UTIs and age — how age impacts urinary health

Why it happens: By the age of 7, approximately 7.8% of girls and 1.7% of boys in the United States will have had a UTI. Recurrence rates are typically between 30 to 50% and occur much more frequently in girls (2).

In infants, it’s possible diapers are a contributing cause of UTIs due to bacteria having a higher chance of entering the urethra. In children, it’s possible they are holding their bladder, or not fully emptying the bladder, which can allow bacteria to remain stagnant in the bladder.

What to do: Change an infant's diaper as soon as a bowel movement or voiding occurs and help teach children proper bathroom hygiene including wiping front to back, changing undergarments regularly and going when they need to (avoid holding it).

Why it happens: At least one-third of all females in the U.S. are diagnosed with a UTI by the time they're 24-years-old (3).

This can occur for a multitude of reasons including the simple fact that women are inherently more likely to contract a UTI due to simple anatomy of the urethra. However, other factors can come into play as we enter adulthood including sexual activity, menstruating, exercise and even stress.

Another common UTI trigger in this age demographic is pregnancy. 31% of pregnant women will have either a symptomatic or an asymptomatic UTI while pregnant (4). UTIs in pregnancy are common because the anatomy of the urinary tract actually changes. Your growing uterus adds pressure onto your bladder, which can affect your ability to fully void. In addition, your progesterone and estrogen levels increase during pregnancy, which can weaken your bladder and ureters (5). Pregnancy also alters the makeup of your urine, reducing the acidity and increasing the amount of protein, hormones, and sugar in your urine. All of the above contribute to a heightened chance of developing a UTI in pregnancy. It’s recommended that all pregnant women receive a urinalysis and urine culture at 12 to 16 weeks or during the first prenatal visit to ensure there is not an infection.

What to do: It’s important to practice good hygiene including peeing after sex, wiping front to back and changing out of wet/damp undergarments regularly. Other factors to consider include staying hydrated, avoiding acidic foods and overall being mindful with your diet when it comes to alcohol, sugar or caffeine intake as all of those pose as possible irritants to the bladder.

Why it happens: Women are premenopausal if they are still having normal periods and are not experiencing any symptoms associated with fluctuating estrogen levels. Keep in mind that some women enter menopause in their 30s (called premature menopause), so age is not necessarily an indicator when it comes to this, or any, stage.

UTI triggers can be similar to those experienced by young adults such as sex, menstruating, or pregnancy.

31% of pregnant women will have either a symptomatic or an asymptomatic UTI while pregnant (5). UTIs in pregnancy are common because the anatomy of the urinary tract actually changes. Your growing uterus adds pressure onto your bladder, which can affect your ability to fully void. In addition, your progesterone and estrogen levels increase during pregnancy. Pregnancy also alters the makeup of your urine, reducing the acidity and increasing the amount of protein, hormones, and sugar in your urine. All of the above contribute to an increased likelihood of getting UTI in pregnancy. It’s recommended that all pregnant women receive a urinalysis and urine culture at 12 to 16 weeks or during the first prenatal visit to ensure there is not an infection.

What to do: It’s important to be in tune with your body during this time to ensure you are taking into account the vaginal microbiome and urinary health. And, as always, upkeep the ‘Golden Rules’ of urinary health (pee after sex, wipe correctly, stay hydrated, etc.)

Why it happens: Perimenopause is the beginning of the transition to menopause. An irregular period is the hallmark sign of perimenopause.

While your estrogen levels will be trending downward during perimenopause, it is not a slow, steady decline. Instead, hormone fluctuations are somewhat erratic, which affects all body systems.

These fluctuating levels of estrogen can begin to make UTIs more frequent and more difficult to treat.

UTIs can become a big problem for women starting in menopause, and getting one UTI can mean a high-risk for more. In postmenopausal women, UTI recurrence rates (recurrence rate is the likelihood of getting another UTI after a first) are 55%, compared to 19–36% in younger women (6). UTIs also tend to get more severe, and more common, as women age.

What to do: Now it is vital to take into account the vaginal microbiome for urinary health success. Take a vaginal probiotic to restore the good bacterial strains in the vaginal microbiome to help keep disruptive bacteria in check.

Why it happens: A woman is considered in menopause when her ovaries no longer release eggs and her periods stop. Menopause starts when you have not had a period in at least 12 months. The average age of menopause is 51. Once you have not had your period for a full year, you are considered to be postmenopausal.

This change in ovarian function results in the loss of estrogen production. This lack of estrogen then disrupts vaginal pH, which can put menopausal women at higher risk of UTIs.

It is estimated that 10–15% of all women over the age of 60 experience recurring UTIs (rUTI) (7).

In addition to other symptoms like vaginal dryness, pelvic pain, and urinary urgency and frequency, this transformation has been shown to significantly increase the risk of UTIs (8). These symptoms affect up to 80% of menopausal women (9).

rUTI in postmenopausal women can be very difficult to treat, as standard antibiotic therapies may not effectively clear the infection. Long-term prophylactic antibiotics are often recommended for rUTI in postmenopausal women, leading to high rates of antibiotic resistance.

What to do: Take a vaginal probiotic to restore the good bacterial strains in the vaginal microbiome, to keep disruptive bacteria in check. You may also consider pelvic floor physical therapy to help strengthen your pelvic floor to combat issues with incontinence and dysfunctional voiding. Now, there are alternative approaches emerging. Topical estrogen therapy is a common and often successful recommendation for postmenopausal women with rUTI (10). Vaginal estrogen therapy has been shown to improve menopausal symptoms like vaginal dryness, and generally improve vaginal health. Yet, evidence has shown that benefit will decline if the therapy is stopped (11). Consult with your doctor if you think this could be beneficial for you.

Why it happens: As age advances, a weakened immune system and a history of UTIs, which also means the potential for more antibiotic resistance, may lead to an increased likelihood of rUTI in postmenopausal women.

There are also a wider variety of bacteria, often with multiple types present during the same infection. In postmenopausal women, E. coli is not the dominating cause of UTI. An estimated 50% of women over 80 have bacteria in the urine, making them at constant risk of infection (12). This population is largely asymptomatic, and should not be treated unless symptoms develop, but they remain vulnerable to new infections.

Additional risk factors for UTIs develop with increased age. These include catheter use, incontinence, lack of mobility, and, in men, benign prostate hyperplasia (BPH), which affects 90% of males above age 80 (13).

Symptoms of a UTI in older adults or the elderly are also different than in younger people. For example, symptoms of a UTI in the elderly can can include psychological and behavioral symptoms like confusion, forgetfulness, imbalance, and irrational behavior, all of which are frequently confused with dementia. Due to difficulty of diagnoses and late-onset symptoms, UTIs can result in fevers and hospitalization before being identified.

What to do: It’s important to consistently flush the urinary tract considering the bacterial risk that is present in the urine at all times. Ensure you are staying hydrated (the act of urination is our first line of natural defense!) If you can, find a doctor that understands your history with UTIs to discuss any other methods of treatment necessary.