Chronic UTI’s? PT can help.

Urinary tract infections (UTIs) are common. They’re so common that they account for nearly 10 million doctors visits a year, with an estimated 150 million UTIs occurring annually, costing roughly 6 billion dollars in health care expenditure.1,2 So what is a UTI? A UTI is an infection in any part of your urinary tract, including your urethra, bladder, ureters and kidney. This can happen when bacteria gets into the tract, overcoming the bodies immune system, resulting in inflammation and pain.

These infections affect both women and men, however women at a higher rate due to anatomical differences. Women have shorter urethras, located more closely to the anal opening, putting them at higher risk for infection. This is one of the reasons conventional wisdom recommends wiping front to back following using the bathroom.

So what does a UTI feel like? Symptoms of UTIs include:

  • Urgent and frequent need to urinate
  • Difficulty emptying the bladder
  • Burning sensation while urinating
  • Pain in the lower abdomen
  • Cloudy urine or blood in the urine
  • Low back pain, fever and chills (these are signs of a more serious infection)

You may experience some of these and not others.

If you’re feeling any of these symptoms, follow up with your physician. They will likely do a urinalysis. What is a urinalysis, one may ask? It’s an analysis of your urine. This test requires a urine sample that can be cultured for bacteria to assist your physician in determining the cause of your symptoms and the appropriate treatment. If bacteria is found, you will likely be prescribed an antibiotic, and if all goes according to plan you’ll be feeling better in no time.

So what if that isn’t enough? What if you take the antibiotics and your symptoms are still there? That’s a reasonable question and an unfortunately common scenario. The National Kidney Foundation reports that if a woman has a UTI, she is 30% likely to have a recurrence. If a woman has two UTIs, she is 80% likely to have a recurrence. If you’re symptoms persist, your physician will likely have you come back to drop off another sample. If that sample comes back positive, maybe one round of antibiotics wasn’t enough and they’ll prescribe you another one. But what if the test comes back negative? What if they do further testing that comes back negative, too, but you’re still feeling bladder pain, burning with urination, etc.?

Maybe infection is no longer the culprit. Maybe your pelvic floor is.

When your body experiences pain, the muscles surrounding the painful area go into protection mode. They guard to keep your body safe. This can be effective and helpful in the short term, but if our body continues to think we’re under attack when the painful stimulus has been dealt with, it can cause pain to continue. In the case of UTI’s your pelvic floor muscles are the ones that guard in response to a perceived attack on your body, and they’re the muscles that may not realize the threat has resolved even if your antibiotics do the trick.

In these cases, your pelvic floor continues to stay contracted, continues to irritate your urethral sphincter and tissue surrounding the urethra and can even contribute to a tightening of muscles in your lower abdomen surrounding your bladder. All of these angry muscles can mimic the bladder pain and urinary discomfort you experienced during your UTI.

This explains why your urinalysis can continue coming back clear, while your body is very certain something is wrong. So if you have been back and forth to your physician’s office, dropped off samples of your urine multiple times, taken medication, followed all appropriate steps and you’re still sure your bladder is revolting against you, consider pelvic floor physical therapy. An evaluation with a trained PT can help determine whether the muscles are the culprit of your continued pain.

A trained pelvic floor physical therapist can help teach your muscles to relax again and help you improve your control over those muscles so this doesn’t happen again in the future. Using a combination of internal and external manual therapy along with relaxation exercises and stretches can help your muscles calm down and do wonders to manage that UTI-like-pain.

I hope this was a useful read! Feel free to leave questions or comments below- I’d love to hear from you. I can also be reached at becky@sullivanphysicaltherapy.com

-Rebecca Maidansky, PT, DPT

Resources

1.https://www.kidney.org/sites/default/files/uti.pdf

2.https://www.auanet.org/education/auauniversity/for-medical-students/medical-student-curriculum/adult-uti

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