Symptoms of urinary infections in post-menopausal women are probably among the most common reasons that urgent appointments are made to see not only urologists but also primary care and gynecological practitioners. Common symptoms are burning, frequency, urgency, nocturia, and sometimes blood in the urine. Some urinary infections are found incidentally and without symptoms. The evaluation and care of urinary infections in post-menopausal women are discussed here.
When Would You Need to See a Urologist?
Apparent urinary infections found without symptoms are somewhat of a dilemma. Usually if found by primary care or gynecology this will be treated and if recurrent a referral to a urologist will often be made. I have seen signs of infection in the urine like white cells and even positive cultures that are rarely associated with bladder tumors, and probably more commonly with stone disease or hypotonic bladder, a situation where the bladder muscles are weak and the bladder doesn’t empty well.
One method of diagnosis is doing a complete work up such as kidney X-rays or ultrasound and cystoscopy only if the recurrent UTIs are of the same organism on cultures and respond quickly to antibiotics. That may be reasonable in an academic setting or a research study, but I don’t think most urologists would feel this kind of narrow setting for further evaluation is reasonable. If work up is negative and there are not significant symptoms related to bacteria found in the urine, the diagnosis of asymptomatic bacteriuria can be made, and that condition can be observed without aggressive antibiotic treatment which can lead to resistance and more symptomatic UTIs.
Preventive measures in some cases can include local estrogen cream to improve the vaginal tissue condition which can increase resistance to developing UTIs but there are some risks to this treatment which remain controversial. Daily cranberry tablets or juice can prevent bacteria attaching to bladder tissue and establishing conditions to develop a UTI. Staying well hydrated can also help simply by diluting and flushing out any bacteria that find their way into the bladder.
If a patient does suspect a UTI I would suggest the patient insist on not just a urinalysis to look for suspicion of UTI but also a culture to prove infection, identify the bacteria, and make sure whatever antibiotics were prescribed will work based on the sensitivity testing that is part of any urine culture.
Urologists are often charged with determining the cause of a UTI and how to best treat and prevent recurrences and having that information as a baseline can be very helpful. If you suspect you have a UTI, Dr. Newman of Las Vegas Urology can help.