UTIs don’t have to be a recurring issue. With the right knowledge and preventative measures, people can significantly reduce their risk and protect their health.

Urinary tract infections (UTIs) are among the most common bacterial infections, affecting millions each year. Older adults and individuals who use urinary catheters are at particularly high risk—not only of infection but also of serious complications, such as kidney infections or sepsis, if left untreated. In these groups, symptoms may be atypical or masked by other conditions, often leading to delayed diagnosis.

Fortunately, UTIs are both preventable and treatable. By understanding the causes, recognising early signs, and adopting simple prevention strategies, individuals can reduce their chances of infection and avoid potential complications. This article explores the key facts about UTIs and how they can be managed for better urinary health and overall wellbeing.

What are UTIs?

Urinary Tract Infections (UTIs) occur when bacteria—most commonly Escherichia coli (E. coli)—enter the urinary system through the urethra and multiply. The infection can affect any part of the urinary tract, including the kidneys, ureters, bladder, and urethra.

UTIs are generally classified into two types:

Lower UTIs (Cystitis): Affect the bladder and are the most common. Symptoms include frequent urination, burning or pain during urination, and cloudy or strong-smelling urine
Upper UTIs (Pyelonephritis): Involve the kidneys and are more serious. Symptoms may include high fever, chills, back or side pain, nausea, and vomiting. If untreated, they can lead to kidney damage or sepsis

Most UTIs affect the bladder (lower UTI) and cause symptoms such as:

Pain or Burning During Urination: A sharp or stinging sensation when you urinate
Frequent Urge to Urinate: Feeling the need to urinate often, even if little or no urine comes out
Cloudy, Bloody, or Strong-Smelling Urine: Changes in the appearance or smell of your urine
Pelvic or Lower Abdominal Pain: A feeling of pressure or cramping in the lower belly
Fatigue or Feeling Unwell: A general sense of tiredness or discomfort

If the infection spreads to the kidneys (upper UTI), symptoms can become more severe and may include:

High fever and chills
Nausea or vomiting
Pain in the back or sides (flank pain)

UTI Symptoms Specific to Older Adults

Older adults may not always have the typical symptoms of a UTI. Instead, they may experience:

Confusion or Delirium: Sudden changes in mental state, such as confusion, agitation, or unusual behaviour
Fatigue or Weakness: Feeling unusually tired or lacking energy
Loss of Appetite: Not feeling hungry or eating less than usual
Incontinence: Sudden or worsening loss of bladder control
Low-Grade Fever or No Fever: Older adults may not develop a high fever even with an infection

These symptoms can be mistaken for other conditions such as dementia or aging, so it’s important to consider a UTI as a possible cause.

UTI Symptoms Specific to Urinary Catheter Users

For people who use urinary catheters, UTIs can be more difficult to detect, as some symptoms may not be as obvious. Key signs to watch for include:

Pain or Discomfort: Around the catheter site or in the lower abdomen
Changes in Urine: Cloudy, bloody, or foul-smelling urine, or visible particles in the urine bag
Leakage or Spasms: Increased bladder spasms or urine leaking around the catheter
Feeling Unwell: General fatigue or a sense of malaise without an obvious cause

Early detection and treatment are essential to prevent serious complications like kidney damage or sepsis. If any of these symptoms are present, it’s important to consult a healthcare professional as soon as possible.

Urinary catheters increase the risk of infection by providing a direct route for bacteria to enter the urinary tract. Even with proper hygiene, the longer a catheter is in place, the higher the risk of bacterial colonisation.

Studies show that 10-50% of patients with indwelling catheters for more than 7 days develop a catheter-associated urinary tract infection (CAUTI). Additionally, improper catheter care—such as inadequate handwashing, poor cleaning of the catheter site, or using contaminated equipment—can further raise the risk.

UTI Risk Factors

While UTIs can affect anyone, they are more common in women, older adults, and people using urinary catheters. Residents in aged care facilities are particularly at high risk. According to research from the Australian Commission on Safety and Quality in Health Care (ACSQHC), up to 50% of women and 30% of men over 65 experiences at least one UTI each year.

Several factors increase the likelihood of developing a UTI, especially among older adults and those with existing health conditions:

Anatomy: Women are more prone to UTIs due to a shorter urethra and its proximity to the anus, making it easier for bacteria to enter the urinary tract
Incomplete Bladder Emptying: Retained urine in the bladder, common in older adults, creates an environment where bacteria can thrive
Dehydration: Insufficient fluid intake reduces urination, allowing bacteria to remain in the urinary tract longer
Urinary Catheters: Catheters can introduce bacteria into the urinary tract, particularly affecting older adults, whose immune systems may be weakened
Chronic Health Conditions: Conditions like diabetes, kidney stones, and an enlarged prostate (in men) can increase UTI risk. For example, diabetes can impair immune function and increase sugar levels in urine, encouraging bacterial growth
Hormonal Changes: Postmenopausal women experience reduced oestrogen levels, weakening the urinary tract’s natural defences
Immune System Decline: Age-related immune system changes make it harder for the body to fight infections, including UTIs
Hospitalisation or Institutional Care: Older adults in hospitals or aged care facilities are more likely to encounter antibiotic-resistant bacteria, raising the risk of infection

Prevention of UTIs

It goes without saying that preventing UTIs is important, especially for older adults and catheter users. While some risk factors, such as age or the need for a catheter, cannot be changed, there are many practical steps you can take to significantly reduce your risk.

By adopting good hygiene practices, making lifestyle adjustments, and following medical advice, you can protect your urinary health and avoid the discomfort and complications of UTIs.

General Prevention Tips

These strategies can help reduce the risk of UTIs for everyone:

Stay Hydrated: Drink plenty of fluids, especially water, to help flush bacteria out of the urinary tract. Aim for 6-8 glasses of water per day, unless otherwise advised by your doctor.
Practice Good Hygiene: Always wipe from front to back after using the toilet to prevent bacteria from the anal area from spreading to the urethra. Wash the genital area daily with mild soap and water. Avoid harsh or scented products that can irritate the skin.
Urinate Frequently: Don’t hold in urine for long periods. Empty your bladder completely each time you urinate to prevent bacteria from growing.
Avoid Irritants: Limit the use of products that can irritate the urinary tract, such as caffeine, alcohol, and spicy foods.

For Older Adults

Take these additional steps to reduce the risk of UTIs:

Manage Chronic Conditions: Keep conditions like diabetes, kidney stones, or an enlarged prostate under control, as these can increase the risk of UTIs.
Promote Bladder Health: Practice pelvic floor exercises to strengthen bladder muscles and improve bladder control. Avoid constipation, as it can put pressure on the bladder and prevent complete emptying.
Consider Cranberry Products: Some studies suggest that cranberry juice or supplements may help prevent UTIs by preventing bacteria from sticking to the bladder wall. However, consult your doctor before using these, especially if you take blood-thinning medications.
Regular Bathroom Breaks: Older adults should urinate regularly (even if they don’t feel the urge) to prevent urine from stagnating in the bladder.

For Catheter Users

For individuals who use catheters, preventing UTIs requires extra care and attention:

Proper Catheter Care:
– Always wash your hands thoroughly before and after handling the catheter.
– Clean the catheter and the area around it daily with mild soap and water.
– Ensure the catheter tubing and collection bag are kept clean and free from kinks or blockages.
Minimise Catheter Use: If possible, use intermittent catheters instead of indwelling catheters, as they carry a lower risk of infection. Only use a catheter when advised by a physician.
Follow Medical Advice:
– Replace the catheter as recommended by your healthcare provider.
– Use sterile techniques during catheter insertion and removal.
Stay Hydrated: Drinking plenty of fluids helps flush out bacteria and reduces the risk of infection.
Monitor for Signs of Infection: Regularly check for symptoms such as fever, cloudy urine, or discomfort around the catheter site, and report any concerns to your doctor immediately.

Preventing Recurrent UTIs

Recurrent UTIs are defined as having two or more infections within six months or three or more within a year. These often require further investigation to identify the underlying causes, which could be anything from anatomical abnormalities to chronic conditions or persistent bacterial colonisation.

For those who experience frequent UTIs, preventive strategies may include:

Prophylactic Antibiotics: A low-dose antibiotic taken daily or after specific triggers.
Lifestyle Changes: Staying hydrated, practicing good hygiene, and avoiding bladder irritants.
Medical Evaluation: Testing for underlying conditions, such as kidney stones or anatomical abnormalities, that may contribute to recurrent infections.

In any case, wearing breathable clothing (such as cotton underwear) is always a good measure to prevent UTIs. Avoid tight-fitting pants to reduce moisture build-up which can promote bacterial growth, likewise, stay away from douches or sprays as these products can disrupt the natural balance of bacteria in the genital area (and thereby increase the risk of infection). If you rely on a caregiver for assistance, ensure they are trained in proper hygiene and catheter care techniques.

When to See a Doctor

While many UTIs can be managed with timely treatment, certain symptoms or situations require immediate medical attention. Delaying care can lead to serious complications such as kidney infections, sepsis, or permanent damage to the urinary tract so knowing when to seek help is crucial – especially for older adults and catheter users who are at higher risk of severe outcomes.

Symptoms Persist or Worsen: If your symptoms do not improve within 2-3 days of starting treatment, or if they worsen despite home remedies or over-the-counter medications, consult a healthcare professional.
Severe Pain or Discomfort: Intense pain in the lower abdomen, back, or sides (flank pain) may indicate a kidney infection, which requires prompt medical intervention.
High Fever or Chills: A fever above 38°C or chills could signal that the infection has spread to the kidneys or bloodstream, necessitating urgent care.
Nausea, Vomiting, or Inability to Keep Fluids Down: These symptoms may indicate a more severe infection or dehydration, both of which require medical attention.
Blood in the Urine: While blood in the urine (hematuria) can occur with a UTI, it should always be evaluated by a doctor to rule out other serious conditions.
Confusion or Delirium: In older adults, sudden confusion, agitation, or changes in behaviour may be the only signs of a UTI. These symptoms should never be ignored.
Recurrent UTIs: If you experience more than 2-3 UTIs in a year, your doctor may need to investigate underlying causes, such as kidney stones, an enlarged prostate, or anatomical abnormalities.

Treatment and Cure for UTIs

Despite your best efforts, UTIs can still occur especially if you have risk factors like a weakened immune system or chronic health conditions. Fortunately, UTIs are highly treatable, especially when diagnosed early.

What to Expect During a Doctor’s Visit

When you see a doctor for a suspected UTI, they will likely:

Take a Medical History: Discuss your symptoms, medical history, and any recent catheter use or recurrent UTIs.
Perform a Physical Exam: Check for tenderness in the abdomen or back, which may indicate a kidney infection.
Order Diagnostic Tests:
– Urine Test: A urinalysis can detect bacteria, white blood cells, or blood in the urine.
– Urine Culture: This test identifies the specific bacteria causing the infection and determines which antibiotics will be most effective.
– Imaging Tests: In cases of recurrent or complicated UTIs, imaging tests like an ultrasound or CT scan may be needed to check for structural abnormalities or kidney damage.

The approach to treatment may vary depending on the severity of the infection, a person’s overall health, and whether they are an older adult or a catheter user. In any case, prompt and appropriate treatment is essential to relieve symptoms, eliminate the infection, and prevent complications such as kidney damage or sepsis.

Treatment for UTIs:

Medical Treatment

The primary treatment for UTIs is a course of antibiotics prescribed by a healthcare professional. The type and duration of antibiotics depend on the type of UTI, the bacteria causing the infection, and the patient’s medical history.

Lower UTIs (Cystitis):
– A short course of antibiotics (typically 3-7 days) is usually sufficient to treat uncomplicated bladder infections.
– Commonly prescribed antibiotics include trimethoprim and nitrofurantoin.
– Symptoms often improve within 1-2 days, but it’s important to complete the full course of antibiotics to ensure the infection is fully cleared.
Upper UTIs (Pyelonephritis):
– Kidney infections are more serious and may require a longer course of antibiotics (7-14 days) or even intravenous (IV) antibiotics in severe cases.
– Hospitalisation may be necessary for older adults or those with underlying health conditions to monitor and manage complications.
Recurrent UTIs:
– If you experience frequent UTIs (more than 2-3 times a year), your doctor may recommend a low-dose antibiotic taken over a longer period.
– Non-antibiotic options, such as vaginal estrogen therapy for postmenopausal women, may also be considered.

Special Considerations for Older Adults and Catheter Users

Older adults may require special considerations when treating UTIs:

Tailored Antibiotic Therapy: Due to age-related changes in kidney function, doctors may adjust the type or dosage of antibiotics to avoid side effects.
Monitoring for Complications: Older adults are at higher risk of complications like sepsis, so close monitoring is essential.
Addressing Atypical Symptoms: Confusion or delirium caused by a UTI should improve with treatment, but it’s important to rule out other causes of cognitive changes.

Home Remedies (Supportive Care)

While antibiotics are the primary treatment for UTIs, incorporating simple home remedies can help ease discomfort, speed up recovery, and support your overall urinary health.

From staying hydrated to using heat therapy, these practical steps can complement medical treatment and support recovery —but remember, they are not a substitute for professional care.

Increase Fluid Intake: Drinking plenty of water helps flush bacteria out of the urinary tract.
Use Pain Relievers: Talk to your pharmacist about over the counter medications that may be suitable for your circumstances.
Apply Heat: A heating pad on the lower abdomen can help relieve bladder pressure or cramping.
Avoid Irritants: Stay away from caffeine, alcohol, and spicy foods, which can irritate the bladder.

Conclusion

UTIs are a common but manageable health issue, especially for older adults and catheter users. By understanding the causes, recognising symptoms early, and taking steps to prevent infections, you can protect your urinary health and avoid complications.

Remember, prevention is key. Stay hydrated, practice good hygiene, and follow proper catheter care guidelines. If you notice symptoms, don’t wait—seek medical advice promptly. With the right knowledge and action, UTIs don’t have to disrupt your life.

References:
1. Australian Commission on Safety and Quality in Health Care. (2020). Preventing and Controlling Infections in Health Care
https://www.safetyandquality.gov.au/sites/default/files/2021-04/fourth_atlas_2021_-_2.4_kidney_infections_and_urinary_tract_infections.pdf

2. Therapeutic Guidelines Limited. (2023). Urinary Tract Infections.
https://tgldcdp.tg.org.au/viewTopic?etgAccess=true&guidelinePage=Antibiotic&topicfile=urinary-tract-infection-aged-care&guidelinename=Antibiotic&sectionId=toc_d1e117#toc_d1e117

3. Healthdirect Australia. (2023). Urinary Tract Infections (UTIs)
https://www.healthdirect.gov.au/urinary-tract-infection-uti

4. Better Health Channel (2023) – Urinary Tract Infections (UTIs)
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/urinary-tract-infections-uti

5. Mayo Clinic. (2023). Urinary Tract Infection (UTI)
https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447