It burns when I pee and I keep having to urinate: Why women get recurrent urinary tract infections as they age

Painful peeing, the constant urge to go to the bathroom, sleepless nights from too many bathroom trips, lower abdomen discomfort, and feeling tired, overall. It’s the dreaded urinary tract infection (UTI), which some women notice seems to occur more frequently as they get older.   

Some of my girlfriends, who are in their forties, told me they’ve been dealing with recurrent UTI episodes in recent years. And it’s not like they’ve been getting busy with their partners, so sexual intercourse is unlikely to be a factor. So, what gives?

Recurrent UTI is defined as having two acute infections in six months or three infections in a year, said Dr Beh Suan Tiong, consultant obstetrician and gynaecologist of Beh Clinic for Women.

While experiences vary, older women are indeed more prone to recurrent urinary tract infections, he said.

Among Dr Beh’s patients, some have reported getting UTI several times a year, while others, who might have had sporadic UTI in their youth, have been experiencing it more frequently as they get older.

WHY WOMEN ARE MORE SUSCEPTIBLE THAN MEN

UTI is a bacterial infection affecting the urinary system, which comprises the bladder, kidneys, ureters and urethra. Common symptoms include a frequent urge to urinate, a burning sensation during urination, cloudy or bloody urine, and discomfort in the lower abdomen and/or fever.

The common organ affected is the bladder, but sometimes the infection may be more serious and can involve the kidneys.

The reason why women get UTI more often than men is due to our shorter urethra, the tube that allows urine to pass from the bladder to outside the body.

In females, it’s short – up to about 4cm, said Dr Christopher Chong, obstetrician and gynaecologist at Gleneagles Hospital. That makes it easy for bacteria or any infective organism to move up the urethra to the bladder, causing infection. 

Males have a longer urethra, covering the length of the penis, he added. “Before the organism can travel to the bladder, often the man would have passed urine and the organism would be naturally flushed out, hence avoiding a bladder infection.”

Another factor for women being more prone to UTI: The proximity of the urethra to the anus, which increases the risk of bacterial transfer, said Dr Beh. Add to that, hormonal changes during menopause or pregnancy, which can further increase susceptibility.

WAS IT BECAUSE YOU HAD TOO MUCH SEX?  

There’s an old wives’ tale that too much sexual intercourse can lead to a higher risk of UTI. There is some truth to this – Dr Chong said intercourse can draw infecting organism into the bladder, introducing infection into the urinary tract.

But sex isn’t the only cause. Genetics, anatomy and underlying health conditions are equally important, said Dr Beh. This is why babies, and women who have never had sex or given birth can still develop UTI.

Dr Chong added that certain health conditions, such as diabetes, cancer, autoimmune disease and even those on long-term steroids use, can result in low body resistance, which when met with a high infection rate can lead to an increased risk of UTI.

IT IS AN AGE THING

If you’re wondering why UTI seems to hit you more as you age, Dr Beh explained that its recurrence “can be attributed to age-related changes in the urinary tract, reduced oestrogen levels, a thinner protective lining of the bladder and weaker pelvic floor muscles”.

The symptoms of UTI are generally consistent, although older women may experience additional symptoms, such as incontinence, changes in urinary patterns and vague abdominal discomfort due to the influence of menopause and age-related factors, he added.

Dr Chong said that women should also be aware that every UTI they get decreases the resistance of the affected area, that is, the bladder. “Cumulatively, the more infection, the lower the resistance.”

During menopause, because there is less oestrogen, the vagina and urinary tract become very dry, and the tissues, very thin. “The thinner and drier the skin, the easier for organisms to penetrate,” Dr Chong added.

But that’s not all. Having UTI episodes in your youth may increase the likelihood of recurring infections later in life, due to potential scarring or damage to the urinary tract, Dr Beh said. 

ACCURATELY IDENTIFYING THE PROBLEM

When it comes to treating persistent, recurring UTI, Dr Chong said it’s important to treat the root cause. For example, the most common infection for UTI comes from the vagina. However, if you were to only treat the bladder infection and not the vaginal infection as well, then resistance to the infection and recurrence can happen in the future.  

He added that prescribing the right medication is crucial. To do that, the first step is to accurately identify the problem.

This goes beyond doing a simple urine test to check for signs of infection. If you suspect you have a UTI, you can ask your doctor to do a urine culture and sensitivity test.

The test takes about three days and involves growing the infecting organism in the lab. It will also match a series of routine antibiotics to any bacteria found in your urine, to see what antibiotics it might be sensitive or resistant to, Dr Chong explained.

“The doctor would have given a course of antibiotics if UTI is suspected even before the urine culture results are back,” he said. And if the results show that the bacteria present is resistant to the antibiotics given, the doctor would be able to switch the patient to more sensitive antibiotics.

“Otherwise, the UTI may not be treated or worse yet, it may become even more difficult to treat in the future,” Dr Chong said.

WAYS TO PREVENT URINARY TRACT INFECTION

Both doctors say women can do some simple things to prevent UTI:

• Stay well-hydrated to flush out any bacteria from the urinary tract
• Urinate before and after sexual intercourse to reduce bacterial entry
• Maintain proper hygiene by wiping from the front to the back
• Avoid using irritating feminine hygiene products
• Wear breathable cotton underwear and avoid tight-fitting pants
• Take supplements like probiotics for the bladder, as well as immune boosters
• Increase your body resistance by sleeping well, reducing stress levels, exercising regularly and eating a balanced diet

For older women, Dr Chong also suggested preventing or treating vaginal atrophy – the thinning, drying and inflammation of the vaginal walls – by using enough lubrication during sexual intercourse.

There is also laser therapy of the vagina, which helps to remodel and regenerate collagen at the area. “This will thicken the vaginal and bladder tissues, making bacteria more difficult to penetrate,” Dr Chong explained, adding that it is done by the doctor in the clinic, takes just two minutes and is not painful.

Dr Beh also recommended doing pelvic floor exercises to maintain muscle tone, opting for topical oestrogen therapy to counteract menopause-related changes or speaking with your healthcare professional about taking prophylactic antibiotics, especially if UTI episodes persist.

Read this story in Bahasa Indonesia here.