It is important to detect and treat urinary tract infection early to prevent it from escalating into something more serious
By DR LOO SAY YEE
By ASSOC PROF DR TAN TOH LEONG
Mrs M is an 85-year-old female who stays in a nursing home. She has dementia and diabetes.
She has been bed bound for two years ago due to a broken right hip. Mrs M has urinary incontinence and was diagnosed with frequent urinary tract infection (UTI), about two to three times yearly.
What is UTI?
UTI occurs when the germs from our skin around the groin, enter our urinary tract via the urethra, which is the tube that allows urine to pass out from our body connected to bladder and kidney. UTI can be quite uncomfortable, even among the younger people.
According to studies, one in three women experience UTI, compared to one in 20 men. The frequency increases with age, which means that older people are at higher risk of getting UTI. Recurrent UTIs mean having three or more episodes in a year or two or more episodes in six months. Further investigation is needed to find out the cause.
Why does it occur more often among the elderly?
In general, the elderly have lower immunity towards infection. Poor health conditions, diabetes or having a stone in the urinary tract increases the chance. Women’ urethras are shorter compared to men, therefore it is easier for the germs that travel to the bladder.
As we get older, the lining of the urethra and bladder become thinner, especially amongst the post-menopausal women. Sometimes, dry skin around the vagina or involuntary leakage of urine may worsen the condition.
For older men, an enlarged prostate is a common risk. Due to partial blockage of urination, urine usually pools in the bladder for longer time. This will attract the germs to grow in the bladder. Sometimes, a catheter is needed to drain the urine but this itself also increases the chance of infection.
How do we know if we have UTI?
UTI usually causes burning pain on urination and frequent urination. It can be quite tricky for older adults to tell us if they are having UTI as the presentation may not be obvious or they may be demented like Mrs M. So, what are the warning signs for us to know if older adults are having UTI?
The elderly may appear to be confused, tired, sleeping more than usual or having frequent falls. Some may have fever with nausea and vomiting, pain over the lower part of the tummy or back.
These are signs of early sepsis. Having urinary incontinence, smelly and cloudy urine (or with blood), frequent small amounts or with a great need to go to the toilet for urination are also common complaints.
How to treat UTIs
Once UTI is suspected, we need to get treatment from the doctor. A good course of antibiotics will usually treat the problem. However, if there is recurrent UTIs or more complicated issues are found, further investigation and treating the underlying cause is needed.
Preventing UTI in older adults
There are many simple ways we can keep UTI away. Having good personal hygiene is important. For ladies, after urination or having a bowel action, we should wipe from front to back to prevent the spreading of bacteria from the anus.
Wearing cotton underwear also helps. Other natural ways to help prevent UTI include drinking enough water (at least 2 L/day) to help with flushing of the urinary tract, cranberry juice and lactobacillus containing yogurt.
Finally, the take home message is: UTIs are common in older adults. Keeping the genital areas clean helps prevent UTI.
Always remember to wipe from front to back after urination or bowel action. And seek treatment early if UTI occurs. — The Health
Dr Loo Say Yee is a Trainee Lecturer in Family Medicine, Faculty of Medicine, UKM and a Committee Member of Malaysian Sepsis Alliance (MySepsis) while Associate Professor Dr Tan Toh Leong is a Senior Lecturer and Consultant Emergency Physician at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) and President and Founder of MySepsis.