Urine Infection in Older People

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Having a urine infection can be a common problem when you are older. There may be underlying health problems that are responsible. Urine infections are usually easily treated with a course of a medicine called an antibiotic. Once cleared with treatment, in most cases there are no long-term problems following a urine infection. There are some simple steps you can take to help prevent a urine infection.

There are two kidneys - one on each side of the tummy (abdomen). They make urine which drains down tubes called ureters into the bladder. Urine is stored in the bladder and is passed out through a tube from the bladder (called the urethra) from time to time when we go to the toilet. 

Male genitals and urinary tract
Side view of female genitals and cross-section diagram of urinary tract

Most urine infections are caused by germs (bacteria) that come from your own bowel. They cause no harm in your bowel but can cause infection if they get into other parts of your body. Some bacteria lie around your back passage (anus) after you pass a stool (faeces). These bacteria sometimes travel to the tube from the bladder that passes out urine (the urethra) and into your bladder. Some bacteria thrive in urine and multiply quickly to cause infection.

A urine infection is often called a urinary tract infection (UTI) by doctors. When the infection is just in the bladder and urethra, this is called a lower UTI. If it travels up to affect one or both kidneys as well then it is called an upper UTI. This can be more serious than lower UTIs, as the kidneys can be damaged by the infection.

Urine infections are much more common in women. This is because in women the tube from the bladder that passes out urine (the urethra) is shorter. Also it opens nearer the back passage (anus) than in men. Half of all women will have a urine infection that needs treating in their lifetime.

Urine infections are less common in men. They are very uncommon in young and middle-aged men. They are more common in older men. They are more likely to occur in men who have to use a catheter. A catheter is a thin, flexible, hollow tube used to drain urine.

Urine infections tend to become more common as you get older.

In many cases the infection occurs for no apparent reason. There is no problem with the bladder, kidney, prostate, or defence (immune) system that can be identified. In other cases, an underlying problem can increase the risk of developing a urine infection.

In older women

In older men

In either

  • Bladder or kidney problems may lead to infections being more likely. For example, kidney stones or conditions that cause urine to pool and not drain properly.
  • Having a thin, flexible, hollow tube, called a catheter, in place to drain urine.
  • An underlying health condition may also be responsible. A poor immune system increases the risk of having any infection, including urine infections. For example, if you are having chemotherapy to treat cancer. Diabetes can also increase your risk of having urine infections.
  • Being constipated. If your lower gut (bowel) is full and swollen, it may press on the bladder. This may stop it emptying properly, making you more prone to urine infection.
  • Infection in the bladder (cystitis) usually causes pain when you pass urine. You pass urine more frequently. You may also have pain in your lower tummy (abdomen). Your urine may become cloudy, bloody or offensive-smelling. You may have a high temperature (fever).
  • Infection in the kidneys may cause you to feel generally unwell. There may be a pain in your back. This is usually around the side of the back (the loin), where each kidney is located. You may have a high fever. You may feel sick, or be sick (vomit).

In some older people the only symptoms of the urine infection may be a recent onset of confusion or just feeling generally unwell. The confusion is caused by a combination of factors such as having a fever and having a lack of fluid in the body (dehydration). The confusion should pass when the infection has been treated.

In some cases the diagnosis may be obvious and no tests are needed. A test on a urine sample can confirm the diagnosis and identify what germ (bacterium) is causing the infection. Sometimes a "dipstick" test can provide enough information immediately. In other cases the urine sample is sent to a laboratory for further examination under a microscope. This result takes several days.

Further tests are not usually necessary if you are otherwise well and have a one-off infection. However, your doctor may advise tests of your kidney, prostate, or bladder if an underlying problem is suspected.

An underlying problem is more likely if the infection does not clear with antibiotic medication, or if you have:

  • Symptoms that suggest a kidney is infected (and not just the bladder).
  • Recurring urine infections (for example, two or more episodes in a three-month period).
  • Had problems with your kidney in the past, such as kidney stones or a damaged kidney.
  • Symptoms that suggest an obstruction to the flow of urine.

Relevant tests may include:

  • A course of an antibiotic medicine will usually clear the infection quickly. You should see a doctor if your symptoms are not gone, or nearly gone, after a few days.
  • Paracetamol or ibuprofen will usually ease any pain, discomfort, or high temperature (fever).
  • An underlying cause such as an enlarged prostate or constipation may be found and need treatment.

NB: If you have an infection of your bladder (cystitis) then having plenty to drink is traditional advice to flush out the bladder. However, there is no proof that this is helpful when you have cystitis. Some doctors feel that it does not help and drinking lots may just cause more (painful) toilet trips. Therefore, it is difficult to give confident advice on whether to drink lots or just to drink normally when you have mild symptoms of cystitis. However, if you have a high temperature (fever) and/or feel unwell, having plenty to drink helps to prevent having a lack of fluid in your body (dehydration).

Most people improve within a few days of starting treatment. See a doctor if you do not quickly improve. If your symptoms do not improve despite taking an antibiotic medicine then you may need an alternative antibiotic. This is because some germs (bacteria) are resistant to some types of antibiotics. This can be identified from tests done on your urine sample.

Unfortunately there are few proven ways to prevent urine infections. No evidence has been found for traditional advice given, such as drinking cranberry juice or the way you wipe yourself.

There are some measures which may help in some cases.

  • It makes sense to avoid constipation, by eating plenty of fibre (such as fruit) and drinking enough fluid.
  • Older women with atrophic vaginitis may wish to consider hormone replacement creams or pessaries. These have been shown to help prevent urine infections.
  • If there is an underlying medical problem, treatment for this may stop urine infections occurring.
  • For some people with recurring urine infections, a low dose of antibiotic taken continuously may be prescribed.
Original Author:
Dr Hayley Willacy
Current Version:
Peer Reviewer:
Dr Laurence Knott
Document ID:
13770 (v3)
Last Checked:
Next Review:
The Information Standard - certified member
Now read about Lower Urinary Tract Symptoms in Women

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