Tuesday, August 23, 2016

Urine Trouble

Katherine Trent* of Austin,
Texas, had to deal with an occasional
urinary tract infection
(UTI) when she was younger.
Symptoms were obvious (pain,
burning, and a persistent need to
urinate) and easy enough to clear
up with antibiotics. But once Trent
entered her late 60s, the sporadic
UTIs of her earlier years suddenly
returned—and wouldn’t go away.
Within a few days of one infection
easing, another round of symptoms
would start. This cycle continued,
getting progressively worse over
the course of five years. “I could tell
when one was coming on. My bladder
would feel irritated. I went to the
bathroom frequently, and it was
painful. If I couldn’t get to a doctor
or a walk-in clinic within 24 hours,
I would sometimes see blood in my
urine,” Trent recalls.
We tend to think of UTIs as a
young women’s problem, but many
women—and men—who have never
or rarely been troubled can become
prone at midlife. Understanding how
your age changes your risk and the
best approaches to treatment can
bring life-changing relief.
Surprise Sufferers: Men
UTIs are extremely uncommon in
*Name has been changed. young males. So it can come as
a nasty surprise when men get one
for the first time in their 50s, often
because of an enlarged prostate.
“The prostate surrounds the
urethra—the tube from the bladder
through the penis—like a doughnut,”
says Neil Baum, MD, an associate
clinical professor of urology at Tulane
University School of
Medicine in Louisiana.
A growing prostate
compresses the urethra,
causing a weak urine
stream, the need to
pee frequently, and
a dribble after a void.
If the bladder doesn’t
completely empty, the
reservoir of urine can
become infected.
Some 5 to 10 percent
of men who have an enlarged
prostate experience repeat UTIs,
says Dr. Baum. Medication can relax
muscles in the gland or shrink it
so urine can pass easily. Minimally
invasive procedures to relieve blockage
or pressure can also help.
Why Women Get Worse
While blocked pipes can cause an
upswing in UTIs in men, weakened
pipe linings—a result of menopause—
contribute to women’s increased risk.
This was a factor in Katherine Trent’s
repeated infections.
Prior to menopause, estrogen keeps
the lining of the urinary tract thick
and healthy, producing germ-killing
compounds and limiting the ability of
infection-causing microbes to invade
tissues. As estrogen levels decrease
during menopause, the germ-fighting
capability and physical barrier of
the urinary tract weaken and the mix
of bacteria in the vagina changes—all
of which can increase the odds of
developing UTIs.
Antibiotics treat
acute infections, but
other treatments may
be necessary to prevent
recurrences. In 2013,
Swedish researchers
reported that a few
weeks of topical
estrogen treatment in
women strengthened
the urinary tract wall,
making it less prone to infection.
Trent’s urologist suggested that she
apply a prescription estrogen cream
to the vaginal area every day for a few
weeks and then follow a less frequent
regimen. The urologist also supported
Trent’s idea to use vaginal suppositories
containing probiotics (see “Cut
Your Infection Risk,” page 46). Trent
hasn’t had a UTI in 18 months, and
last summer she spent a month in
London—a vacation she would not
have been able to fully enjoy while
UTIs were controlling her life.
If you start experiencing UTIs out
of nowhere, your doctor will want
to rule out other issues. “If standard
treatments fail, we check for stones
in the bladder or kidneys,” says
Elizabeth Mobley, MD, of the Urology
Team in Austin, Texas. If you have
poorly controlled diabetes, UTIs hang
around longer, since bacteria feed off
sugars that spill into the urine.
The Scariest Symptom:
Two years ago, when Meredith
Channing made her daily phone
call from Hawaii to her elderly mom
in the Midwest, she knew something
had gone dramatically wrong.
“One day, she was happy; the next,
she was nasty, paranoid, and totally
off her rocker,” Channing says. “She
was telling me that the neighbors
were stealing from her and something
had entered her apartment and
moved her sewing machine.”
Others in Channing’s shoes might
have panicked and suspected dementia,
but Channing knew better. While
she was caring for her mother-in-law
several years earlier, the older woman
had developed two UTIs and become
confused and suspicious during both
infections. “You can really mistake the
symptoms for insanity or dementia
and think that it’s time to ramp up the
home care or consider a nursing


■ Boost good bacteria. Small studies have found that women with repeat
UTIs are less likely to get another if they use vaginal suppositories with the
probiotic lactobacillus, which balances good and bad bacteria.
■ Drink cranberry juice. In a 2012 meta-analysis, cranberry juice and
supplements reduced repeat UTIs.
■ Wipe the way Mom taught you. The most common UTI-causing germs
are E. coli bacteria from the gastrointestinal tract, so wipe from front to
back to avoid moving the bugs closer to your urinary tract.
■ Excuse yourself after intercourse. Peeing after sex gives bacteria less
chance to enter the urinary tract.
■ Drink lots of water. When you urinate, bacteria are flushed from the
urinary tract, so drink enough to go regularly, especially if you have
incontinence. Those prone to leakage often restrict fluids to prevent
accidents, but this is a recipe for infection.

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