If you have ever had a urinary tract infection, or UTI, you know how fast it can take over your day: the burning, the urgency, and bathroom trips that never seem to help. After 50, a UTI can be more than an annoyance. It is one of the most common infections in older adults, and it is not only a women's issue. November puts the spotlight on men's health, which makes this a good time to talk about how women and men can both lower their risk.
Why Women Get Hit Harder After Menopause
For women, the story starts with estrogen. Before menopause, estrogen keeps the tissue of the vagina and urethra healthy. It also supports the protective bacteria, called lactobacilli, that help guard the area against infection. When estrogen drops, that tissue thins, the protective bacteria decline, and germs that cause UTIs have an easier time taking hold (Perelmuter et al., Journal of Women's Health, 2026). About half of all women will have at least one UTI in their lifetime, and at least 1 in 4 women who have one will go on to have repeat infections (Raphael and Huang, JAMA Internal Medicine, 2024).
Where Vaginal Estrogen Fits In
This is where estrogen comes back into the conversation, and the evidence is stronger than most women are ever told. The American Urological Association's guideline, updated in 2025, recommends vaginal estrogen for perimenopausal and postmenopausal women who keep getting UTIs, as long as there is no reason they should not use it (American Urological Association, 2025). A 2026 review called vaginal estrogen evidence-based yet underused. One reason may be that these products are officially approved for vaginal dryness and related menopause symptoms, not specifically for UTI prevention (Ghasoub et al., Gynecologic and Obstetric Investigation, 2026).
Vaginal estrogen comes as a cream, tablet, or ring placed in the vagina, and it works directly in the tissues that need it. Very little reaches the bloodstream. It is not the same as estrogen pills or patches, which have not been shown to prevent UTIs (American Urological Association, 2025). If you have a history of breast cancer, there is good news. Vaginal estrogen has not been shown to raise the risk of breast cancer coming back, and the guideline supports considering it together with your oncology team (American Urological Association, 2025). Talk with your oncologist and your provider together before you decide.
What Else Actually Helps
Drinking more water can help, especially if you do not drink much now. A 2020 review of randomized trials found that people prone to UTIs who increased their fluids had about half as many repeat infections (Scott et al., British Journal of General Practice, 2020). The best of these studies was done in younger women who started out drinking less than about 1.5 liters (roughly 50 ounces) a day (Hooton et al., JAMA Internal Medicine, 2018). The 2025 urology guideline suggests drinking more water for women below that amount (American Urological Association, 2025). Ask your provider what amount is right for you, especially if you have a heart or kidney condition that limits fluids.
Cranberry has more science behind it than many people realize. A 2023 Cochrane review, one of the most rigorous kinds of evidence review, found that cranberry products reduced repeat UTIs in women who get them often, by about a quarter (Williams et al., Cochrane Database of Systematic Reviews, 2023). The same review did not find a clear benefit for older adults living in nursing homes or for people who have trouble emptying their bladder. In 2025, the American Urological Association began recommending that clinicians offer cranberry as a prevention option. The guideline notes that products providing at least 36 mg of the active ingredient, proanthocyanidins (PACs), appear to work better (American Urological Association, 2025). Many products do not list PAC content, so check the label.
There is also a non-antibiotic prescription option called methenamine hippurate. In a large trial in women with repeat UTIs, it prevented infections nearly as well as daily low-dose antibiotics, without the long-term antibiotic use (Harding et al., BMJ, 2022). The 2025 urology guideline lists it as an option (American Urological Association, 2025). It is not right for everyone, so ask your provider whether it makes sense for you.
D-mannose, a natural sugar sold as a supplement, is popular, but the best evidence so far does not support it. Some early, smaller studies looked promising. However, the largest and most rigorous trial to date compared D-mannose with a placebo in about 600 women with repeat UTIs and found no meaningful difference in how many went on to have another infection (Hayward et al., JAMA Internal Medicine, 2024). The 2025 urology guideline now advises that D-mannose alone may not be effective for prevention (American Urological Association, 2025). If you are considering any supplement, talk with your provider first. Never use cranberry or D-mannose in place of care when you have symptoms, because an untreated infection can spread to the kidneys.
Everyday Habits
These habits are sensible and low-risk, although most have not been tested in large trials (Harding et al., Neurourology and Urodynamics, 2025):
Do not hold your urine, and take your time so your bladder empties fully.
Wipe front to back.
Change incontinence pads and briefs promptly.
If you have diabetes, keep your blood sugar well controlled. Good diabetes management is linked with a lower UTI risk.
Treat constipation. Studies in children show fewer repeat UTIs once constipation is treated, and the same is likely true for adults.
If your bladder does not empty well, or you have a pelvic organ prolapse, tell your provider. Urine that stays behind sets the stage for infection.
Men, This Part Is for You
UTIs are uncommon in younger men, but they become much more common with age, especially after 60. By their 80s, men get UTIs at rates close to women's (Schaeffer and Nicolle, New England Journal of Medicine, 2016). The most common reason is an enlarged prostate. As the prostate grows, it can squeeze the urethra and keep the bladder from emptying all the way, and urine that sits gives bacteria a place to grow. Kidney stones, prostate infections, and urinary catheters can raise the risk too. Watch for:
a weak or slow stream
trouble getting started
stopping and starting
getting up again and again at night
Please do not wave these off as just getting older.
In men, a UTI is often a sign that something is making it harder to empty the bladder. A man with a UTI should be seen by a provider. A man who keeps getting them needs a full evaluation of the prostate and urinary tract, because a lingering prostate infection can cause the same infection to keep coming back (Schaeffer and Nicolle, New England Journal of Medicine, 2016). Getting an enlarged prostate evaluated and managed is an important step in preventing the next infection.
When Confusion Is Not Automatically a UTI
This one surprises families. Many older adults carry bacteria in their urine without being sick from it, which is called asymptomatic bacteriuria. It becomes more common with age and is especially common in nursing home residents. The Infectious Diseases Society of America advises against testing for or treating bacteria in the urine of older adults who have no urinary symptoms. The exceptions are a few situations, such as before certain urology procedures. Antibiotics in this setting have not been shown to help and can cause harm, including diarrhea, a serious gut infection called C. difficile, and germs that are harder to treat later.
The same guideline addresses older adults who become suddenly confused or have a fall. When they have bacteria in the urine but no urinary symptoms, fever, or other signs of serious infection, the guideline recommends looking carefully for other causes and watching closely instead of starting antibiotics (Nicolle et al., Clinical Infectious Diseases, 2019). Common culprits include dehydration, medications, constipation, pain, or a different infection. Cloudy or strong-smelling urine alone does not mean a UTI either.
But do not wait it out. If confusion shows up along with fever, chills, pain, burning with urination, or a person who simply looks very ill, get seen right away.
Know When to Get Care Today
Call your provider the same day for:
burning or pain with urination
new urgency or frequency
blood in the urine
pain in the lower belly
Older adults may not run a fever even with a serious infection, so do not rely on a thermometer alone. Get prompt medical care for back or side pain, shaking chills, nausea and vomiting, or feeling suddenly very unwell. These can mean the infection has reached the kidneys or the bloodstream.
The Bottom Line
UTIs are common, but you do not simply have to live with them as you age. Talk with your provider about your own risk factors. If you are a woman who keeps getting infections, ask about vaginal estrogen and other proven, non-antibiotic options. If you are a man with changes in your stream or nighttime urination, get your prostate checked. And keep your hydration and daily habits working for you.
~ Dr. Scharlotte Spencer, NP-C