Could You Have a UTI and Not Know It?
The signs and symptoms to watch out for
Urinary tract infections are common, and the risk generally increases with age. They happen when bacteria infect your urethra, bladder, or other organs in your urinary tract. In older people, UTIs might not cause the telltale burning, so they can be easy to miss. But left untreated, a UTI can be serious, spreading to the kidneys or bloodstream and even causing unexpected symptoms like lethargy, fever, or confusion.
Some people—especially older ones—have bacteria in their urine but don’t have any symptoms, says Michelle Yu, MD, an assistant professor of urologic oncology at the University of Pittsburgh School of Medicine. In older men, an enlarged prostate can cause urine to sit in the bladder, giving bacteria time to replicate. In older women, declining estrogen levels can thin the vaginal wall, making it easier for bacteria to spread to the urinary tract.
Here’s how to tell whether you have a UTI, and what treatment makes sense.
Signs of a UTI
Classic signs of a UTI include frequent urination and a burning feeling when you go. It’s also common for older people to experience lower abdominal pain, blood in the urine, or new-onset incontinence. Low-grade fevers and smelly or cloudy urine can also occur. If the infection advances to the kidneys or the bloodstream, that can lead to changes in mental status, including symptoms that resemble dementia.
If your doctor thinks your symptoms suggest a UTI, they might do a few tests to confirm it. Dipstick tests, which quickly check for bacteria in a urine sample, can be a good first step. But they’re often inaccurate because they’re easily contaminated with bacteria from outside the urinary tract, Yu says. Plus, the naturally higher bacteria levels found in the urine of some older people can cause false positives.
The Right Treatment
A urine culture can be a helpful additional step, says Ronan Factora, MD, a geriatrician at the Cleveland Clinic. That can confirm an infection and identify the type of bacteria causing it, which can help a doctor assess what kind of antibiotics it’s sensitive to, Yu says.
How to Prevent a UTI
Lifestyle tweaks can help prevent UTIs from developing. As a rule, you should be urinating every 4 to 6 hours during the day to empty your bladder. “Urine in the bladder is a good medium for bacteria to grow in, like stagnant water,” Ayoub says. And drinking plenty of fluids—aim for 50 to 70 ounces per day, Yu says—can keep urine from being too concentrated. That can prevent bacteria from adhering to your bladder wall.
Hygiene also plays a role in prevention, according to Ronan Factora, MD. After a bowel movement, always wipe from front to back to avoid spreading bacteria. Put on new underwear every day, and if you use disposable undergarments, change those whenever they’re soiled.
If you have recurrent UTIs, your doctor may recommend other treatments to prevent them, such as topical estrogen cream to thicken your vaginal wall or medications for urinary retention.
Editor’s Note: This article also appeared in the June 2024 issue of Consumer Reports On Health.
