UTI Prevention for Dementia

Practical strategies for reducing the burden of UTIs and dementia

People living with dementia are more vulnerable to bacterial invasion due to:

• High stress
• Long periods of sitting
• Refusal or difficulty with changing clothes or washing
• Difficulty making it to the bathroom on time
• Incontinence and incontinence garments
• Catheters
• Reduced liquid intake
• Difficulty reporting symptoms

What are recurrent UTIs?

A UTI (urinary tract infection) is a bacterial invasion located in the bladder, which can spread to the kidneys or even the whole body (sepsis). For those who do experience recurrent UTIs, cognitive decline occurs faster than for those who do not have recurrent UTIs (Kim, Kremen, Danovitch, & Lahiri, 2026¹).

In healthy individuals, the immune system and the lining of the bladder are able to quickly and effectively respond to threats, so invaders like E. Coli can’t easily gain a foothold. However, under conditions of systemic metabolic stress, opportunistic bacteria can colonize the bladder with less resistance from the body.

After the initial acute infection has passed, bacteria can remain dormant in the bladder lining, where they are resistant to standard antibiotics.

These bacteria can then trigger a “new” UTI months later, as the bladder lining naturally sheds over time and releases the hidden bacteria (Detection of Intracellular Bacterial Communities in Human Urinary Tract Infection²)

Breaking the cycle

• By preventing UTIs, you can give the body a break from the resource intensive job of responding to invaders, freeing up its resources for rest, repair, and daily activity.
• Recognize that recurrent UTIs are difficult to eradicate, and that a new instance of a UTI is not necessarily a failure of hygiene. Keeping body tissues as healthy as possible by supporting metabolism is as important as hygiene.

Stop invaders at the front door

The bacterial strain responsible for the majority of UTIs is a gut-dwelling bacterial called E. Coli, mainly spread through feces. Bacteria can migrate from the anus, up the perineum, up the urethra, and take residence in the bladder. Women are more vulnerable due to having a shorter urethra.

• Wash the entire underwear region daily with a clean washcloth, warm water, and unscented soap, rinsing thoroughly.
• If baths are preferred, wash the entire body first, rinse, and then soak in clean water to avoid self-contamination.
• If the individual refuses bathing, while already on the toilet for a bathroom visit, try offering a warm soapy washcloth for bathroom hygiene followed by a warm water rinse washcloth instead of toilet paper or wipes.
• Bidets can be a good option after bowel movements since washing with water is more thorough and does not introduce abrasion to the skin like toilet paper and wet wipes. If you do use a bidet, ensure you use the “feminine wash” setting (water sprays front to back) to avoid flushing fecal bacteria from back to front.
• If fecal incontinence occurs, wash with warm soapy water as soon as possible. If using a purewick, discard and replace with new wick.

Make the bladder inhospitable to invaders

• There is some mixed evidence that D-mannose may makes it more difficult for E. coli to adhere to the bladder (Lenger et al., 2020³; Vargas et al., 2025⁴).
• E Coli thrive in acidic urine (Shields-Cutler et al., 2015⁵; Carreras-Abad et al., 2024⁶). A small amount (¾ teaspoon) of baking soda dissolved in 8oz water taken twice a day away from meals may improve urinary symptoms (Sönmez et al., 2018⁷). As a bonus it inhibits oral bacterial as well.
• Maintain hydration and do not avoid liquids. Some people with incontinence reduce fluid intake in an attempt to reduce the need to use the restroom. However, reduced fluid intake lowers the pH of the urine and makes the environment more friendly to bacteria. Tea, milk, coffee, fruit, fruit juice, soups, broths, stews, and jello all count as liquid (Hooper et al., 2015⁸; Hooton et al., 2018⁹). You do not need to avoid acidic beverages. Orange juice and other citrus juices are acidic in the glass, but contain high amounts of citrate. Citrate is turned into bicarbonate by the kidneys, which raises urinary pH like baking soda (Odvina, 2006¹⁰).
• Keep the pipes flowing: Constipation (fewer than 5 bowel movements a week) leads to a compacted bowel. This extra mass can press on the urethra, which can cause the bladder to not empty fully with urination (Averbeck & Madersbacher, 2011¹¹). Residual stagnant urine in the bladder is especially vulnerable to colonization from bacterial invaders. Aim for daily bowel movements.

Warning signs of a possible UTI

• New or worsening urinary incontinence, urgency, or frequency
• New pain in in low abdomen or lower back
• Pain with urination
• Blood in urine
• Oral temperature > 100*F (fever)
• Oral temperature < 96.8 (hypothermia)

If you suspect a UTI

Prompt treatment for UTIs is absolutely essential for preventing worsening of dementia. Delayed or withheld treatment of UTIs can accelerate cognitive decline compared to those who received prompt treatment. If you suspect a UTI, communicate with your physician promptly to determine appropriate next treatment steps.

Bottom line

In a brain with impaired metabolism, there is no extra fuel to spare to manage additional threats. Preventing recurrent UTIs, alongside preventing constipation and oral bacteria, reduces demands on an already burdened system.