You are here:

Urology/UTI infections


Hello, my mother is 84 years old. She currently has a UTI. She has them quite a bit. She is on amoxicillin for the second time in a four week period. This time her GP has her on a more powerful amoxicillin pill. I have two questions at what point should she see a urologist ? Secondly a retired LPN friend of mine that worked in a nursing home claims that most elderly people has some form of UTI most of the time and I shouldn't be overly concerned about this. I totally disagree ! What is the truth ?
Thank You!


Nursing homes often have people with infections but studies have suggested that they are often overtreated, overdosed or incorrectly treated.

For your mother, we typically recommend treatment of UTIs by a urologist when we're dealing with 3 or more UTIs within one year and they don't respond to hygienic modifications.  A copy of my patient guide on proper hygiene follows:

Preventing Urinary Tract Infections
Stephen W. Leslie, MD FACS
Urinary tract infections (UTIs) are extremely common especially in women.  About 50% of all women will have at least one such infection at some time.  While a UTI is usually just bothersome with symptoms such as burning on urination, urinary frequency, urgency, nocturia and odor, it is possible for a urinary tract infection to progress and affect the kidneys or other organs which can potentially be serious.
When a patient has three or more urinary tract infections within one year, this is called a recurrent infection and a medical review may be recommended.  Much of the time, the problem can be easily corrected with some simple changes in personal hygiene.  Of course, you donít have to wait for three new infections before starting any of the following suggestions.  Donít feel bad if you are not doing everything correctly as most women will find several things they could improve.  Just make the necessary changes starting right now and help reduce your future risk of urinary tract infections.

Wash Your Hands Before Wiping:  Wash your hands before you use the toilet to urinate or at least before wiping. You should also wash your hands before you get into the shower to avoid passing germs from your hands back to your body near the bladder opening area.

Wipe Front to Back:  Always wipe yourself from the front to the back after you urinate.  Start from the front and push down and away towards the rectum.  Donít try to reach from behind because your hand, wipes or tissues will pick up germs and bacteria from the rectum.  Most urinary infections are from bacteria that normally live around the rectum and anus.  Any wiping motion that starts nearer to the rectum and then approaches the bladder opening area will move potentially dangerous bacteria closer to the bladder and urinary tract.  Also wipe the same way, front to back, after a bowel movement.  

When You Wipe, Use Toilet Paper or Baby Wipes, But Only Wipe Once:          Itís OK to use toilet paper to wipe after urination, but just wipe once or you may actually add more bacteria to the bladder opening area.  Sterile baby wipes are even cleaner than toilet paper and you can carry them with you in your purse for use outside the home.  They can also be useful if no other wipes are available!  As a general rule, anything safe for babies can also be used in the delicate area around the vagina and bladder opening.
Avoid Baths:  Bath water is full of dirt and bacteria from your skin.  Sitting in a tub just gives the bacteria an easy way to reach the urethra and bladder opening area.  After all, you wouldnít drink that water, would you?  So donít put your bladder opening area, which we are trying to keep as clean as humanly possible, in the dirty filthy water!  If you absolutely must take a bath instead of shower, donít use any bubble bath or other cosmetic bath additives which tend to be irritating to the delicate skin of the vaginal mucosa.

Take Showers Instead:  Showers are much preferred to baths in women who are prone to urinary tract infections.  Just let the water run off naturally and donít spray any water directly into the vagina or bladder opening area.  

Avoid Luffas and All Reusable Sponges:  Luffas and other reusable sponges including nylon cannot be adequately cleaned or sterilized once used, so they retain bacteria that cannot be eliminated.  They also are used over and over for days, weeks or even months during which they can accumulate more and more bacteria and germs.  Women who are prone to infections, especially UTIs, should absolutely not use or even touch such reusable but heavily contaminated items.


Use A Gentle Liquid Soap When Washing Yourself:  Bar soap will always have some germs and bacteria on it just due to exposure to the air and bathroom environment.  Also, other household members may handle it and use it.  Body wash is fine for regular skin cleaning, but regular body wash is too harsh for the very gentle tissue of the vagina and bladder opening area.  Itís important to avoid using products with unnecessary perfumes, astringents, creams or other possibly irritating chemicals.  We recommend using a gentle liquid soap with minimal additives such as Ivory, Eucerin, Dial or Neutrogena.  You can also use any gentle liquid baby soap because if itís safe for babies, itís probably OK for the bladder opening area, too.  


Use Washcloths: The best and cleanest way to apply soap is to use a very clean washcloth.  The washcloths can be placed into a clean, sealable plastic bag immediately after they are washed and dried as they are cleanest when they are just coming out of the dryer.  This keeps them extra clean until they are used and avoids any bacterial contamination from body spray in the shower or unnecessary handling.  No matter how often you wash your hands, they will not be as clean as these freshly laundered washcloths.  You may want to use a second washcloth to finish your shower after youíve properly cleaned the bladder opening area.    

Clean the Bladder Opening Area First!:  The bladder is the only area of the body that can get infected if it isnít cleaned properly when you wash yourself.  Since itís the most important area to get clean, it should be washed first before the washcloth or your hands have picked up any dirt, germs or bacteria from other parts of your body.  When we do surgery, we clean the surgical site first before moving to the surrounding area.  The same principle applies to cleaning the bladder area.  Remember to only wipe once, wiping from the front towards the back.

How to Wash Yourself - Summary:  Wash your hands first, even before you get into the shower.  Take a fresh clean washcloth from the sealed plastic bag as described previously.  Wet the washcloth, add some clean liquid soap, and clean the bladder opening area first with a single front to back wipe with the washcloth.  Rinse well without directly spraying the bladder opening area.  The washcloth used to clean the bladder opening area should probably not be used for anything else and should only be used once before being laundered.

Douches May Be Okay, But Avoid Other Personal Hygiene Products:  In most cases, a vinegar and water douche or a douche with iodine or benzalkonium chloride is helpful if carried out correctly at appropriate intervals.  Donít use any feminine hygiene sprays, cosmetics, perfumes, medicated towelettes or similar products in the vagina or bladder opening area unless specifically approved by your physician.

Use Tampons For Periods:  Tampons are advised during your menstrual period rather than sanitary napkins or pads.  A tampon will keep the bladder opening area drier and cleaner than a sanitary pad and help keep any bacterial growth and contamination away.

Avoid Long Intervals Between Urinations:  Try to empty your bladder at least every four hours during the daytime while youíre awake even if you donít feel the specific need or urge to void.  When you do feel the need to empty your bladder, donít try to ďhold itĒ until a more convenient time or place.  When your bladder is telling you itís time to go potty, listen to it and use the restroom as quickly as possible.

Donít Wear Tight Clothes:  Avoid wearing pantyhose, bathing suits or tight slacks for prolonged periods.  Cotton panties for general use are suggested.  Try to avoid habitual leg crossing.  All of these will tend to press the skin folds around the vagina into the body and may introduce more bacteria into the area around the bladder opening.          
Drink More Water:  Start with one extra glass with each meal.  If your urine appears any darker than a very pale yellow, this could mean that you are not drinking enough and should increase your fluid intake.  Cranberry juice is helpful in patients with urinary tract infections, but if you donít like cranberry juice you can or substitute other beverages.

Take Some Extra Vitamin C and Drink Some Cranberry Juice:  Your physician may recommend taking some additional Vitamin C.  This may help increase your bodyís resistance to infection.  Extra Vitamin C that your system canít use immediately will be released into the urine where it helps block bacterial growth.   As noted earlier, cranberry juice may be of some extra benefit in reducing urinary tract infections.  If you donít like cranberry juice, you can get the same benefit from cranberry pills which are available in most drug and health food stores.
Avoid Irritating Foods Like Caffeine:  Symptoms of bladder irritation may be aggravated by caffeine, regular coffee, tea, alcohol, ďhotĒ spices, ďNutraSweetĒ, chocolate, cola drinks and high potassium foods like bananas and oranges.
Avoid Activities That increase Your Risk of Bladder Infections:  Prolonged bicycling, motorcycling, horseback riding and similar physical activities and exercises may increase your risk of bladder infections.  You may need to limit these types of activities.  When you do engage in physical activity and exercise, make sure to empty your bladder frequently and drink plenty of water and other fluids.  Sexual activity may also increase your risk because it can introduce bacteria into the bladder area.
Take Special Precautions After Sexual Activity:  After intercourse, empty your bladder and drink two extra glasses water.  Some patients will be advised by their physicians to take a urinary antiseptic or antibiotic after sexual activity.  Make sure you take the medication exactly the way and at the time your physician suggested.
An Estrogen Vaginal Cream May Help Increase Resistance to Bladder Infections:  
Your physician may suggest an estrogen cream for the vagina if you have had menopause even if you are already on an oral estrogen supplement or patch.  The vaginal cream will help keep the tissues around the bladder opening healthy and more resistant to infection.
Take Antibiotics Only As Prescribed by Your Doctor:  If your physician has prescribed a medication to take as preventive therapy, you should follow his instructions carefully.  Be aware that medications may be necessary for up to a year or more depending on the nature and severity of the urinary infection problem.  For some patients, a small amount of a urinary antibiotic or antiseptic taken daily at bedtime will prevent most urinary infections, give the bladder a chance to heal and restore its natural resistance.  Other patients may be told to take an antibiotic only when they think they are getting an infection.  Take any prescribed medication the way your physician recommended.  If you donítí remember exactly how to take the medicine and there are no clear instructions on the container bottle, contact your physician or pharmacist.

If You Follow All These Suggestions And Get An Infection Anyway:  The guidelines and suggestions listed here will help most women avoid bladder infections most of the time.  If you get an infection in spite of these precautions, seek medical help promptly.  A urine specimen for examination should be given to your physician if requested.  See prompt help for excessive vaginal discharge or other signs of vaginal inflammation and infection.  If an antibiotic has been given to you to use for this purpose, you may begin taking it.  In some cases, your physician may request additional tests such as kidney X-rays or a direct examination of the bladder with a telescope.  Sterilization of your washcloths may be the next reasonable step to take for those where simpler measures have not been adequate.
Sterilizing Washcloths for Home Use
Your doctor may recommend sterilizing washcloths for washing and personal hygiene to help prevent recurrent urinary tract infections.  This extra step is probably unnecessary for the majority of patients with recurrent infections, but it can be very helpful for the more severe or resistant cases.  Use only those washcloths purchased for this purpose and remember to wipe correctly from front to back.
Home Sterilization of Washcloths
1.   Wash the washcloths with hot water and soap or detergent as you normally would in your clothes washer.  If you donít have washer, use soap and hot water in your sink.
2.   Boil the washcloths in water for at least 20 minutes.
3.   Take the washcloths out of the water and allow them to dry or use your clothes dryer.
4.   When dry, place each washcloth in a separate, sealable plastic bag such as a iplock bag.
6.   Place the bags in your microwave.  In the center of the microwave, put a large glass of cold water.  DO NOT PLACE THE BAGS WITH THE WASHCLOTHS IN TH WATER!
7.   Put the microwave on High for five minutes and turn it on.  Replace the glass of cold water (now very hot!) with a new glass of cold water and microwave on High for an additional five minutes.  
8.   Let the bags cool; then close them.  You now have a sterile washcloth inside a sterile bag.

This technique will kill the germs and bacteria on the washcloths by using microwave radiation for sterilization.  Without the glass of cold water to absorb the heat, the bags would melt and the washcloths would catch fire.

ē   Wipe in the correct direction; from front to back.
ē   Wash your hands before using washcloths, tissues or toilet paper for wiping or washing yourself.
ē   Use a clean, gentle liquid soap because it tends to be much cleaner than bar soap.
ē   Only wipe once with each washcloth or tissue.  If you need more, use another washcloth.
ē   Clean the bladder area first when you wash yourself to prevent contamination with bacteria from other parts of the body.
ē   Donít use these washcloths for any other purpose except to clean the area around the bladder opening.
ē   Drink extra water and take some extra Vitamin C.  Drink cranberry juice or take cranberry pills.  Consider using an estrogen cream twice a week if you are past menopause.


All Answers

Answers by Expert:

Ask Experts


Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

©2016 All rights reserved.