Stay a step ahead of urinary tract infections

Harvard Health Letter

Drink plenty of uids to help flush out bacteria in the urinary tract. Drink enough each day so that your urine is almost clear in color.

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Keep hydrated, and empty your bladder often to stave off these risky infections.

Urinary tract infections (UTIs) are among the most common infections in older adults, especially in women. But the infections are also commonly overdiagnosed and overtreated. "The overuse of antibiotics to treat urinary tract infections is a problem," says Dr. Michael O'Leary, a urologist at Harvard-affiliated Brigham and Women's Hospital.

How it starts

The urinary system is made up of the kidneys, which filter toxins and extra water out of blood to create urine; the ureters, which send urine to the bladder; and the urethra, through which urine is excreted.

UTIs often result when urine pools in the bladder, making it a perfect spot for bacteria to grow. Pooling may be caused by an obstructed urinary flow—from an enlarged prostate in a man or a descended bladder in a woman. Or a UTI may happen if "bad" bacteria cling to the urethra and find their way to the bladder. Other causes include sexual activity, catheters, kidney stones, and a lack of estrogen in the lining of a woman's vagina (estrogen helps protect against UTIs).

Symptoms and risks

UTI symptoms include frequent urination, a sense of urgency to urinate, and a burning feeling that occurs with urination. In older adults, confusion is also a common clue that may go unnoticed or chalked up to mild dementia. "Older men usually get obvious symptoms, but sometimes the only symptom for older women may be confusion," says Dr. O'Leary.

If a UTI is untreated, it may spread to the kidneys, where the bacteria can get into the bloodstream easily. This can lead to sepsis, the body's toxic and sometimes deadly response to infection.

Diagnosis and treatment

Diagnosing a UTI requires testing a sample of urine to look for bacteria and white blood cells, indicating the presence of infection. If a test turns out positive, it's necessary to grow the bacteria in a lab to see which type is causing infection. Treatment is usually a short course of antibiotics, but a more advanced infection may require stronger antibiotics given in a hospital.

Dr. O'Leary says this process is where many doctors overdiagnose a UTI. "Older women have bacteria and white blood cells in their urine. But if the person doesn't have symptoms, it's not a UTI, and the person is needlessly treated with antibiotics. That's how you get resistant organisms."

What you should do

Call your doctor at the first sign of symptoms. The sooner you can catch a UTI, the better. And do try to prevent UTIs by staying hydrated. "Don't worry about trying to drink eight 12-ounce glasses of water a day," says Dr. O'Leary, "but do drink plenty of fluids, since urinating helps to flush out bacteria." A general rule is to drink enough so that your urine is almost clear in color. Other suggestions include emptying the bladder throughout the day, emptying the bladder after sex, and—for women—a vaginal estrogen cream. 

Can diet lower your UTI risk?

A urinary tract infection (UTI) may not be completely avoidable. But some dietary choices may ward off UTIs.

  • Cranberries: These may help prevent (but not treat) UTIs by keeping bacteria from sticking to the lining of the urinary tract. Add cranberries to salads or brown rice; use cranberry extracts, which are low in sugar; or drink unsweetened cranberry juice.

  • Blueberries: Like cranberries, blueberries may also keep bacteria from attaching to the urinary tract lining. Try them in salads, stir them into smoothies, add them to plain Greek yogurt.

  • Vitamin C: "This can help make the urine more acidic, which may prevent bacteria from growing," says geriatrician Dr. Suzanne Salamon, an instructor at Harvard Medical School. She recommends taking a supplement of 500 to 1,000 milligrams of vitamin C daily, or getting vitamin C from foods, such as oranges, lemons, grapefruits, strawberries, blueberries, green leafy vegetables, and green peppers.

  • Probiotics: These products contain colonies of "good" bacteria. Some evidence suggests that probiotics may help prevent UTIs by keeping "bad" bacteria from growing in the vagina. Probiotics are available in supplements and in fermented foods such as plain Greek yogurt, cheese, and a drink called kefir.