What You Need to Know About UTIs and Sepsis

When "Charlie's Angels" and James Bond actor Tanya Roberts died on January 4, 2021, at the age of 65 due to complications stemming from a urinary tract infection (UTI), people were undoubtedly shocked. After all, isn't a UTI typically treatable with general antibiotics? What went wrong?

Turns out, complications can develop quickly and lead to sepsis, an extreme physical response to infection that leads to organ failure and possible death.

It's vital to recognize the signs and symptoms of a urinary tract infection before such a point, especially in women older than 65. Women in that age group are more likely to contract a UTI, a notion corroborated by a 2013 study published in Aging Health, which reported more than 10 percent of women older than 65 reported a UTI infection within a calendar year. The number jumps to 30 percent once women hit 85, according to the study.

Despite a higher prevalence in women, men experience increased incidences of UTIs as they age, too.

What causes UTIs?

While various factors trigger urinary tract infections, they primarily occur when bacteria get into the urinary tract through the urethra and continue to grow in the bladder. From there, bacteria develop into an infection.

"UTIs are especially common in women and can be caused by, or made worse by, a woman's female anatomy, sexual activity, types of birth control and menopause," said Aleece Fosnight, Medical Advisor at Aeroflow Urology.

"A factor to consider is a woman's changes in hormones," Fosnight explained.

"During menopause, women experience a decline in estrogen and testosterone, causing a change in the urinary tract and making them more susceptible to infection."

The decline in estrogen during menopause thins the lining of the vagina, compromising the protection it provides against harmful bacteria. For women in childbearing years or older women engaging in sexual intercourse with men, certain types of birth control, such as condoms and spermicidal foams, can also lead to urinary tract infections.

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Being a sexually active woman, especially if you've introduced a new partner, increases the tendency to contract a UTI. Sex can introduce bacteria to the urethra, and in particular, when the bacteria hasn't been in the body previously, as with a new partner, it can lead to infection.

There are many reasons why someone might be more susceptible to a urinary tract infection, according to Fosnight.

"Those who have diabetes or other diseases that weaken the immune system can also be more prone to UTIs. Additionally, people who use a catheter due to not being able to urinate on their own and those who have had a recent urinary procedure both increase the risk of developing an infection," Fosnight explained.

It's also possible to be susceptible to UTIs due to congenital urinary tract abnormalities where urine cannot leave the body normally, causing urine to back up in the urethra, though this generally applies to young people.

Warning signs

"The well-known symptoms of a UTI include dysuria, burning, irritation while urinating, increased pelvic pressure, particles in urine, and cloudy or bloody urine. Women can also experience pelvic pain around the pelvic bone and center of the pelvis," Fosnight said. "Some people will feel pain in their lower back and the urge to urinate frequently, even if nothing much is coming out. Loss of bladder control can occur, as well as unpleasant-smelling urine."

When a urinary tract infection starts to turn into a life-threatening condition because of sepsis, there are additional, lesser-known warning signs. When people experience sepsis, the body triggers a chemical reaction throughout, which results in extreme levels of inflammation. Symptoms for sepsis can include a fever, difficulty breathing, low blood pressure and a fast heart rate, among others.

Symptoms for sepsis can include a fever, difficulty breathing, low blood pressure and a fast heart rate, among others.

"A common symptom older women tend to experience when a UTI is turning into sepsis is sudden confusion," Fosnight said. "In certain cases, this can make it harder to diagnose someone of this age with a UTI, especially if they could potentially have Alzheimer's or dementia."

It's crucial to address these symptoms immediately. If the infection is not diagnosed when the above symptoms present, later signs of a UTI can show a fever, nausea, vomiting and pain in the lower abdomen, where your kidneys are located. If urinary tract infections progress past these symptoms and are left untreated, they can spread to the kidney and cause pain and illness known as urosepsis.

Prevention

One of the leading causes of urinary tract infections is entirely preventable and simple to control.

"Dehydration is the most common underlying cause of a UTI, due to the fact that we tend to drink less as we age," Fosnight said. "It's important to focus on increasing your water intake specifically—coffee, tea and any sugar-free drinks don't count when it comes to hydration."

It's recommended for women who are 60 and older to drink a total of at least 60 ounces of water per day, allowing for bacteria to get adequately flushed out of the urinary tract and keep the kidneys healthy.

"The more concentrated your urine is, the higher chance of bacteria staying in the urethra and traveling up to the upper urinary tract, resulting in septic infection," Fosnight said.

Practicing good hygiene is another way to decrease the chances of having a UTI develop into a septic infection. You should clean your genitals before and after sex, and use the bathroom afterward to flush out any bacteria that may have gotten into your urethra.

"Women who experience urge or mixed incontinence need to discuss their condition with their healthcare provider and make sure they regularly change their leakage pads, which can be a breeding ground for bacteria if worn all day," Fosnight added.

Immediate care is necessary

According to the CDC, approximately 270,000 Americans die as a result of sepsis each year. One in 3 hospital deaths is due to sepsis, though 87 percent of those cases begin outside the hospital. Urosepsis, or sepsis caused by an infection in the urinary tract, is one of the leading causes of this condition.

While UTIs may seem like an inconvenience that can be cleared up with a quick round of antibiotics, it's best to address any concerns as soon as possible. Some UTIs are asymptomatic at first, so it's important to keep an eagle eye out for any noticeable symptoms.