How Long Does it Take for Confusion from UTIs to Go Away

While most people are familiar with the physical discomfort that urinary tract infections (UTIs) bring, in some older people, UTIs can actually cause confusion. Recovery from this kind of UTI-induced confusion isn’t one-size-fits-all; it can depend on things like the type of bacteria causing the infection, age and other medical conditions you might have. 

The good news is that UTIs are generally curable, and confusion caused by a UTI is usually reversible, with full recovery possible. In this blog, we’ll provide an overview of confusion regarding UTIs and its management. 

Understanding UTIs and confusion

UTIs are a common type of infection involving anywhere along the urinary tract:

• Urethra
• Bladder
• Ureters 
• Kidneys

To be diagnosed with a UTI, a primary care provider such as a doctor will conduct a urine test (also known as a urine culture). A positive urine culture identifies the bacteria and fully confirms the diagnosis, but they’ll also account for urinary symptoms like:

• Painful urination
• Difficulty urinating or fully emptying your bladder
• Frequent urination
• Bloody urine 
• Pain in your plank or pubic region

Some people, particularly older adults (over 65 years) and those affected by dementia are susceptible to developing confusion from a UTI. It’s not fully known why UTIs can cause confusion, but it’s believed to be due to a complex interaction of various pathways, including inflammation in the body.

When confusion is a symptom of a suspected UTI, it can be tricky to pinpoint any urinary symptoms. This is problematic because the confusion might be due to something else entirely, and a urine culture could come back positive because of something called asymptomatic bacteriuria (ASB).

ASB occurs when bacteria are found in the urine without any typical urinary symptoms. Bacteria in the urine without these symptoms are not a reliable diagnostic indicator of a UTI and don’t necessarily require antibiotics.

Treatment with antibiotics in the absence of confirmed urinary symptoms is ineffective. Plus, using antibiotics when they’re not needed can lead to complications that make confusion worse by: 

• Interacting with other drugs you may be taking. 
• Causing gastrointestinal upset.
• Causing infections (such as clostridium difficile or yeast infections).
• Causing kidney impairment and your ability to clear toxins from your body.

Therefore, to effectively treat confusion caused by a UTI, it’s crucial to get an accurate diagnosis and carefully rule out any other potential causes. If you can’t speak to a primary care provider right away, primary care providers on Maple — including doctors and nurse practitioners — can make UTI assessments over secure text, audio or video call any day or time of the week.

When it comes to cognitive changes, it’s important to remember not to delay care for yourself or a loved one. Make sure you’re seeking out a path to care as soon as possible if you suspect cognitive issues. 

How recovery time varies in different people

For most people, recovery from UTI-induced confusion will take a few days to a week after treatment has been started.

Unfortunately, some people won’t achieve a full or fast recovery; in some cases, people may experience cognitive changes for weeks to months after their UTI. This can be because of pre-existing conditions such as cognitive impairment or dementia.

UTIs that are challenging to treat, or have a tendency to reoccur, may also make it more difficult to overcome confusion. Resolution of confusion can also be complicated by UTIs that are challenging to treat, are inadequately treated, or tend to recur.

Factors and conditions that can make treating a UTI more challenging or contribute to treatment failure are:

• Delaying antibiotic treatment. ed initiation of antibiotics.
• Inadequate treatment with insufficient duration or dosage.
• Antimicrobial resistance: the infecting bacteria is resistant or does not respond to the prescribed antibiotic.
• Complicated UTIs:  UTIs that are classified as more severe and can be difficult to treat due to structural differences in an individual’s urinary tract, catheter usage, kidney impairment, or possible kidney transplantation.
• Older age
• Immunocompromised individuals: people who have a weakened immune system due to conditions like cancer, HIV, pregnancy, diabetes, or are taking medications that suppress the immune system.
  

Identifying confusion

The onset of confusion with a UTI can range from hours to one or two days of infection. Confusion, or cognitive changes, can range from mild to severe and is sometimes difficult to recognize.

A delay in identifying cognitive changes can lead to complications like the development of delirium, which is an acute, confusional state that requires hospital treatment and is associated with possible long-term cognitive changes. This can be distressing to individuals and their loved ones. 

Here are some examples of how cognitive changes can present:

• Drowsiness, slowed responses
• Disorientation to time, place, or person
• Disordered thinking or speech
• Hallucinatory or delusional experiences
• Inattention, reduced ability to focus 
• Short- and long-term memory impairment
• Restlessness, agitation, emotionality
• Changes in appetite or anorexia 
• Sleep disturbances

Treatment effectiveness

Once confusion is determined to be caused by a UTI, treatment with the appropriate course of antibiotics will help cure the confusion. If the confusion is severe enough or if one is delirious, treatment may require hospital time for observation until symptoms improve.

In extreme circumstances, when someone poses a risk of harm to themselves or others, or if they’re experiencing distressing hallucinations or delusions, therapy with an antipsychotic medication at a low dose may be used for a short period of time at a health professional’s discretion. 

If you’re experiencing confusion or taking care of a family member with UTI-induced confusion, closely monitor yourself or your loved one to ensure adequate nutrition, hydration, and sleep and to prevent immobility and falls. While antibiotics treat the infection — which is the underlying cause of confusion — supporting other health needs can improve the effectiveness of UTI treatment. These measures may help to minimize other risk factors for confusion and include:

• Addressing sensory impairments by using aids like hearing devices and glasses.
• Avoiding malnutrition and dehydration by maintaining a balanced diet with adequate fluid intake.
• Ensuring blood sugars are well controlled in diabetics.
• Participating in cognitively stimulating activities (i.e. reading, crossword puzzles).
• Regular visits with family and friends.
• Staying active with walking or range of motion activities.
• Minimizing sleep disturbances such as noises, screens and bright lights at night.
• Treating any concurrent pain you may be experiencing.
• Avoiding constipation by ensuring regular bowel movements. This may require establishing a toileting routine.
• Maintaining proper hygiene.
• Review medications with a primary care provider or pharmacist to ensure that none of them may be interacting or contributing to mental status changes.

As outlined in this blog, diagnosis and treatment of UTI-induced confusion can be complicated. The severity of confusion caused by a UTI can range from mild to critical. Appropriate diagnosis will help guide the most effective treatment. Treatment responses can vary significantly between people depending on the infecting bacteria, the involvement of the infection within the urinary system, and other comorbidities you may have.

Depending on the person, recovery timelines can range from days to months or longer. Although the physiology of UTI-induced confusion has not yet been completely explained, supportive care measures to minimize other risk factors for confusion can help with recovery. All individuals with UTI-induced confusion require close monitoring until symptoms resolve. 

When to seek medical attention 

If you’re experiencing symptoms of painful urination, difficulty fully emptying your bladder, having urgency or frequency, or having fevers, you should seek diagnosis for UTI symptoms. If you feel like you can’t take the time off to get a diagnosis, Maple is there to get you connected with a primary care provider quickly. If it is a UTI, they can get you sorted with a prescription — and if confusion or cognitive decline is a risk, they can determine the next course of action.

Confusion caused by UTIs is usually reversible with full recovery possible. If you or your loved ones have noticed changes to your thinking or behaviour, you should be assessed for cognitive changes. Regarding the health of your mind and body, timely care is always best. 

The information presented here is for educational purposes and is not meant to replace the advice from your medical professional. Virtual care is not meant for medical emergencies. If you are experiencing an emergency like chest pain or difficulties breathing, for example, please call 911 or go to your nearest emergency room.