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The ABCs of UTIs

Catherine Roberts

For many women, the painful urination that’s characteristic of a urinary tract infection is familiar. Estimates vary, but up to 60 percent of women may get a UTI at least once in their lifetime, and women older than 65 are about twice as likely to have a UTI as younger women. They're much less common in men, occurring in less than 1 percent of those 85 and older.

Although getting a UTI diagnosed and treated can often be straightforward, many people, especially older adults, receive incorrect diagnoses and medication they don’t need. Here, we explain when you really need treatment and what you can do to protect yourself from UTIs that return again and again.

Understand the Signs

A UTI occurs when bacteria infect part of your urinary tract, often the bladder. The symptoms can include burning, painful, or difficult urination; needing to use the bathroom more frequently; pain in your lower abdomen; and fever, chills, and fatigue. In some cases, especially among nursing home residents, loss of appetite and confusion may occur instead of more characteristic symptoms, such as painful urination.

Getting treated when you have a UTI is important to keep the infection from progressing from your bladder to your kidneys. But it’s also critical not to be treated for a UTI if you don’t have one.

That’s because UTIs are treated with antibiotics, which shouldn’t be taken ­unnecessarily. Certain types of antibiotics can cause severe side effects, such as the diarrheal illness Clostridioides difficile, says Nicola Thompson, Ph.D., a research epidemiologist with the Centers for Disease Control and Prevention.

The problem is that a urine test given for unrelated reasons (such as for evaluating blood sugar for diabetes) can reveal bacteria even though you don’t have any symptoms of a UTI. When this occurs, it’s called asymptomatic bacteriuria, or AB. It’s more common the older you get, and it doesn’t require any treatment.

AB can make diagnosing a UTI tricky, especially among people experiencing some of the more vague symptoms that can be present with a UTI, such as confusion and a loss of appetite. Because of this, many experts now say that providers shouldn't prescribe antibiotics unless they're able to confirm that a person has telltale UTI symptoms, such as painful urination. 

Get the Proper Treatment

If you receive a true UTI diagnosis, a good first-line option is nitrofurantoin (Macrodantin, Furadantin, and generic), which may cause fewer side effects than certain other antibiotics, according to Lindsay Nicolle, M.D., a professor emeritus at the University of Manitoba in Winnipeg.

Sometimes fluoroquinolone antibiotics, such as ciprofloxacin (Cipro and ­generic), are prescribed. A recent CDC study found that in nursing homes, these were the most common antibiotics prescribed for UTI symptoms. But experts say these drugs should be used only for complicated infections because of the risk of serious side effects. If a doctor suggests them, ask whether another drug could work. 

Keep Infections at Bay

One of the biggest predictors of a UTI is having had one in the past. If you’ve had a UTI before, chances are you may have one again, and recurrent UTIs are a common problem, especially for older women.

While you may have heard that cranberry juice can help to prevent UTIs, recent research suggests otherwise. Keeping yourself hydrated may be a better bet. A 2018 trial published in JAMA Internal Medicine found that young women with recurrent UTIs who drank an extra liter and a half of water per day went about two months longer between UTIs than those who stuck to their usual fluid ­intake. Whether this would be as effective in older women isn’t known, Nicolle says.

Antibiotics are also sometimes used as a preventive for people who get UTIs every few months or more often; ask your doctor whether you might be a candidate. And some doctors suggest urinating after intercourse to flush out bacteria. This practice isn’t proved, but it can’t hurt. 

Editor’s Note: This article also appeared in the April 2020 issue of Consumer Reports On Health

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