keep them healthy is to drink plenty of water. It is recommended by the Mayo Clinic to drink at least six 8-ounce glasses of water a day to prevent bladder infections such as a UTI, because frequent urination helps keep bacteria flushed out of the urinary tracy.

Questions regarding the validity into the old wives tale about drinking cranberry juice to stave off UTIs have been unanswered so far, but it is known that compounds in cranberries destroy e. Coli bacteria, the cause of 90% of UTIs. But, researchers aren’t exactly sure how cranberries kill e. Coli. Cranberry juice can be a great alternative to water if you are concerned about UTIs, but it is important to remember that juice cocktails can be full of sugar and artificial sweeteners that may cause more harm than good. Cranberry supplement tablets are available to provide the health benefits of cranberries without burdening the digestive system with too many unhealthy products like sugar. Other foods that have shown promise in fighting UTIs include blueberries and foods high in probiotics, and vitamin C. 

UTI Treatment

It is not only uncomfortable, even painful, to have a urinary tract infection- if left untreated it can become a serious health risk. While sometimes a UTI will clear up on its own, there is a risk that the infection can spread to your kidneys, which will sustain permanent damage, and can create a condition called urosepsis, a blood infection that can travel quickly throughout the body and causes a third of all sepsis-related deaths worldwide.

If you are one of the millions of women that suffer from urinary tract infections, often recurring, don’t worry- there are many options to try that can clear up the bacteria causing the infection, as well as relieve your painful symptoms. In addition to antibiotics, there are synthetic and natural estrogen therapies, over-the-counter medications, and lifestyle changes we can make to ease the symptoms of a UTI and prevent future flare ups. Read about the most common treatments for a UTI:

• Antibiotics are the most effective treatment for a bacterial infection like a UTI, with a cure rate of up to 96% in elderly women. There is a risk of symptoms of delirium increasing with antibiotic use. 

• Estrogen replacement therapy, which has been shown to prevent recurring UTIs by regulating the environment in the bladder and genital region. This type of treatment is typically appropriate for elderly women, but those with cancer concerns, blablabla may not be good candidates for hormone therapy.

• Over-the-counter medication is available that can stop the uncomfortable symptoms of a UTI, well before the doctor prescribed antibiotics would work. 

• Natural treatments have not been approved by the FDA, but have been used for centuries across the globe, including coconut oil, vitamin E, and essential oils. Users of coconut oil report that the moisturizer helps relieve symptoms as well as serve as a preventative measure, with its antibacterial and antimicrobial properties. Many essential oils, such as lavender or myrrh, contain soothing and antibacterial agents, as well as other helpful properties. 

• Preventative measures such as taking cranberry supplements, drinking plenty of water, and maintaining a clean genital region and strong pelvic floor are recommended to ease symptoms as well as prevent future UTIs. 

Whether you are currently experiencing a UTI, or have a loved one who needs help controlling their infection, preventing a UTI can be handled at home. If you think you or a loved one are suffering from a UTI, you can easily test for bacteria in your urine with an at-home dipstick test, and save yourself a costly doctor’s appointment. The at-home test strips are easy to use, taking two minutes to provide you with an accurate reading. If you have a Health Savings Account (HSA) or Flexible Health Savings Account (FHA), this product does qualify for reimbursement.

If you do decide to test yourself at home and find you have positive results for bacteria that could be causing a UTI, the best course of action is to visit your primary doctor to determine the best medicine for you. Most times, antibiotics are the best treatment. Depending on your personal situation, such as your current medications and health factors, you may or may not need antibiotics, estrogen therapy, or some other form of treatment. Your doctor will be able to help you determine what will work best for you.