Managing UTIs After Menopause

Identifying, preventing and treating UTIs after menopause

Perhaps you’re no stranger to urinary tract infections (UTIs), or maybe you’re the opposite, and you’ve been spared by the urinary health gods. Whichever the case, UTIs after menopause can happen to anyone. They are the second most common type of bacterial infections seen by healthcare providers. Today we’re looking into UTI symptoms, treatment, and prevention post menopause. You’re no longer dealing with your period, so UTIs should take a hike as well!

Why are women at a higher risk of UTIs post menopause?

When you are perimenopausal, menopausal, or postmenopausal, the lack of the hormone estrogen plays a key role.

• Vaginal pH: The natural flora of good and bad bacteria exist harmoniously in your vagina. Estrogen allows the “good” bacteria (Lactobacillus) to thrive. Lactobacillus produces acid, which lowers vaginal pH. This ultimately keeps the “bad” bacteria in check. When your ovaries no longer produce estrogen, there is less good bacteria to fight off bad bacteria. Bad bacteria such as  E. coli, make their way from the rectum to your urethra (the gateway to your urinary tract). This bacteria then attaches to the wall of the urethra and results in a urinary tract infection.

• Stress incontinence: Over 40% of menopausal women face urinary incontinence. This happens in advanced age women because over time, the muscles of the pelvic floor (i.e. the muscles that support your bladder and rectum like a hammock) become weak. Estrogen stimulates blood flow to the pelvic region, which strengthens pelvic floor muscles. Therefore, when estrogen decreases, these muscles become weak, and they lack the strength to keep the bladder closed. In addition, prolonged use of wet, moist absorbent pads exposes your urethra directly to bacteria and increases the chance of a UTI.
• Bladder prolapse: The front wall of the vagina keeps your bladder in place. Lack of estrogen can also weaken the tissues of the vaginal wall, and the bladder can prolapse, or descend into the vagina. This makes it more difficult to empty the bladder completely when urinating. When urine stays stagnant in your bladder, bacteria can multiply and cause a UTI.  

What are UTI symptoms for women after menopause?

UTIs may present themselves differently in postmenopausal women. You may not experience the common UTI symptoms (strong and frequent urge to urinate, burning sensation when urinating, etc.). Instead older women with UTIs can be asymptomatic:

• Urosepsis or septic shock (severe hypotension, fever, tachycardia, tachypnea).
• Have symptoms only of urinary incontinence, or a combination of symptoms.
• Mental changes or confusion, nausea or vomiting, abdominal pain, or cough and shortness of breath.
• A study of women aged 18 to 87 years revealed that a generalized sense of “feeling out of sorts” was frequent in adult women with acute uncomplicated lower UTI.

Treatment

The only way to cure a urinary tract infection is with antibiotics. Studies show that a 3-day course of antibiotics is equally effective over a 7-day course among postmenopausal patients.

• According to national guidelines, common antibiotics for treating UTIs are trimethoprim/sulfamethoxazole.
• Studies show that prescribing sulfonamides, ampicillin, and amoxicillin is not as effective as trimethoprim/sulfamethoxazole.
• Fluoroquinolones should not be considered as first-line therapy.
• Although nitrofurantoin is frequently used in pregnancy, it has not been studied among the postmenopausal population.

UTI prevention:

Hope Ricciotti, MD and editor in chief of the Harvard Women’s Health Watch, writes, “there are effective prevention strategies for healthy women at midlife who are struggling with recurrent UTIs.”  

• Urination:  When sitting on the toilet, make yourself comfortable in a relaxed seated position (not squatting). Start the stream of urine by relaxing the pelvic floor muscles, instead of straining to urinate. Give yourself the time you need to empty your bladder completely.
• Empty your bladder after intercourse because this helps flush out any bacteria that might have been introduced into the urinary tract during sex.
• Vaginal estrogen creams or rings can help restore the “good/bad” balance of  bacteria in your vagina. Speak with your doctor to see if this method works for you.
• Your doctor can also check to see if you have pelvic organ prolapse, which can be associated with an inability to fully empty your bladder.
• Take the prescribed antibiotics exactly as your physician prescribes. It is important to take the entire course to completely eliminate the infection and prevent it from coming back.
• Drink plenty of water.
• Avoid sitting in a bath, shower instead.
• Ditch the douches, feminine sprays, and harsh soaps in the genital area.
• Wear cotton underwear, go commando at night.
• Do not have intercourse while being treated for a UTI.
• Wipe front to back.
• Drink Uqora—an effective way to chase out UTI-causing bacteria using natural, safe ingredients, which is safe to use during pregnancy, breastfeeding, and for women of all ages.

Take control of your urinary health, don’t accept UTIs as a fact of getting older. If you are struggling with UTIs, speak with your doctor to find a solution specifically suited for you. Let’s face it, you have better things to do with your time than worry about UTIs-- Uqora is an effective and safe way to prevent UTIs for women after menopause.