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Urinary tract infections (UTIs) are a common health concern, particularly among postmenopausal women. Hormonal changes and other age-related factors can make older women more susceptible to these infections, which can be uncomfortable and sometimes serious if left untreated. Understanding why this happens, and how to prevent and manage UTIs, can help improve quality of life and reduce the risk of complications.

Why are older women susceptible to UTI?

Postmenopausal women are at higher risk for UTIs due to changes in their bodies after menopause. The drop in estrogen levels can lead to thinning of the vaginal and urethral tissues, which makes it easier for bacteria to enter the urinary tract. Additionally, estrogen helps maintain a healthy balance of bacteria in the vaginal area; a reduction in this hormone can disrupt this balance, increasing the risk of infection.

Bladder changes can also increase risk. In some older women, the bladder may not empty completely, or they may experience urinary incontinence, allowing bacteria to multiply.

Women who undergo medical procedures may also be at increased risk if catheters or other devices that can introduce bacteria into the urinary tract are used.

UTI symptoms

UTIs often cause noticeable symptoms, but they can sometimes be subtle in older women. Common UTI symptoms include:

• a strong, persistent urge to urinate
• a burning sensation during urination
• frequent urination, often passing small amounts of urine
• cloudy, strong-smelling urine or blood in the urine
• pain or discomfort felt in the lower belly, just above the pubic bone.

UTI symptoms that are more common in older women

UTI symptoms can sometimes be subtle and harder to identify in older women. Older women are more likely to experience less typical symptoms, such as:

• new incontinence
• confusion or changes in mental state
• fatigue or general weakness
• loss of appetite
• increased falls.

Preventing UTIs

Preventing UTIs is particularly important for older women, who are more vulnerable to recurring infections.

The first step in UTI prevention is to practice good hygiene. Wiping from front to back after using the toilet can prevent bacteria from spreading to the urethra. If you have a loss of bladder control, ensure you're regularly changing your protective underwear and keeping these areas clean and dry.

In addition, staying hydrated helps flush bacteria from the urinary tract. Aim to drink at least four to six cups of water a day. Avoid holding urine for long periods, which can allow bacteria to grow.

Diabetes is an independent risk factor for UTIs. If you have diabetes, managing your blood sugar level through a healthy lifestyle and taking medications as prescribed is an important protective strategy.

Cranberry juice and probiotics are often touted for UTI prevention. But studies on whether cranberry juice or cranberry pills reduce risk for UTI do not show consistent results. And no research has found that probiotics are effective in treating UTIs or preventing recurrence.

Preventing recurrent UTIs

If you experience recurrent UTIs — defined as two or more UTIs in six months or three or more UTIs in a year — you may need to consider additional strategies. These include:

• Vaginal estrogen. For some postmenopausal women, low-dose vaginal estrogen, which is available by prescription, can restore the health of vaginal tissue and reduce UTI risk.
• Antibiotic prophylaxis. Research has shown that taking antibiotics regularly to prevent infections (antibiotic prophylaxis) can reduce UTI recurrence. Discuss the risks of this approach, which include antibiotic resistance, disruptions to the gut microbiome, and increased risk of Clostridium difficile (C. diff) infections, with your doctor.
• Methenamine. A nonantibiotic prescription medication called methenamine (Hiprex) can help prevent recurrent UTIs. Taken twice daily, methenamine works by turning into formaldehyde in urine, which kills bacteria. shows it may be as effective as antibiotics in reducing recurrent infections.

UTI treatment

When UTIs occur, prompt treatment is essential to prevent complications such as kidney infections. Treatment typically involves a short course of antibiotics. It's important to complete the full course as prescribed, even if symptoms improve, to ensure the infection is completely cleared and that symptoms do not recur.

For recurrent UTIs, your doctor may recommend:

• additional courses of antibiotics
• preventive antibiotics taken every day, or after certain activities such as sexual intercourse
• nonantibiotic preventive options such as methenamine.

If you're experiencing UTI symptoms or have concerns about recurring infections, talk to your doctor.