Urinary tract infections, or UTIs, are common in older people. When urine remains in the bladder too long, a condition called bladder retention, bacteria are able to grow freely and cause an infection in the bladder or kidneys. Causes of urinary retention in the elderly include physical blockages, loss of tone in the bladder muscles and nerve damage or neurogenic bladder. Bacteria can be introduced into the body by a urinary catheter, often used for elderly people who cannot control the flow of urine; through an infection of the prostate that spreads to the urinary tract; or by poor hygiene practices that spread bacteria from the rectum to the urethra. UTIs can be serious in the elderly if they progress to kidney damage or sepsis.
Antibiotics
UTIs are almost always caused by bacteria, primarily by Escherichia coli, according to the Merck Manual. Enterococcus and Staphylococcus infections occur less often, and UTIs caused by a virus or fungus are rare. For lower urinary tract bacterial infections, antibiotics such as trimethoprim-sulfamethoxazole, cephalexin, ciprofloxacin, levofloxacin, and nitrofurantoin may be prescribed. Short courses of antibiotics, less than 7 days, have not been shown to be effective in the elderly. Therefore, older women are instructed to take the antibiotics by mouth for 10 days and men for 14 days, according to the Merck Manual. If the upper urinary tract is involved, elderly patients of both genders should be treated with oral or intravenous antibiotics for at least 14 days.
Symptom Relief
UTIs do not always cause symptoms. Patients who have symptoms often complain of a painful burning sensation, called dysuria, and an urgent, frequent need to urinate caused by bladder spasms. Sometimes the urge is so strong that the patient becomes incontinent or unable to control the flow of urine. Prescription medications--phenazopyridine for the burning pain and dicyclomine for bladder spasms---may be helpful in controlling symptoms of UTIs, according to the Merck Manual. These medications do not kill the bacteria causing the UTI; they are prescribed in addition to antibiotics.
Change in Habits
If the patient has an indwelling catheter, it should be removed and cultured. Thereafter, indwelling catheters should be changed at least monthly using aseptic technique. Patients who are not catheterized should be taught to go to the bathroom at the first urge to urinate, use good hygiene practices, increase fluid intake to at least 8 cups per day and empty the bladder as completely as possible. If the patient is retaining urine after voiding, gentle pressure can sometimes be helpful. Otherwise, intermittent catheterization may be needed.
Instrumentation or Surgery
Bladder retention can occur in older men when the prostate enlarges enough to press on the urethra, the tube that passes urine from the bladder to the outside of the body. Older women are at risk for developing cystoceles---bulges in the bladder---that can block the flow of urine and allow bacteria to multiply. Physical blockages may require drainage of urine with special instruments called cystoscopes or ureteroscopes, or surgical correction of the underlying cause, according to the Merck Manual.
