Urinary tract infections may seem simple to manage; however, the truth of the matter is they are not. Often symptoms of a urinary tract infection mimic symptoms of an overactive bladder. To clarify let’s begin by separating them. Patients with male reproductive systems who suffer from a urinary tract infection should be thoroughly investigated “worked up” if you will, by the urology team. If a male has a UTI, it is deemed complicated and requires anatomic evaluation.
In adult medicine, patients with female reproductive systems can be divided into female pre-menopause and female peri and post-menopause. For our pre-menopause group, UTI symptoms are usually the classic three: frequency, urgency, and dysuria. All symptomatic patients with the classic symptoms should have a urine culture and the infection treatment should be culture-driven. Within this group, recurrent UTIs can occur. According to guidelines, recurrent UTI diagnosis applies when she has three culture-confirmed UTIs within six months. Post-coital UTIs are very prevalent within this age group and can be well managed with a post-coital prophylactic regimen. Once the patient within this age group is found to have recurrent UTIs unrelated to intercourse, further specialized investigation should be done, preferably by the urology team.
For the peri and post-menopause groups, the issue is totally different. Signs are commonly subtle and symptoms can vary from patient to patient. UTIs within this age group are multifactorial in nature. Factors or issues such as vaginal atrophy due to estrogen depletion, urine or bowel incontinence, decreased mobility and flexibility for hygiene, sweet urine as a result of sodium-glucose cotransporter-2 (SGLT2) inhibitors, and antibiotic resistance organisms can make in the management of their UTIs a clinical challenge.
Therefore, prevention is worth millions in this patient population. And because there are many factors to control, one intervention does not particularly trump the other. Here at TPMG Urology, our team aims to guide patients toward prevention as much as possible by recommending the following:
1. Wash with hibiclense suds a few times a week and don’t apply the liquid straight on the skin. Bubble it up as much as possible and wash.
2. Wipe front to back. This may seem simple but we lose flexibility during the golden years and front to back may be difficult.
3. If front-to-back is not possible or poorly achieved, a hand-held portable Bidet water spray bottle can be very helpful.
4. For patients who suffer from predominantly E. coli infections, one to two cranberry capsules that contain 36 mg of PACs (proanthocyanidins) can be very helpful.
5. D-mannose, 1 gram twice a day can also help those with E. coli if they are not diabetic.
6. Avoid cranberry juice! Cranberry juices hardly contain any cranberry. It is mainly sugar and it can also be a bladder irritant.
7. Avoid wearing a urinary pad 24/7, so go commando to bed. For those who find this difficult, commando with loose PJ pants may be more achievable.
8. If there is fear of “wetting the bed” use a bedside commode. This is better than urinary pads all night.
9. Drink 8-10 glasses of water a day (If this is allowed with your renal regimen).
10. Do 30 Kegels a day. This increases pelvic circulation and improves pelvic muscle tone.
11. Use topical estrogen cream as prescribed; if this is not obtainable or contraindicated, there are other non-hormonal OTC vaginal tissue moisturizers available at the drug store.
This is a long list to consider but one does not fit all and all does not fit one. Individualized care at the prevention level for this patient population is a true art but it can be accomplished, and success can be achieved.
For further consultation regarding recurrent UTIs, consult our board certified experts at TPMG Urology in Newport News.
About Ingrid Ortiz, FNP-BC
Ingrid Ortiz, FNP-BC is a board-certified family nurse practitioner with TPMG Urology in Newport News. Ingrid treats adults for a variety of acute and chronic urological conditions, including low testosterone, erectile dysfunction, benign prostatic hyperplasia, overactive bladder, incontinence, stress incontinence, urinary tract infections, pelvic floor dysfunction, scrotal pain, urinary retention, elevated PSA (Prostate-Specific Antigen), and kidney stone disease.