If you’ve had one before, the symptoms are unmistakable: an intense urge to pee, burning with urination, urethral/vulvar pain, maybe you have to run to the bathroom every few minutes even though only a few drops come out. The symptoms are intense and consume your attention — you drop everything so that you can see your physician and get those antibiotics — you undoubtedly have another urinary tract infection (aka UTI). Or do you?
What you may not know is that the same symptoms that you experience when you have a UTI — the burning, urgency, and frequency — can also be a result of pelvic floor muscle dysfunction, and not related to an infection at all. You may have heard of a ‘Phantom UTI,’ which is when you have symptoms of a UTI without an actual infection.
Here’s another twist: you could have a UTI and pelvic floor dysfunction. In a classic “chicken and egg” scenario, having a stubborn UTI (or multiple in a row) can contribute to developing pelvic floor muscle dysfunction. In turn, pelvic floor muscle dysfunction can lead to developing UTIs. So what can you do about it? Read on for some helpful advice you may not have heard before.
Signs you may have a urinary tract infection
A urinary tract infection develops when the bacteria that was once hanging out around your urethra sneaks up the urethra, into the bladder. This bacteria can irritate the lining of the urethra and bladder, cause severe inflammation and lead to painful urethral burning and irritating symptoms.
If a true infection is present, your body will trigger an immune response to prevent the infection from taking over your body. You may develop symptoms such as cloudy or foul-smelling urine or even a fever. If you develop these symptoms, there’s a greater chance that they are due to an actual UTI — but it’s always best to check in with your physician to be certain.
There are many factors that have been found to increase your chances of getting a UTI, including certain medical conditions, genetic factors, and frequent sexual intercourse (don’t forget to pee after sex, which helps keep bacteria out of your urethra). UTIs are also more common for individuals who have pelvic organ prolapse, trouble emptying their bladder completely, or who are in menopause. That connection isn’t coincidental, but more on that later.
When pelvic floor dysfunction could be to blame
Your pelvic floor muscles (see diagram below) are the group of muscles positioned at the bottom of your pelvis that lift and support the position and function of your pelvic organs (bladder, bowel, uterus), and help with blood flow and circulation in this area. Ideally, these muscles should be strong, coordinated, and flexible, but this isn’t always the case. When these muscles aren’t working as they should, it’s called pelvic floor dysfunction (PFD).
One type of PFD occurs when the muscles are tight and overactive. With overactivity, the muscles become shortened, inflexible, and wreak havoc on your joints, nerves, blood flow, and disrupt normal bladder, bowel, and sexual function. Basically, there is a charley horse in your pelvis, and this can lead to symptoms such as pain around the vulva and urethra, urinary frequency and urgency, as well as pain with urination. Other symptoms of an overactive pelvic floor include constipation, pain with sex, or even bladder leakage.
PFD & UTIs can create a vicious cycle
It’s not just your immune system that works overtime when you have an infection, your pelvic floor muscles may also go into defense mode. Research shows that your pelvic floor muscles are reliable guard dogs for your pelvic health and will tense up in response to actual, or perceived threats, which in this case would be a UTI.
Now imagine a sudden stroke of bad luck and you get a few UTIs in a row, or you have a particularly stubborn one that just won’t go away until you take a mega-dose of antibiotics. After responding to the threat of infection, your pelvic floor muscles may struggle to relax and return to normal functioning — this is how overactive pelvic floor muscle dysfunction can develop after a UTI.
When pelvic floor muscles are overactive, they have a hard time relaxing enough to help you pee. Normally when it’s time to pee and you sit down on the toilet, your pelvic floor muscles relax which helps your urethra to open, making a path for urine to exit. The muscle that surrounds the bladder then contracts and pushes the urine out, hopefully without resistance from your pelvic floor muscles. If your muscles aren’t relaxing enough — or at all — then all of the urine can’t get out, which then increases the chances of another UTI developing.
When to see a pelvic floor physical therapist
Because an infection can lead to pelvic floor muscle dysfunction, and pelvic floor muscle dysfunction can lead to infection, and they can even be occurring and worsening at the same time, it’s hard to know what to do or who to turn to when symptoms pop up.
If it’s the first time you’re experiencing these bladder symptoms — especially if your symptoms are associated with cloudy or smelly urine, or a fever — then it’s best to check in with your physician to see if you have an infection. A simple urine culture test can rule an infection in or out, within a day or two. If you need antibiotics, they will know what to prescribe.
If you don’t have an infection and your physician determines that there is not a medical explanation for what is going on, then checking in with a pelvic PT is the next best step. They’ll be able to help determine if your symptoms are related to PFD, and create a treatment program to restore your muscle and bladder function to relieve your pain.
Another reason you want to check in with a pelvic PT is if your UTIs keep coming back because there is likely a PFD that is hiding in the background, keeping your bladder from working efficiently. Remember the UTI risk factors we listed above — pelvic organ prolapse, incomplete bladder emptying, and menopause? By improving your pelvic floor muscle function and reducing the muscle-related risk factors of UTIs, pelvic floor therapy can help get you off of the UTI/antibiotics merry-go-round, and get you back to feeling good again.