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THE HEALTH | MAY , 2021
| Hot Topic |
Painful urination : Early sepsis ?
It is important to detect and treat urinary tract infection early to prevent it from escalating into something more serious
According to studies , one in three women experience UTI , compared to one in 20 men . The frequency increases with age , which means that older people are at higher risk of getting UTI . Recurrent UTIs mean having three or more episodes in a year or two or more episodes in six months . ”
SEPSIS ALERT
BY DR LOO SAY YEE
AND ASSOC PROF DR TAN TOH LEONG
Mrs M is an 85-year-old female who stays in a nursing home . She has dementia and diabetes .
She has been bed bound for two years ago due to a broken right hip . Mrs M has urinary incontinence and was diagnosed with frequent urinary tract infection ( UTI ), about two to three times yearly .
What is UTI ?
UTI occurs when the germs from our skin around the groin , enter our urinary tract via the urethra , which is the tube that allows urine to pass out from our body connected to bladder and kidney . UTI can be quite uncomfortable , even among the younger people .
According to studies , one in three women experience UTI , compared to one in 20 men . The frequency increases with age , which means that older people are at higher risk of getting UTI . Recurrent UTIs mean having three or more episodes in a year or two or more episodes in six months . Further investigation is needed to find out the cause .
Why does it occur more often among the elderly ?
In general , the elderly have lower immunity towards infection . Poor health conditions , diabetes or having a stone in the urinary tract increases the chance . Women ’ urethras are shorter compared to men , therefore it is easier for the germs that travel to the bladder .
As we get older , the lining of the urethra and bladder become thinner , especially amongst the post-menopausal women . Sometimes , dry skin around the vagina or involuntary leakage of urine may worsen the condition .
For older men , an enlarged prostate is a common risk . Due to partial blockage of urination , urine usually pools in the bladder for longer time . This will attract the germs to grow in the bladder . Sometimes , a catheter is needed to drain the urine but this itself also increases the chance of infection .
How do we know if we have UTI ?
UTI usually causes burning pain on urination and frequent urination . It can be quite tricky for older adults to tell us if they are having UTI as the presentation may not be obvious or they may be demented like Mrs M . So , what are the warning signs for us to know if older adults are having UTI ?
The elderly may appear to be confused , tired , sleeping more than usual or having frequent falls . Some may have fever with nausea and vomiting , pain over the lower part of the tummy or back .
These are signs of early sepsis . Having urinary incontinence , smelly and cloudy urine ( or with blood ), frequent small amounts or with a great need to go to the toilet for urination are also common complaints .
How to treat UTIs
Once UTI is suspected , we need to get treatment from the doctor . A good course of antibiotics will usually treat the problem . However , if there is recurrent UTIs or more complicated issues are found , further investigation and treating the underlying cause is needed .
Preventing UTI in older adults
There are many simple ways we can keep UTI away . Having good personal hygiene is important . For ladies , after urination or having a bowel action , we should wipe from front to back to prevent the spreading of bacteria from the anus .
Wearing cotton underwear also helps . Other natural ways to help prevent UTI include drinking enough water ( at least 2 L / day ) to help with flushing of the urinary tract , cranberry juice and lactobacillus containing yogurt .
Finally , the take home message is : UTIs are common in older adults . Keeping the genital areas clean helps prevent UTI .
Always remember to wipe from front to back after urination or bowel action . And seek treatment early if UTI occurs . — The Health
Dr Loo Say Yee is a Trainee Lecturer in Family Medicine , Faculty of Medicine , UKM and a Committee Member of Malaysian Sepsis Alliance ( MySepsis ) while Associate Professor Dr Tan Toh Leong is a Senior Lecturer and Consultant Emergency Physician at Universiti Kebangsaan Malaysia Medical Centre ( UKMMC ) and President and Founder of MySepsis .