Already have an account?
Get back to the

Gynecologist: If You’re Always Tired & Over 50, You May Have a ‘Silent UTI’ (Even If You Don’t Have Any Other Symptoms)

The at-home test that confirms the diagnosis + the brilliant vitamin C tip that keeps it from coming back

First For Women has affiliate partnerships. We receive compensation when you click on a link and make a purchase. Learn more!

If you’ve ever had a urinary tract infection (UTI) — and so many women have — you know the telltale symptoms: pain and burning with urination along with frequent, strong urges to ‘go.’ When these symptoms strike, you call your doctor for antibiotics to nip the infection in the bud. But what if instead of the familiar burning, you just feel unusually tired or have unexplained muscle aches or brain fog? Turns out these symptoms can also point to a lesser-known condition called ‘silent UTI.’

What is a silent UTI?

This type of infection isn’t really “silent,” it just has symptoms that are different from the typical UTI symptoms we’re accustomed to, explains integrative ob/gyn Felice Gersh, MD, medical director of the Integrative Medial Group of Irvine in California and author of Menopause: 50 Things You Need to Know. The reason? By the time we’re in the second half of life, more than half of women acquired pathogenic bacteria, which have colonized their bladder, she says, including E. coli, klebsiela and enterococcus.

For many women, these bacteria live peacefully, without causing any issues and don’t require treatment. “They’re like trespassers who live in an inappropriate place but don’t actually cause harm,” says Dr. Gersh.

But sometimes the population of these bacteria can reach the point where they can create illness. “If the transformation from peaceful coexistence to pathogenic invader happens, symptoms that are atypical for classic bladder infections can occur,” says Dr. Gersh. In other words, once these bad bacteria grow to a certain point, they can cause an infection that has symptoms not usually associated with a UTI.

As bad bacteria and/or their byproducts circulate in the bloodstream, they create a whole-body effect, not just a local one, as the immune system fights the infection, Dr. Gersh explains. The result? Some combination of fatigue, fevers, muscle aches, forgetfulness, abdominal pain, nausea, back pain and shakiness.

Adding to the challenge: Up to half of these infections go undiagnosed, asserts Pamela Peeke, MD, author of Body-for-Life for Women. That’s because the whole-body symptoms that pop up are so vague that they don’t automatically lead many doctors to a UTI diagnosis.

Women over 50 are at greater risk of silent UTIs

The loss of estrogen during the menopause transition also raises the risk of these atypical infections, says Dr. Gersh. That’s because estrogen has a protective effect on the vagina and bladder, bolstering production of antimicrobial proteins that prevent colonization of bad bacteria. But as estrogen dips and these beneficial proteins with it, the numbers of bad bacteria can sky rocket. What’s more, an aging immune systems may have more trouble keeping the growth in check.

How do I know if I have a silent UTI?

Unexplained fatigue can be be a major clue, says Dr. Gersh. A few more telltale signs of a silent UTI:

  • Shakiness
  • Forgetfulness
  • Fevers
  • Nausea
  • Back pain
  • Muscle aches
  • Abdominal pressure or pain

But some UTIs have no symptoms at all. These are typically diagnosed via urine tests, which come back positive for UTI-causing bacteria. That’s why it’s critical to see your gynecologist for annual exams. Indeed, untreated UTIs can result in kidney infections and urosepsis, a dangerous and life-threatening condition.

This at-home test can diagnose a UTI

You can diagnose a UTI with an at-home urine test, like AZO UTI Test Strips. (buy on Amazon, $11.97), says Dr. Gersh. If the result is positive, see your doctor for confirmation. The first line of treatment is prescription antibiotics, which kill infectious bacteria and relieve symptoms in days. But even when taking antibiotics, there are some additional measures you can follow to kick the UTI out of your system completely.

How can I treat a silent UTI?

Take vitamin C

Increasing your intake of vitamin C can treat and prevent UTIs by acidifying the bladder, making it less hospitable to unhealthy bacteria. You can get a daily dose of vitamin C via grapefruit juice or by taking a supplement, like Nature’s Bounty Time-Release C, 500 mg (buy on Amazon, $7.59).

Enjoy cranberry juice

Not only does cranberry contain vitamin C, it’s rich in proanthocyanidins, antioxidants that research has found prevent UTI-causing bacteria from sticking to the bladder wall. And you get them in either cranberry juice or capsules. In fact, research in the journal Cochrane Reviews found that these products significantly reduced the risk of recurrent UTIs in women who are prone to them when taken daily.

Drink more water

Drinking lots of water can help treat and prevent UTIs, says Dr. Gersh. Water helps cleanse your system, and every time you pee, you empty your bladder and flush out any harmful bacteria lurking in the urinary tract. In fact, a study published in JAMA Internal Medicine found that among women who had at least three UTIs in the past year, those who drank 6 cups of additional fluid daily slashed their UTI risk in half.

Take plenty of bathroom breaks

All that water will leave you running to the bathroom several times a day — and that’s a good thing! Regularly emptying your bladder makes it harder for infection-causing bacteria to colonize your bladder, says Dr. Gersh. Four to eight times daily is a good rule of thumb.

Choose cotton underwear

Paying extra care to the material of your underwear can go a long way in preventing infections. Dr. Gersh advises opting for breathable cotton underwear, organic if possible.

Maintain optimal hormone levels

Because the main cause of silent UTIs is the drop in estrogen during the menopause transition, Dr. Gersh says using a vaginal estrogen product (you’ll need a prescription from your doctor) can help prevent them.

How one woman healed a silent UTI and restored her energy!

When 63-year-old grandmother Maryjane Mashunkashey was too tired to play with her young grandchildren, who had traveled 45 miles away to spend time with her, she knew something was up.

“That heavy blanket of fatigue covered me all week,” she recalls. “All I wanted to do was lie down, and that just wasn’t like me—I’m not a napping kind of person.

“At work I wasn’t as effective as I should have been, and after work I didn’t want to do anything extra. And I didn’t have a good excuse—I didn’t feel sick exactly. I simply couldn’t run at full speed.

 “I put my faith in my physician but he didn’t know why I was so tired, so I stopped asking. This wasn’t like other health issues I’d had in the past, though. Years earlier I was prone to urinary tract infections. I once had six in the span of six months. I dreaded that unmistakable backache, the painful urination and the urgency to pee, not to mention the doctors’ appointments and prescription co-pays for all those antibiotics. Thankfully, I seemed to have outgrown UTIs, but this new health complaint was such a mystery…it worried me.

How Maryjane discovered the surprising cause of her fatigue

“My fatigue got worse while I was on vacation. By the second day of our trip, I was dragging. I knew something was definitely wrong. Frightened and far from home, I went to the emergency room .

“When the doctor told me it was a UTI, I was stunned. ‘I don’t believe it,’ I responded. ‘I don’t have any of the symptoms. None whatsoever!’

“Yet there was the proof on my chart, confirmed through a urine test. After my history of UTIs, I thought I knew how to recognize them. But this infection completely snuck up on me.

“I found out there was such a thing as a ‘hidden’ or ‘silent’ UTI. Looking back, I realized that every time I’d suffered a UTI, I always felt fatigue first. It was my body’s way of trying to fight off infection.

“After that ER visit, I took the antibiotics the doctor prescribed and headed home. But then, several months later I started feeling exhausted again. My gut reaction was to power through it, but then I remembered my vacation. Being proactive, I quickly asked my doctor to test my urine. As I suspected, it was another sneaky UTI.

“I felt empowered knowing I didn’t have to suffer for days or weeks before more serious symptoms may have shown up.

Maryjane’s happy ending thanks to PM vitamin C

“I was so grateful my newfound knowledge was helping me improve my life. But I wasn’t satisfied with early detection. I wanted to find a way to prevent UTI infections. So I kept pressing my doctor and I guess I finally asked the right question because I learned that taking vitamin C at bedtime can prevent bacteria from building up in the system. The doctor explained that C allows healthy acid to rest in the bladder overnight so that the harmful acid in urine can’t take hold. I started taking 1,000 mg each night and I haven’t had a single flare-up in years.

 “These days I don’t have to put tea parties on the back burner. In fact, I have no problem keeping up with my 5 granddaughters and all their activities—softball, dance, Junior Olympics…I’m a ball of joyful energy once again.

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

A version of this article first appeared in our print magazine.

Use left and right arrow keys to navigate between menu items. Use right arrow key to move into submenus. Use escape to exit the menu. Use up and down arrow keys to explore. Use left arrow key to move back to the parent list.