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Overactive Bladder
June 17, 2022 2 min read

What is the recommended treatment of an elderly patient with incontinence and recurrent UTIs?

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By Board Certfied Urologist, Dr. Yana Barbalat

Incontinence and recurrent UTIs often co-exist in the same population of geriatric patients. Therefore, it can be tricky to figure out whether to treat a UTI based on the degree of incontinence. UTIs can cause an increase in severity of incontinence, but I have found that typically is not the case. The two often co-exist parallel to each other.

When an elderly patient presents to my office with incontinence and a urine culture positive for a UTI, without any other symptoms, I typically get a catheterized urine sample to really make sure this is true bacteriuria. If the culture is still positive, I will treat the infection to see if the symptoms improve. If they do not improve much, then I know that the incontinence is not a “symptom” of a UTI in that patient. The goal becomes to treat the incontinence if the patient is bothered, rather than chase and treat the infections.  

There are some patients that have “worsening” incontinence when they have a UTI. If that’s the case and their incontinence improves after treatment of UTI, then it’s reasonable to consider “worsening incontinence” a symptoms of UTI in that particular patient. However, I still get a clean catch urine sample before treating any such infections since many factors can contribute to “worsening incontinence” in the elderly. 

The American Urological Association and the Canadian Urological Association guidelines specifically state not to treat asymptomatic urinary tract infections in any patient unless they are pregnant or about to undergo a urological procedure. There are many elderly patients that have bacterial colonization as opposed to infection. Those patients generally do not need to be tested or treated. 

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