Can a UTI Cause Confusion in the Elderly?

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Older adults may not always show the classic signs of a UTI. They may experience other symptoms, including confusion and lethargy.

The classic symptoms of a urinary tract infection (UTI) are burning pain and frequent urination. UTIs may not cause these classic symptoms in older adults. Instead, older adults, especially those with dementia, may experience behavioral symptoms such as confusion.

Although the connection between UTI and confusion has been established, the reason for this connection is still unknown.

The urinary tract includes:

• the urethra, which is the opening that carries urine from your bladder
• the ureters
• the bladder
• the kidneys

When bacteria enter the urethra and your immune system doesn’t fight them off, they may spread to the bladder and kidneys. The result is a UTI.

A study reports that UTIs were responsible for around 10.5 million doctor visits in the United States in 2007. Women are more likely to get UTIs than men because their urethras are shorter than men’s.

Your UTI risk increases with age. According to one study, more than one-third of all infections in people in nursing homes are UTIs. More than 10 percent of women over age 65 report having a UTI within the past year. That number increases to almost 30 percent in women over 85.

Men also tend to experience more UTIs as they age.

It may be hard to figure out that an older adult has a UTI because they don’t always show classic signs. This may be due to a slower or suppressed immune response.

Classic UTI symptoms include:

• urethral burning with urination
• pelvic pain
• frequent urination
• an urgent need to urinate
• a fever
• chills
• urine with an abnormal odor

When an older adult has classic UTI symptoms, they may be unable to tell you about them. That may be due to age-related issues such as dementia or Alzheimer’s disease. Symptoms such as confusion may be vague and mimic other conditions.

Other UTI symptoms may include:

• incontinence
• agitation
• lethargy
• falls
• urinary retention
• decreased mobility
• decreased appetite

Other symptoms may occur if the infection spreads to the kidneys. These severe symptoms can include:

• a fever
• flushed skin
• back pain
• nausea
• vomiting

The main cause of UTIs, at any age, is usually bacteria. Escherichia coli is the primary cause, but other organisms can also cause a UTI.

In older adults who use catheters or live in a nursing home or other full-time care facility, bacteria such as Enterococci and Staphylococci are more common causes.

Certain factors may increase the risk of UTIs in older people.

Conditions common in older adults may lead to urinary retention or neurogenic bladder. This increases the risk of UTIs. These conditions include Alzheimer’s disease, Parkinson’s disease, and diabetes.

They often require people to wear incontinence briefs. If the briefs aren’t changed regularly, an infection may occur.

Several other things put older adults at risk for developing a UTI:

• a history of UTIs
• dementia
• catheter use
• bladder incontinence
• bowel incontinence
• a prolapsed bladder

In women

Postmenopausal women are at risk of UTIs because of estrogen deficiency. Estrogen may help protect the vagina and urethra from an overgrowth of E. coli. When estrogen decreases during menopause, E. coli may take over and trigger an infection.

In men

The following may increase the risk of UTIs in men:

• a bladder stone
• a kidney stone
• an enlarged prostate
• catheter use
• bacterial prostatitis, which is a chronic infection of the prostate

Vague, uncommon symptoms such as confusion make UTIs challenging to diagnose in many older adults. If your doctor suspects a UTI, a urinalysis will likely be ordered along with other tests to determine the true cause of the symptoms.

Your doctor may perform a urine culture to determine the type of bacteria causing the infection and the best antibiotic to treat it.

There are home UTI tests that check urine for nitrates and leukocytes. Both are often present in UTIs. Because bacteria are often in the urine of older adults to some degree, these tests aren’t always accurate. Call your doctor if you take a home test and get a positive result.

Not every UTI requires treatment with antibiotics. For example, asymptomatic older adults in hospitals and residential care facilities are usually not prescribed antibiotics because of the risk of drug resistance and even more dangerous opportunistic infections. When indicated, antibiotics are the treatment of choice for symptomatic UTIs. Your doctor may prescribe amoxicillin and nitrofurantoin (Macrobid, Macrodantin).

More severe infections may require a broad-spectrum antibiotic such as ciprofloxacin (Cetraxal, Ciloxan) and levofloxacin (Levaquin).

You should start antibiotics as soon as possible and take them for the entire duration of treatment as prescribed by your doctor. Stopping treatment early, even if symptoms resolve, increases the risks of recurrence and antibiotic resistance.

Antibiotic overuse also increases your risk for antibiotic resistance. For this reason, your doctor will likely prescribe the shortest treatment course possible. Treatment typically lasts no more than 7 days, and your infection should clear up in a few days.

It’s important to drink plenty of water during treatment to help flush out the remaining bacteria.

People who have two or more UTIs in 6 months or three or more UTIs in 12 months can use prophylactic antibiotics. This means taking an antibiotic every day to prevent a UTI.

Healthy older adults may want to try over-the-counter UTI pain relievers such as phenazopyridine (Azo), acetaminophen (Tylenol), or ibuprofen (Advil) to ease burning and frequent urination.

Other medications are also available online.

A heating pad or hot water bottle may help relieve pelvic pain and back pain. Older adults who have other medical conditions shouldn’t use home remedies without first consulting a doctor.

It’s impossible to prevent all UTIs, but there are steps that help lessen a person’s chance of infection. They can do this by:

• drinking plenty of fluids
• changing incontinence briefs frequently
• avoiding bladder irritants, such as caffeine and alcohol
• keeping the genital area clean by wiping front to back after going to the bathroom
• not using douches
• urinating as soon as the urge hits
• using vaginal estrogen

Proper nursing home or long-term care is critical in preventing UTIs, especially for people who are immobile and unable to take care of themselves. They rely on others to keep them clean and dry.

If you or a loved one is a nursing home resident, talk to management about how they manage personal hygiene. Make sure they’re aware of UTI symptoms in older adults and how to respond.

A UTI can cause confusion and other symptoms of dementia in older adults. Taking preventive steps and looking out for UTI symptoms should help prevent infection. If your doctor diagnoses a UTI early, your outlook is good.

Antibiotics cure most UTIs. Without treatment, a UTI can spread to the kidneys and the bloodstream. This may lead to a life threatening blood infection. Severe infections may require hospitalization for intravenous antibiotics. These can take weeks to resolve.

Get medical attention if you suspect that you or a loved one has a UTI.

What to Do and When to See a Doctor

Written by WebMD Editorial Contributors

• Remedies for Bladder Infections
• When to See a Doctor

Bladder infections are a common type of urinary tract infection (UTI). Bacteria enters your urethra and moves to the bladder, where the bacteria can multiply quickly. Anyone can have a bladder infection, but they are particularly common among women. 

Approximately 40 to 60 percent of women will develop a bladder infection or UTI in their life, and about one in four women will have a repeat infection. Women are at increased risk for a bladder infection since they have a shorter urethra than men. As a result, the bacteria has less distance to travel to reach the bladder.

Common symptoms of a bladder infection include:

• Pain or a burning sensation when urinating
• Feelings of frequent urination even though your bladder is empty
• Urinating more frequently than usual
• Pain in your bladder, stomach, or pelvis
• Urine that appears cloudy or smells foul

Most bladder infections are classified as simple or uncomplicated bladder infections. These types of bladder infections are typically not difficult to treat and respond well to treatment.  

Complicated bladder infections involve situations where the person has an abnormal urinary system or medical conditions that will need to be considered when determining a course of treatment, such as pregnant women, age, diabetes, renal insufficiency, and more. This situation may make it more difficult to treat the infection or take a longer course of treatment. Cases of bladder infection in men are always considered complicated bladder infections since their longer urethra should stop this type of infection from occurring. 

If you think you have a bladder infection, you should contact your doctor and schedule an outpatient appointment. You’ll need medication to get rid of the bacterial infection. That said, there are home remedies you can also use to help ease symptoms and help with the healing process. Here are five remedies and treatments for bladder infections that you can use:

1. See your doctor for an antibiotic

If you’re diagnosed with a bladder infection, your doctor will likely prescribe an oral antibiotic. Antibiotics work by getting rid of the bacteria that is causing your bladder infection. Research has shown that antibiotics are effective and perform better than a placebo. 

You need to complete the full course of the prescribed antibiotic, even when you start to feel better. If you stop the antibiotic before completing the prescription, you risk getting another infection. In an uncomplicated or simple bladder infection, you’ll typically notice an improvement in your symptoms within a day or two of starting the antibiotic. Your doctor may select an antibiotic treatment course that will last three to five days. In complicated bladder infections, the course is longer, typically seven to fourteen days.   

2. Drink more water

When caring for a bladder infection, it’s critical to drink lots of fluids to help flush the bacteria out of your bladder. The additional fluids also help dilute your urine, which can make urinating less painful while you’re healing from the infection.  

Water is an excellent choice since it doesn’t contain any bladder irritants like other beverages, such as caffeine or artificial sweeteners. Drinking more water can also help prevent bladder infections.

3. Apply a heating pad or warm pack

A heating pad or warm pack can help ease the discomfort from a bladder infection, especially at night. 

4. Take over-the-counter pain medications

While antibiotics treat the cause of the infection, they don’t address symptoms of pain. If you’re experiencing pain in your pelvis area, ask your doctor if you can take an over-the-counter pain reliever. Alternatively, your doctor may prescribe phenazopyridine to help address symptoms of pain and irritation related to the bladder infection that you may be experiencing before the antibiotics start working.

Contact your doctor if you have pain or discomfort when you urinate or other symptoms of a bladder infection, especially if the symptoms have been present for two days or more. If an infection lingers for too long, you risk the bacterial infection traveling to other parts of your body, including your kidneys. Therefore, you should seek treatment if you notice symptoms. 

Your doctor will complete a physical examination and collect a urine sample to send for lab analysis to determine if an infection is present. Complications from an uncomplicated bladder infection are typically rare with antibiotic treatment. However, if you develop fever, chills, nausea, or confusion, you should immediately contact your doctor. These symptoms suggest a more serious infection that has spread to your kidneys. If you have a kidney infection, you may need an IV treatment of high-dose antibiotics, which may require hospitalization.

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Ultrasound of the genitourinary system is a complete examination of the bladder, urinary tract and urethra. In men, the scrotum (testicles) and prostate gland are additionally examined. Inspection with ultrasound has great diagnostic value and is used in urology to detect pathological processes, inflammations, infections, neoplasms at an early stage.

Ultrasound of the genitourinary system (MPS) is a reliable and safe diagnostic method that has practically no contraindications. It will allow you to control the course of the disease of the urinary system and prostate, evaluate the effectiveness of the prescribed therapy, and find out exactly the root cause of the disorders.

At the SOVA clinic, you can undergo a comprehensive examination of the genitourinary system, quickly receive the results with a transcript and provide them to your doctor. We also have experienced specialists – urologists and nephrologists, who can be consulted about disturbing symptoms, receive recommendations for the treatment and prevention of diseases.

Readings

For what symptoms is it recommended to do an ultrasound of the genitourinary system:

• frequent urination or, conversely, urinary retention;

• frequent episodes of incontinence;

• pain in the lumbar region, groin, lower abdomen;

• the presence of blood in the urine;

• burning and pain when urinating;

• change in the shade and uniformity of urine;

• swelling of the lower extremities;

• increased fatigue, weakness, loss of strength;

• deviations of indicators in laboratory tests;

• pathological discharge from the urethra;

• decrease in the total daily volume of urine;

• feeling of insufficient emptying of the bladder.

For preventive purposes, it is useful to undergo an examination for men over 40 years of age who have a history of genital infections, congenital or acquired malformations of organs, suffering from chronic pyelonephritis or cystitis, who have had bladder injuries.

What this survey will show:

• inflammatory and infectious diseases;

• urolithiasis;

• benign MPS formations: cysts, polyps;

• tumors;

• narrowing (stricture) of the urethra;

• the exact volume of residual urine after urination;

• injury and damage;

• erectile dysfunction due to impaired blood flow;

• prostatitis in acute or chronic form;

• seminal vesicle cysts;

• anomalies of the structure and localization;

• pathological changes in the prostate.

In addition, in our medical center, men undergo ultrasound of the scrotum and prostate (TRUS). Such a complete examination will help to find the cause of pain, fatigue and erectile dysfunction in men.

Contraindications

The procedure has no negative impact on the body and side effects. It can be performed at any age, including children and the elderly. A relative contraindication is a serious damage to the skin in the area under study. for example, burns. cuts, deep wounds, or skin conditions requiring urgent treatment. Then it is worth postponing the study until complete healing.

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How is an ultrasound of the bladder and other organs of the MPS performed?

We offer a number of methods for studying the state of the genitourinary system: standard diagnostics, with measurement of residual urine, with duplex scanning of blood vessels. The choice of technology depends on the symptoms and on which organs and structures need to be studied.

Preparation

Ultrasound of the genitourinary system consists of two stages, following one after another. First, the uziologist examines the patient with a full bladder. Then comes the examination after emptying. It is advisable not to urinate 2-2.5 hours before the procedure. Drink about 1 liter of non-carbonated clean water about an hour before your scan.

To make the results as reliable as possible, follow a special diet two days before it. The accumulation of gases makes it difficult to visualize, including the organs of the urinary system. Temporarily remove from your diet foods that stimulate increased gas formation: brown bread, cereals, legumes, soda, coffee, milk, fresh fruits and berries.

On the eve of the study, a light dinner of low-fat, dietary products is allowed. If there are serious problems with the intestines, constipation and increased bloating, then it is better to do a cleansing enema. Ultrasound of the MPS is performed on an empty stomach.

Inform the specialist in advance about the medications taken, allergic reactions and concomitant pathologies. Take with you to your appointment the results of previous examinations (if any) and medical reports. These data will help in interpreting the results and making a diagnosis.

Procedure

Usually the diagnosis is carried out in the supine position. The patient lies down on the couch, the doctor applies a conductive gel to the area of ​​interest and starts moving the probe. In women, the study of the organs of the urinary system is possible through the anterior wall of the abdomen (transabdominally) or transvaginally. Transrectal examination (TRUS) is available for men, it is especially informative in cases of suspected prostate pathology. The whole procedure lasts 15-20 minutes.

Thanks to the ultrasound scan, the doctor determines:

• size and structure of the bladder, urethra;

• structural features of the MP walls;

• the amount of residual urine after the completion of the process of urination;

• pathology of the testicles, scrotum, prostate gland in men;

• the presence of tumor-like formations, cysts, polyps in women.

The diagnostician will issue a conclusion and a picture to the patient immediately after the end of the ultrasound examination. Based on the ultrasound data, your doctor may prescribe auxiliary instrumental studies or tests, refer you to a narrow specialist: a gynecologist, urologist, nephrologist. Most of the analyzes and various types of diagnostics are available to you within the walls of our center. If necessary, treatment in a day or round-the-clock hospital is possible.

Sign up for an ultrasound scan of the genitourinary system by calling the “hot line” of our clinic at Nikitinskaya, 52 or fill out the online form on the website. We guarantee comfort, safety and accuracy of examinations.

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Urinary retention (ischuria) – treatment, causes, symptoms in the URO clinic -PRO Rostov-on-Don, Yekaterinburg, Krasnodar, Sochi.

Home / Useful information / Glossary / Urinary retention

Urinary retention (ischuria) is a failure in the healthy functioning of the human body due to the inability to independently, consciously urinate (or this does not occur in full). In this case, urine accumulates in the bladder, causing serious discomfort and pain.

Causes

Urinary retention may be provoked by:

• embarrassment, inability to go to the toilet on time (enduring the need)
• mechanical obstruction (enlarged prostate, etc.)
• injuries of the spinal cord, perineum, lumbar, pelvic nerves
• weak bladder muscles (mainly in the elderly)
• pharmacological causes, taking certain medications
• compression of the ureter by tumors, scars
• physical and emotional strain
• obstruction of the mouth of the urethra by a blood clot
• bed rest after surgery
• drinking alcohol
• phlebitis of hemorrhoidal veins
• neurological factors
• dehydration
• feverish condition
• bladder stones
• renal deficiency
• too spicy food
• development of infections
• blood loss
• inflammation.

Symptoms

With urinary retention, urination is either completely absent, or the bladder is not completely emptied (an overestimated amount of residual urine), or there is a drip of urine, although the bladder is full.

When a person has a long urinary retention, his general condition becomes severe due to poisoning of the body with metabolic products that need to be excreted in the urine. Edema, headache, nausea, vomiting appear, the tongue becomes dry, sometimes consciousness is lost, there are convulsions, diarrhea, blood pressure rises.

Gradually, bladder distention and rather severe pains in the abdomen are added to this. Such symptoms, in turn, provoke dysfunction and performance of other organs: the heart, intestines, lungs, etc.

Help with urinary retention

If a person has such an ailment, then you should seek professional examination and treatment from good, experienced doctors as soon as possible. Delay is not appropriate here, because urinary retention in addition to the above problems, it can even lead to death due to poisoning of the body with uric acid, etc.