Cystitis in Elderly Female: Tackling Bladder Infections

Cystitis, a bladder inflammation, is the most common type of Urinary Tract Infection (UTI). This condition typically arises when bacteria, primarily from the bowel, travel up the urethra and rapidly multiply once inside the bladder. 

Cystitis is particularly prevalent among women due to their shorter urethra and the proximity of the urethra. It is also common in elderly women due to physiological changes associated with aging, such as decreased Estrogen levels and changes in the urinary tract.

This article will look at Cystitis in elderly females, its symptoms, causes, treatment options, and prevention methods. 

Symptoms of Cystitis in elderly women

The symptoms of Cystitis can vary, but they commonly include:

• A stinging or burning sensation during urination
• Passing only small amounts of urine at a time
• A frequent urge to urinate
• A sensation of incomplete bladder emptying
• Urine that is smelly, cloudy, dark, or bloody
• Lower abdominal pain
• Nausea, fever, and headache (though these are less common)

Cause of Cystitis in elderly female

Cystitis is common in women of all ages, with approximately 30-50% experiencing it at some point. However, older women are especially susceptible due to several factors:

Post-menopausal changes

The decline in Estrogen levels that accompanies Menopause leads to significant changes in the urinary tract. Estrogen maintains the strength and elasticity of the vaginal and urethral tissues. After Menopause, the lack of Estrogen can make the lining of the urethra thin and become more susceptible to infection. 

Incomplete bladder emptying

As women age, they may experience difficulty fully emptying their bladder due to weakened bladder muscles or neurological conditions. Residual urine in the bladder can harbor bacteria, leading to recurrent infections.

Incontinence

Urinary incontinence, common among elderly women, can increase the risk of Cystitis. Incontinence products like pads and adult diapers can create a warm, moist environment that develops bacterial growth. Additionally, the skin around the urethra can become irritated, making it easier for bacteria to enter the urinary tract.

Weakened immune system

Aging often results in a weakened immune system, making it harder for the body to fight infections. This decreased immune response means that bacteria that enter the urinary tract are more likely to cause infection and inflammation in elderly women.

Catheter use

Catheters, often used by older women with severe mobility or incontinence issues, can introduce bacteria into the bladder. Long-term catheter use is a significant risk factor for urinary tract infections and Cystitis. 

Difficulty maintaining hygiene

Physical limitations or cognitive decline can make it challenging for elderly women to maintain proper personal hygiene. Difficulty in cleaning the genital area adequately can cause bacterial contamination and increase the risk of Cystitis.

Medical conditions

Women with diabetes are at risk of developing Cystitis due to a weakened immune system and elevated glucose levels in the urine. Similarly, women with kidney stones can obstruct the urinary tract and create a breeding ground for bacteria, leading to recurrent UTIs.

Treatment of Cystitis in elderly women

Treating Cystitis in elderly women requires careful consideration of several factors, including the specific causative organism. 

Antibiotic for uncomplicated Cystitis

For uncomplicated Cystitis following antibiotics works best: 

• Nitrofurantoin: It is to be taken 100 mg orally twice per day for 5 to 7 days. This drug is bacteriostatic and is effective in the urinary tract
• Trimethoprim-Sulfamethoxazole: Take 160 mg/800 mg two times a day for 3 days if local resistance is less than 20%
• Fosfomycin: A single dose of 3 grams orally. Phenazopyridine can be used as adjunctive therapy for dysuria
• Ciprofloxacin or Levofloxacin: These are generally not preferred as first-line therapy due to increasing resistance, but they may be used if no other options are appropriate
• Amoxicillin-Clavulanate: 500/125 mg two times daily for 7 days or Cephalexin 250 mg four times per day for 3 to 7 days can be considered as alternatives

Treatment duration

While a three-day course of therapy often achieves excellent cure rates, longer treatment durations (5-7 days) may be necessary, especially in elderly women with more severe or recurrent infections.

Complicated Cystitis

For complicated Cystitis, antibiotic therapy typically lasts longer than uncomplicated cases, ranging from seven to fourteen days.

• Nitrofurantoin Monohydrate: 100 mg orally twice per day for 5 to 7 days. This antibiotic is often preferred due to its effectiveness and lower risk of resistance
• Trimethoprim-Sulfamethoxazole DS: Take 1 double-strength tablet orally twice a day for 7 to 10 days
• Ciprofloxacin: 500 mg orally twice daily for 7 to 10 days if other antibiotics are not working. This option is generally for cases where first-line treatments are unsuitable

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Catheter management

The catheter should always be replaced when treating a UTI to avoid contaminating urine cultures. Gentamicin solution should be used as an additional treatment option in patients to reduce the bacterial load and prevent further infection.

Generally, prophylactic antibiotics are not recommended for patients with catheters. However, they may be considered in selected cases, particularly at the time of catheter changes, if the healthcare provider deems them appropriate. 

Home care management

Elderly women should focus on the following self-care measures:

• Completely empty the bladder when you urinate
• Get plenty of rest
• Use mild painkillers like paracetamol to manage pain if necessary
• Apply a heat pack to the abdomen to reduce pain, ensuring to check the skin regularly to avoid irritation

Recurrence and prevention

Women who have experienced Cystitis are likely to encounter it again. For elderly women, recurrent Cystitis might be more frequent, and prompt treatment is important to prevent complications.

Preventive measures for Cystitis include:

• Drinking plenty of water
• Urinating frequently and ensuring the bladder is completely emptied
• Wipe from front to back after using the toilet
• Avoiding perfumed soaps or products on the genital area
• Treat any vaginal infections promptly
• Consider daily cranberry juice or supplements, but inform the doctor as they can interact with certain antibiotics

Conclusion

Cystitis represents a significant and recurring challenge for elderly women. The decline in Estrogen levels post-menopause, incomplete bladder emptying, and weakened immune systems all contribute to urinary tract infections. 

Additionally, factors such as urinary incontinence, catheter use, and difficulties in maintaining hygiene further exacerbate the risk of developing Cystitis. Symptoms like burning sensation during urination, frequent urges to urinate, lower abdominal pain, and changes in urine appearance can indicate the onset of an infection. 

Treatment of Cystitis in elderly women requires a careful approach. While antibiotics like Nitrofurantoin and Fosfomycin are commonly used, the duration of treatment may need to be extended for severe or recurrent cases. Proper catheter management, including regular replacement and maintaining hygiene, is important to reduce the risk of infection in the presence of catheters.

Preventive strategies can manage Cystitis in older women. These include maintaining proper hydration, practicing good hygiene, emptying the bladder, and avoiding irritants such as perfumed soaps.

Regular follow-ups with healthcare providers can help monitor the condition, ensuring that elderly women receive the most effective care for managing Cystitis.

Frequently Asked Questions

• safercare.vic.gov.au
• ncbi.nlm.nih.gov
• betterhealth.vic.gov.au