DEAR DOCTOR K:
I am a woman in my 80s. I went to my doctor because I suddenly developed back pain. It turned out to be a urinary tract infection that had spread to my kidneys. Why didn’t I have any other, earlier symptoms?
If you had urinary tract infections (UTIs) when you were younger, you probably remember the burning, pain and intense urge to urinate frequently. But these symptoms don’t always appear in older adults.
UTIs commonly occur when bacteria from the rectum (such as E. coli) infect the skin around the opening of the urethra (the tube leading to the bladder). From there, the bacteria can work their way up to the bladder or kidneys. (I’ve put an illustration of this below.)
A sharp drop in estrogen levels after menopause encourages bacteria to grow near the urethra. This increases the tendency of older women to get UTIs.
UTIs may also occur when urine pools in the bladder. This is more often a problem in older men than in older women. For example, an enlarged prostate gland can slow the outflow of urine and cause it to build up in the bladder. In older women (and men), pooling of urine in the bladder may be caused by problems with the aging of nerves that cause the bladder to empty. Whatever the cause, pooling of urine in the bladder creates an ideal setting for bacteria to grow.
It’s not clear why an older person wouldn’t experience the same symptoms as someone younger. It may be because UTI symptoms are caused by the immune system’s fight against the infection. And the immune systems of older people may not fight as fiercely.
Another possibility is that conditions that affect the brain — such as stroke, Parkinson’s disease and dementia — affect the brain’s ability to feel or describe pain. And, just as aging nerves may make the bladder less efficient in passing urine, those nerves also may not feel pain as effectively as they once did.
UTIs produce subtle signs even when common symptoms don’t occur. For example, an older person may experience confusion or agitation, fatigue and loss of appetite. Other signs may include cloudy and foul-smelling urine, abnormal urine color or blood in the urine. Back pain may be a sign that the infection has spread to the kidneys.
UTIs should be treated with antibiotics. Left untreated, a UTI may spread to the kidneys and then cause a potentially fatal infection in the bloodstream.
To reduce your chances of developing another UTI, drink more fluids, which help wash away bacteria. Also, empty your bladder as soon as you have an urge to do so. You should also empty your bladder after sex, to flush out bacteria.
If you have frequent UTIs, consider using a vaginal estrogen cream. The estrogen will help discourage the growth of bacteria near the urethra. A low dose of certain antibiotics, taken every day for several months, can also help prevent future UTIs.
Urinary tract infection
A urinary tract infection (UTI) occurs when bacteria travel up a woman’s urethra and into the bladder, ureters, and/or kidneys. Most UTIs are caused by bowel bacteria, such as E. coli.