In older or frail people, a urine infection (UTI) does not always cause the usual burning or needing to pee often. The NHS says it can show up as new agitation or confusion, leaking more urine than usual or new shivering. Anyone who suddenly becomes confused needs 999 or A&E. If you are 65 or over, have a weakened immune system from arthritis medicines or have kidney pain, ask for an urgent GP appointment or contact NHS 111.
This guide is for people with arthritis and the family members and carers who notice when something is not right. It covers the signs to look out for, who to call, how arthritis can make UTIs more likely, and the medicines questions to ask. It does not replace a clinical assessment: confusion has many causes, and a UTI should not be assumed.
Signs of a UTI
The NHS lists the usual symptoms as:
- pain or burning when peeing
- needing to pee more often, more urgently or more at night
- cloudy pee or blood in your pee
- pain low in the tummy, or in the back just under the ribs
- a high temperature, feeling hot or cold and shivery, or a very low temperature below 36C
- feeling tired or weak
In older, frail people, people with memory problems such as dementia and people with a catheter, the NHS says a UTI may also cause:
- changes in behaviour, such as acting agitated or confused (delirium)
- leaking pee that is worse than usual
- new shivering or shaking (rigors)
Dark or smelly pee on its own is often a sign of not drinking enough, not an infection.
Sudden confusion is an emergency
Call 999 or go to A&E if someone suddenly becomes confused, drowsy or has difficulty speaking. The NHS says many causes of sudden confusion, including infection, stroke, low blood sugar, a head injury and some medicines, need to be assessed straight away. Do not drive them to A&E yourself; ask someone else to drive or call 999. Take their medicines, or a list, and any steroid card.
While you wait, the NHS suggests you stay with them, tell them who you are and where they are, use short simple sentences, avoid asking lots of questions and only stop them moving around if they are in danger. Signs of sepsis, such as fast breathing, blotchy or blue skin and a rash that does not fade, also need 999.
When to get an urgent GP appointment or NHS 111
The NHS advises an urgent GP appointment or NHS 111 if you think you or someone you care for has a UTI and any of these apply:
- you are 65 or older
- you are a man
- you have a weakened immune system, which can include steroids, methotrexate, biologics or JAK inhibitors
- you have diabetes, use a catheter or are pregnant
- you have a very high or low temperature, or shivers
- you have pain in the back just under the ribs, or blood in your pee
- symptoms get worse quickly or do not improve within 48 hours
- you keep getting UTIs (2 in 6 months or 3 in 12 months)
The NHS says some of these can be signs of a kidney infection, which can lead to sepsis if it is not treated. Women aged 16 to 64 who are not pregnant can usually see a pharmacist first.
Arthritis medicines and UTI treatment
- Do not stop, skip or pause arthritis medicines yourself. If you take methotrexate, biologics, JAK inhibitors or steroids, ask your GP, pharmacist or rheumatology advice line what to do while you have an infection
- Never stop steroid tablets suddenly. If you carry a steroid card, show it. See our steroid emergency card guide
- Methotrexate and antibiotics: the NHS lists trimethoprim and co-trimoxazole among the medicines that affect methotrexate, and asks you to show your methotrexate card. Always tell the prescriber or pharmacist you take methotrexate before you start an antibiotic
- Anti-inflammatory painkillers: if you are dehydrated or unwell, ask a pharmacist before taking ibuprofen or similar tablets. The NHS suggests paracetamol for UTI pain and temperature. Our painkillers guide explains why
- Take the whole antibiotic course you are prescribed, even if you feel better
Why arthritis can make UTIs more likely
Some links are practical rather than medical. Painful hips, knees or hands can make getting to the toilet slow or hard, so people sometimes drink less or hold on longer. Reduced movement can lead to constipation, and difficulty wiping or managing pads can make hygiene harder. All of these are worth tackling:
- drink enough so your pee is pale through the day, spread out rather than all at once. A jug or bottle within easy reach helps
- do not hold on when you feel the urge, and take your time to empty your bladder fully
- wipe from front to back, and change pads promptly
- ask your GP for an occupational therapy assessment for a raised toilet seat, grab rails, a commode or bottle at night, or wiping aids
- plan night-time toilet trips safely: a night light, clear path and walking aid by the bed. Our falls prevention guide has more
- if you take warfarin, the NHS says avoid cranberry products
After a UTI: recovering strength
An infection, especially with confusion, can leave someone weaker and less steady for days or weeks. Restart usual movement gently, keep eating and drinking regularly, and ask for physio or a falls service if walking has become harder. If confusion does not clear as the infection settles, tell the GP. NICE guidance on delirium (CG103) highlights that it can last and that it needs follow-up. Carers can ask for a carer's assessment for extra support.
Frequently asked questions
Is every bout of confusion in an older person a UTI?
No. The NHS lists many causes, including other infections such as a chest infection, stroke, low blood sugar, a head injury and medicines. That is why sudden confusion needs a proper assessment. Our chest infection guide covers another common winter cause.
Do cranberry drinks treat a UTI?
The NHS says there is no evidence that cranberry products ease symptoms or treat a UTI once it has started, though they may help some people prevent them. They can contain a lot of sugar.
Can I prepare for this in winter?
Yes. Write down your medicines, who to call and what to do on a sick day. Our winter viruses guide and printable flare action plan help you plan ahead.
Sources and further reading
- NHS: Urinary tract infections (UTIs)
- NHS: Sudden confusion (delirium)
- NHS: Kidney infection
- NHS: Sepsis
- NHS: Taking methotrexate with other medicines
- NICE CG103: Delirium
Educational information for people in the United Kingdom — not a diagnosis or personal medical advice. Charity no. 1218461. Pending clinical review. Everyone's situation is different, so always follow the advice of your own GP, pharmacist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.
Continue with related help
- Delirium and arthritis — confusion in hospital
- Steroid emergency cards — who needs one and when to show it
- Steroids and infection — what to watch for
- Chest infections and arthritis — self-care and warning signs
- Winter viruses and arthritis medicines — a sick-day plan
- Painkillers and NSAIDs — safer pain relief
- Falls prevention — safer night-time trips
- Carer's assessment — support if you care for someone