Q: An older friend, who is in her 90s, has been having bacteria in her urine, but no symptoms. Despite treatment with antibiotics, she was still having bacteria in the urine, so the doctor recommended chronic antibiotics and a referral to urology.
What can be done when an elderly woman has bacteria in her urine but no symptoms? Can a urology consultation help?
A: This is a great question. People often think that your friend is having a “recurring urinary tract infection (UTI)” or even a chronic UTI. But actually, you are describing something called asymptomatic bacteriuria, which means having urine bacteria without symptoms.
Every older person and family caregiver should know about asymptomatic bacteriuria. Here’s why:
- It’s very common in older adults. This condition is found in an estimated 20% of women aged 80 or older, and also affects older men. The older the person, the more common it is. Asymptomatic bacteriuria is even more common in nursing homes, where it’s estimated to affect 30-50% of residents.
- It’s often confused with a urinary tract infection (UTI). This can lead to unnecessary — and potentially harmful — treatment with antibiotics.
- It usually does NOT need to be treated with antibiotics. As I’ll explain below, research shows that people don’t live better or longer when asymptomatic bacteriuria is treated. In fact, such treatment can be harmful: one study found that treatment increased the risk of future (real) UTIs, and increased the risk of infection with antibiotic-resistant bacteria.
- It’s common for older adults to inappropriately be given antibiotics to treat this condition. Part of why this happens is that distinguishing this condition from a real UTI cannot just be done with a urine test. Instead, health providers must take the time to talk to the patient — or family caregiver — and ask about whether symptoms are present. In a busy clinical environment, this step is all-too-often neglected.
In short, this is another one of those common aging health issues that can easily be mismanaged, unless older adults and family caregivers know to ask extra questions.
Because it’s so common for antibiotics to be inappropriately prescribed for this condition, “Don’t treat asymptomatic bacteriuria with antibiotics” is the number one “Choosing Wisely” recommendation from the Infectious Disease Society of America. The American Geriatrics Society also includes this recommendation on its Choosing Wisely list.
Now, let’s try to equip you to understand this common condition. This will help you — and your older loved ones — avoid unnecessary testing and antibiotic treatment. Specifically, in this article I’ll cover:
- What is asymptomatic bacteriuria?
- How common is asymptomatic bacteriuria?
- How to tell the difference between asymptomatic bacteriuria and a UTI
- Why asymptomatic bacteriuria usually doesn’t warrant antibiotics
I’ll close with some practical tips for older adults and family caregivers concerned about UTIs and/or bacteria in the urine.
What is asymptomatic bacteriuria?
Asymptomatic bacteriuria means having significant quantities of bacteria in the urine, but no clinical signs of inflammation or infection.
In other words, in asymptomatic bacteriuria, a urine culture will be positive. (This means that if your healthcare provider takes a sample of urine and a clinical laboratory incubates it, within 1-2 days, a sizeable quantity of bacteria will grow.)
When bacteria are present in the bladder but not provoking an inflammatory reaction, this can also be called bacterial “colonization” of the bladder.
How common is asymptomatic bacteriuria?
Asymptomatic bacteriuria is more common in older adults than many people — including practicing clinicians — may realize:
- In women aged 80 or older, 20% or more may have this condition.
- In healthy men aged 75 or older, 6-15% have been found to have bacteria with no UTI symptoms.
- Studies of nursing home residents have found that up to 50% may have asymptomatic bacteriuria.
This condition also affects 2-7% of premenopausal women, and is more common in people with diabetes.
Asymptomatic bacteriuria becomes more common as people get older, in part because it is related to changes in the immune system, which tends to become less vigorous as people age or become frailer.
Studies have found that in older adults, asymptomatic bacteriuria does sometimes go away on its own, but it also often comes back or persists.
How to tell the difference between asymptomatic bacteriuria and a UTI
By definition, in asymptomatic bacteriuria, there should be no UTI symptoms present.
The following signs and symptoms can be caused by UTI:
- Burning or pain with urination
- Increased frequency or urgency of urination
- Bloody urine
- Pain in the low abdomen, flank, or even back
- Fever
(What about “cloudy” or “foul-smelling” urine? In the absence of other symptoms, no study has shown that this is a good way to detect a possible UTI. See here: Cloudy, Foul-Smelling Urine Not a Criteria for Diagnosis of Urinary Tract Infection in Older Adults.”)
Whether or not an older person has a clinical UTI, the urine dipstick may be abnormal, in part because certain abnormal results suggestive of UTI may in fact only reflect bacterial colonization of the bladder. So one should not rely on urine dipsticks or related urine analysis tests (which measure the number of white blood cells in the urine, among other things) as the sole justification for diagnosing a UTI. Symptoms are necessary!
The thing is, some older adults may only show vague or non-specific symptoms when they get a UTI, such as confusion or weakness. (That “confusion” would be delirium.) This is especially true of aging adults who are frail, or are quite old, or have Alzheimer’s or another dementia.
For this reason, it can be difficult to determine whether a frail or cognitively impaired older person is having UTI symptoms that warrant treatment.
Experts have debated whether it’s justified to treat for possible UTI, for those cases in which an older person with asymptomatic bacteriuria shows signs of delirium, but no other UTI symptoms.
Why asymptomatic bacteriuria usually doesn’t warrant antibiotics
Clinical studies overwhelmingly find that in most people, treating asymptomatic bacteriuria with antibiotics does not improve health outcomes. Even when it comes to the nursing home population, which is frailer than the general population, a 2022 systematic review found that antibiotic treatment of asymptomatic bacteriuria didn’t improve outcomes.
(The exceptions: pregnant women and men about to undergo urological procedures do benefit from screening for and treatment of asymptomatic bacteriuria.)
A 2015 clinical research study found that treatment of asymptomatic bacteriuria in women was associated with a much higher chance of developing a UTI later on, and that these UTIs were more likely to involve antibiotic-resistant bacteria.
Even when it comes to the nursing home population, which is frailer than the general population, a 2022 systematic review found that antibiotic treatment of asymptomatic bacteriuria didn’t improve outcomes.
Despite the expert consensus that this condition doesn’t warrant antibiotics, inappropriate treatment remains very common. A 2014 review article on this topic noted overtreatment rates of up to 83% in nursing homes. To combat this issue, this 2023 BMJ article outlines an approach nursing homes can take: Reducing unnecessary urine culture testing in residents of long term care facilities.
Is there a role for cranberry to treat or manage urine bacteria?
The use of cranberry juice or extract to prevent UTIs has been promoted by certain advocates over the years, and many patients do prefer a “natural” approach when one is possible.
However, top quality clinical research has not been able to prove that cranberry is effective for this purpose. In a 2016 study of older women in nursing homes, half were given cranberry capsules daily. But this made no difference in the amount of bacteria or white blood cells in their urine.
In a related editorial titled “Cranberry for the Prevention of Urinary Tract Infection? Time to Move On,” which summarized many other studies of cranberry for the prevention of UTI, the author concluded:
The evidence is convincing that cranberry products should not be recommended as a medical intervention for the prevention of UTI. A person may, of course, choose to use cranberry juice or capsules for whatever reason she or he wishes. However, clinicians should not be promoting cranberry use by suggesting that there is proven, or even possible, benefit. Clinicians who encourage such use are doing their patients a disservice.”
A 2012 systematic review of high-quality research studies of cranberry for UTI prevention also concluded that cranberry products did not appear to be effective.
That said, many people really feel that cranberry supplements make a difference.
As cranberry is unlikely to cause harm to older adults, I don’t object when an older person or family caregiver wants to use them. But I don’t particularly encourage it either.
Practical tips on urine bacteria and possible UTIs in older adults
Given all this, what should you do if you are worried about bacteria in the urine, or a possible UTI?
Here are my tips for older adults and families:
- Realize that asymptomatic bacteriuria is common in older adults.
- If you keep having positive urine cultures despite feeling fine, you may have asymptomatic bacteriuria.
- Know that treatment of asymptomatic bacteriuria is not going to help, and might lead to harm.
- Unless you are having symptoms, it’s pointless to try to “eradicate” bacteria from the bladder. Studies show that this increases your risk of getting a real UTI later on, and that you’ll be more likely to be infected with bacteria that are resistant to antibiotics.
- Antibiotic treatment also affects the “good bacteria” in your gut and elsewhere in the body. Research to help us understand the role of the body’s usual bacteria (the “microbiota”) is ongoing, but suggests there can be real downsides to disrupting the body’s bacteria. So you don’t want to use antibiotics unless there’s a good reason to do so.
- Avoid getting a urine culture unless you’re experiencing symptoms of likely UTI, such as pain with urination or low belly pain.
- Some healthcare providers will do a urine culture “just to check” for UTI. Or sometimes patients and family members request this. But this is a bad idea, since all you might do is uncover signs of asymptomatic bacteriuria (which then has a tendency to be inappropriately treated with antibiotics).
- Experts strongly recommend that urine tests for possible UTI only be done if an older person is experiencing symptoms.
- If a health provider suggests a urine test and you aren’t having UTI symptoms, inquire as to the purpose of the test.
If you’re caring for an older adult who has dementia or is otherwise prone to delirium:
- Realize that it can be tricky to determine whether the person is experiencing UTI symptoms.
- The doctors should still attempt to do so before checking a urine culture or treating any bacteria found in the urine. Specific symptoms to check for include dysuria (painful urination), fever, and lower belly pain.
- Realize that some experts believe that increased confusion alone (meaning no fever or other signs of UTI) may not be a good reason to treat a nursing home resident for a presumed UTI.
- A geriatrician explains this debate in this very interesting article: “Urinary Tract Infection”—Requiem for a Heavyweight
In short: I’d summarize the benefits and burdens of treating asymptomatic bacteriuria in a 90-year-old woman as follows:
Benefits: No proven benefit to antibiotic treatment in someone who doesn’t have clinical signs of a UTI.
Burdens: Antibiotics cost money, and increase pill burden. There is a risk of side-effects, of interactions with other medications, of harming your body’s “good bacteria,” and of developing an infection resistant to antibiotics. Also, the overuse of antibiotics in society means we are developing more resistant bugs all around us.
So there you have it. If an older person has a positive urine culture but no symptoms, think long and hard before agreeing to treatment. And ask extra questions before spending time pursuing a urology consultation.
Remember, bacteria in the urine does NOT equal a UTI.
So, ask your clinicians if this could be asymptomatic bacteriuria. Tell them you’ve heard that the Infectious Disease Society of America, the American Geriatrics Society, and other experts say that this condition should not be treated in older adults. (Unless you’re about to undergo a urological procedure.)
You can even share these peer-reviewed articles:
- Reducing unnecessary urine culture testing in residents of long term care facilities
- Approach to a Positive Urine Culture in a Patient Without Urinary Symptoms
- Diagnosis and Management of Urinary Tract Infection in Older Adults
- “Urinary Tract Infection”—Requiem for a Heavyweight
This article was first published in 2015. It was reviewed and updated by Dr. Kernisan in February 2024. (The basics about asymptomatic bacteriuria and UTIs in aging adults don’t change much!)
Christine says
Hello, I am the caregiver for my mother who was diagnosed with dementia. Within the past week she has been acting extra delusional, seeing and talking to people that aren’t there , ect. I’d heard about UTI’s causing more delusions in the elderly so I took her to get a UTI test . When she gets nervous her bowels get loose and when she urinated in the hat for urine some feces got into the ruins to be tested . I told the Dr. about this and she said she’d take note . She said the dip test came back negative but they would send away to the lab to test for a longer culture . They called a few days later and said she had ecoli bacteria that grew and she needs to start on antibiotics. Do you think that it’s really a UTI or do you think it’s just a tainted result from fecal matter?
Thanks
Leslie Kernisan, MD MPH says
Hm, this sounds a bit tricky.
Often in a urine culture they can detect contamination because there are several strains of bacteria that grow in the culture. (Feces contain lots of different bacteria, in pretty ample quantities.) They might also see a lot of cells or actual fecal material. You might want to ask your mother’s health provider to explain why they think the positive culture is unlikely to represent contamination of the sample.
Otherwise, if your mother with dementia has become more delusional or otherwise more confused, that sounds like potential delirium. Yes, UTIs are a common cause, however there are a number of other common conditions that can cause this too, such as medication side-effects, metabolic imbalances (e.g. too high/too low levels of sodium or calcium in the blood), kidney or liver problems, etc.
So, I would say it’s important to not be too narrowly focused on UTI, when evaluating an older person with increased confusion. Good luck and hope your mother feels better soon.
Cynthia Manca says
I am a 64 yr old female with Lupus/Sjogrens & a multitude of other diagnosis as well as incontinence. I have just gotten home to find the urine test & had earlier today came back with WBC/occ RBC/rare, cast cells/few & Bacteria/occas. it has been sent for culture. This is the 5th time this year & usually the bacteria is too numerous to count. I usually have been treated with Keflex but now a urologist I’ve seen wont prescribe antibiotics. My symptoms start with foul smell/urine, great distress in abdomen & sometimes flu like feeling. My argument with the urologist is that I already have a suppressed immune system & any bacterial infections do not get better, only worse, if not treated. I am requesting that I get a cystoscopy to see what the health of my bladder is. I would appreciate any insight to my dilemma. Thank you, Cindy
Leslie Kernisan, MD MPH says
Sorry to hear of these concerns. Well, your medical history sounds complicated, as you point out you have autoimmune diseases and are perhaps taking immunesuppressing medications to control your lupus, so special consideration sounds warranted. Also you describe abdominal pain, so you might be meeting criteria for a clinically significant UTI, rather than asymptomatic bacteriuria.
I don’t know that a cystoscopy would particularly help resolve the question of what should be done about recurrent bacteriuria/UTIs, and when/whether to prescribe antibiotics.
Generally I would recommend discussing further with your urologist. It might help to clarify to him what your priorities are regarding your health, and ask for his/her help. If it’s that you’re very worried about an infection getting out of control, tell them that, and ask what they propose to address this concern.
You may also want to consider getting a second opinion.
Rukma says
My mother was diagnosed with a UTI in Feb during pre-op checks for a knee replacement surgery. Her right knee joint was replaced last year in May and those tests were clear. From Feb this year, the UTI issue has kept lingering. In March, she was hospitalized for 5 days to administer IV antibiotics since the strain was resistant to oral drugs. Her creatinine came down from 2.4 to 1.1 and other kidney parameters settled. A CT scan of the kidney region had also been done to rule out other reasons for kidney infection. We repeated the test to see if the surgery can now be done and the same Ecoli infection still shows. The drs will not operate until the infection is nullified since it may impact the implant. What is your advise in such situations?
Leslie Kernisan, MD MPH says
Sorry but I can’t provide any advice. Your mother’s situation sounds particularly complicated and is well beyond a garden variety “UTI vs asymptomatic bacteriuria” question. There is the question of what is surgically safe (which is for orthopedists to answer) and of her kidney health, which is for urology. You may want to consult with both those types of specialists for a second opinion. Alternatively, some medical centers offer special second opinion services during which they extensively review a patient’s chart and consult with their specialists, and then offer an opinion. UCSF’s service is here: UCSF Second Opinion.
Good luck!
Lawrence Karpman says
I have an ileal conduit after my bladder was removed over 3 years ago. Since last Sept I have been treated for 8 positive cultures, but only had symptoms in 3 of those cases. In 7 of the 8 I was given antibiotics. But now, all my doctors, (PCP, Uro, and infectious disease) agree not to treat asymptomatic cultures any longer. I did have kidney damage shown on my last CT scan in Feb. My problem is with identifying kidney pain. I have back pain for 40 years so it is hard to tell my usual back pain from kidney pain. The pain is mild and not constant. I was put on Ellura by my Urologist last month for uti prevention. Have you heard of it? I’ve been taking Dmannose for years prior. Also, if I have a true uti in my upper tract (I have no lower) how bad or constant would the flank or back pain be if it was inflamming my kidney(s)?
Leslie Kernisan, MD MPH says
Hm, well your situation is quite unusual, with no bladder remaining. I don’t know anything about ileal conduits, any related infection risk, or even asymptomatic bacteriuria in the upper urinary tract.
Generally, based on my experience witnessing people with infections in various parts of the body, I would think that a significant kidney infection will be quite painful and the pain will be fairly constant. But sometimes people have milder or slow-burning infections that can cause milder or vaguer symptoms, I suppose that’s possible for this situation too.
A urologist would probably be better positioned to answer this type of question about kidney infections.
I’m not familiar with Ellura but looks like it’s a supplement based on a cranberry compound. Presumably at best it would be as effective as concentrated cranberry extract, which studies find is generally not very effective. Good luck!
Lawrence Karpman says
Thank you for your reply. There are many thousands of us out there with urostomys. While not as common as colstomys, there are plenty of us. I’m always surprised how little urologists who do not specialize in bladder cancer know about urostomys or urinary diversions in general. But even with those that do, the depth of knowledge about post cysectomy utis/colonization is strikingly low. I appreciate your input though. Yes I’m in a difficult situation, so I reach out for any info I can find. I believe that your views on asymptomatic uti’s are spot on, and I only wish more urologists and MDs in general would quit treating them with antibiotics at the drop of a hat. Thanks again.
Leslie Kernisan, MD MPH says
Yes, urostomy is overall not terribly rare, but given that there is so much misunderstanding about UTIs and asymptomatic bacteriuria (conditions that are not at all rare), I’m not surprised to hear you’re noticing a lack of knowledge relevant to infection and urostomy.
If you haven’t already done so, you may want to see if you can find any online communities of other people with urostomy. This can be a better way to find out about the latest research on your situation. Although honestly, it looks like perhaps there hasn’t been much research done on this topic; when I search google scholar, there is an article on Microbial colonization of human ileal conduits, but it is from 1984 and has only been cited 22 times since…but if you dig around, you might find a urologist somewhere who is studying this.
Good luck!
Leesa M says
My 90 year old Mom has been more and more confused lately. Urinalysis showed slightly over range WBC, RBC, leukemia esterease and epithelial cells but no bacteria or nitrites. The culture was negative. Could it still be a UTI or does there have to be bacteria? Should we have her tested again?
Leslie Kernisan, MD MPH says
If the culture is negative, then it is not a UTI. (And it’s not asymptomatic bacteriuria either.) As far as I know, falsely negative urine cultures are not very common.
A much more likely explanation is that your mother’s recent confusion is due to something else affecting her physical health or perhaps her brain function specifically. She needs an evaluation for delirium causes and triggers. Normally we look for signs of new illness, we consider the possibility of medication side-effects, we consider bloodwork to check for electrolyte imbalances, and then we also consider the possibility of pain, constipation, and dehydration.
You don’t say how quickly this confusion has worsened, but sometimes it reflects the progression of vascular (which means small or larger blood vessels) damage to the brain, or even progression of an underlying neurodegenerative condition affecting brain cells.
We would still normally start by looking for delirium causes. You can learn more about them here: 10 Things to Know About Delirium. Good luck!
Elizabeth says
What a relief to find this site. I have had an off again on again UTI since November. It started with cloudy foul smelling urine but no other symptoms. I bought the urine test kit and due to the positive Leukocyte results scheduled a dr visit. They ran a urinalysis and told me there was book in the urine and prescribed amoxycillan for ten days. They also ran a culture. I took the amoxicillan and the cloudiness and smell cleared up, so I thought I was cured. Five days after completing the ten day amoxicillan regime I recieved a clan from the pharmacy that my script was in. I had never been contacted by the dr, so I called and the receptionist told me that the urine culture showed amoxicillan resistant ecoli, to stop taking the amoxicillan and take Bactrim. My mother was allergic to Bactrim and since I was having no symptoms I got the script but did not take it. Then I had the flu, and approx 1 week later the cloudy smelly urine returned. No other symptoms. All my research said you MUST treat it with antibiotics. After three days I decided to take the Bactrim. Immediately the symptoms cleared, but on the fourth day hives appeared on the back of my neck so I stopped taking the Bactrim . Another month and the cloudy smelly returned, then went away after a couple of days. I always “flush” by monitoring my water intake to assure I’m getting approx 64 ozs daily. I am 66 yrs old and weigh 125 lbs. no other health issues, no other meds. I do NOT have a PCP but am scheduled to get one. I want to discuss this with them, for I think I might be an asymptomatic, but if they test and culture I’m sure they’ll freak and prescribe another round of antibiotics, I would prefer a wait and see attitude. Is this a wise choice based on my experience?
Elizabeth says
Blood. They said there was blood in my urine. Not book. LOL I have since purchased the 10 spots strips and tested posite +, ++’ and +++ occasionally but NEVER positive for blood or anything else.
Leslie Kernisan, MD MPH says
Microscopic blood in the urine can be associated with UTI but also with other things. If it only happened once and has gone away then it’s much less worrisome, but best to ask your doctor to be sure.
Victoria Baker says
I always have blood in my urine Dr says that’s normal for older ppl. But than I live in Florida an good Dr’s are hard to find.
Leslie Kernisan, MD MPH says
I would not describe chronic blood in the urine as “normal”; it’s usually something that should be evaluated, especially in older adults. That said, some people are evaluated and no cause is found. Such cases of “unexplained hematuria” are not uncommon, but generally it’s important that a person be evaluated before chronic blood in the urine be dismissed.
Leslie Kernisan, MD MPH says
As I explain in the article, if you have no symptoms of UTI but a positive urine culture, you may well have asymptomatic bacteriuria, and in most cases, this does not require treatment with antibiotics. So, what you are suggesting sounds reasonable. If your new PCP recommends treatment, he/she should be able to explain why.
Also, as noted in the article, foul-smelling urine on it’s own is not sufficient to diagnose a UTI.
Last but not least, even in cases of true UTI, delayed treatment has been studied and many women experienced improvement of their symptoms with no antibiotic treatment…so a careful wait and see attitude can certainly be reasonable.
Colleen says
I found your explanations/replys quite informative as I have a family member in a nursing home with persistent “UTI’s that
noone has been able to explain thus far. I have tried to get answers and it goes nowhere, almost like the mefical staff does not understand the dufferences between the problems and antibiotics being given, although they claim the cultures come back positive all the time
And there never seems to be folliw up as to whether or not the original uti cleated up until a medical issue happens and they check for one
Leslie Kernisan, MD MPH says
Glad you found the article informative.
Well, if your relative is in a nursing home, you may want to ask if the issue might be asymptomatic bacteriuria rather than “persistent UTI” or “recurrent UTI”. It’s extremely common for nursing home residents to have their bladders colonized with bacteria.
Generally doctors will not repeat urine cultures after antibiotic treatment to see if the issue has “cleared up.”
Good luck!
Loving Daughter says
My 87 year old mother had 3 episodes of gross hematuria. After the 2nd one, her doctor prescribed a course of Ciprofloxacin suspension, 5ml twice a day for 7 days. She then had another episode of gross hematuria. A urinalysis was done: Negative for urine culture growth; however, microscopic analysis showed HI bacteria and erythrocytes 1-2. Does this mean she does or does not have a UTI? Could the HI bacteria be caused by contamination in obtaining the sample? (She did not let me wipe her with the wipe provided, plus she is unable to do a true mid-stream) I don’t want to give her more antibiotics since she had a terrible case of diarrhea from the 1st round. Could there be another cause of the gross hematuria?
Leslie Kernisan, MD MPH says
Yes, having some bacteria visible but a negative culture can be caused by a contaminated sample. It’s certainly often hard to get a clean-catch in an older person.
If her urine culture is negative, then it is often reasonable to look for other causes of hematuria. The Mayo Clinic has a good list here:
Blood in urine (hematuria)
Generally it would not make sense to treat hematuria — or other urinary symptoms — with antibiotics, if the urine culture is negative. Good luck in figuring out your next steps with your mother.
Roxanne Stickler says
I was going to edit my previous post but can find no option, so —
It occurred to me to add that I’m 69, in good health; nothing has particularly changed in my daily habits or my eating/drinking. My doctor reminded me to drink plenty of liquids, be mindful of how I wipe after bathroom visits… Again, nothing different.
Leslie Kernisan, MD MPH says
Thanks for this additional information. Yes, I would still make the same suggestions as above.
Roxanne Stickler says
I came across this article while looking for information to clarify recurring (apparent) UTIs with none of the usual symptoms – no fever, no frequency of urination, no pain when urinating, no pain anywhere. At the time (July, 2017) I just felt awful – no energy, weak – for 2 days. Because I was out of town, I went to an Urgent Care office where I was diagnosed, after UA & blood work, with a UTI and prescribed macrodantin. This seemed to clear the UTI. However, since then, I’ve had a repeat of symptoms 3-4 times and been given antibiotics, though never the same one. Cultures were done 2-3 times and confirmed bacteria in the urine. The latest occurrence was a week ago – same weak feeling, no other symptoms. A clean catch UA was done & confirmed bacteria. This time I was prescribed Keflex 1000mg 2x day which the doctor feels should finally clear the problem. After reading this article & the following questions, I wonder if the issue is actually the asymptomatic bacteriuria (sp?). The doctor had mentioned an ultrasound of the bladder area if the latest culture had shown no bacteria. Would this be a good idea anyway?
Leslie Kernisan, MD MPH says
You don’t say how old you are, but yes, if you keep having positive urine cultures, then it’s certainly possible that your bladder is colonized.
Feeling weak with little energy is what we would call a “non-specific” symptom, it could be caused by all kinds of things.
You might want to ask your doctor about checking your urine for a culture at a time when you are NOT feeling unwell. Right now they are presumably only checking when you have these non-specific symptoms.
You could also try waiting a few days, next time you have symptoms, especially if it seems you might be colonized. Things often get better with time and non-medical approaches, like getting lots of rest. If you are worried about developing a serious infection, talk to your doctor about what kind of signs/symptoms to look out for.
Whether a bladder ultrasound is likely to help depends on a lot of things, including your past medical history, your other symptoms, and what kinds of problems the doctor has already checked for. Generally, imaging of the urinary tract is not useful, see this study.
Good luck!