Urinary tract Infections and the pelvic floor.

In Pelvic Floor Physical therapy, as we look over our patients’ intake paperwork, one thing that is often mentioned is a history of urinary tract infections (UTI).  This can often be a part of their history that is overlooked. Let’s take a look at what a UTI is and how it can affect our treatment and your recovery in pelvic floor PT.   

About 60% of women will have a UTI in their lifetime.  A UTI can be an infection anywhere in the urinary system: kidneys, ureters, bladder, or urethra.  If someone has 3 or more infections in a year, it is considered a recurrent UTI and needs further investigation. 

Symptoms of UTI include frequent and urgent urination that can be painful or burning.  There may also be lower abdominal pain. There may or may not be visual blood in the urine.  A patient can have urine tested in their providers’ office with a dip stick that will test for blood or larger bacterial particles.  The urine can be cultured to see if bacteria grow and see what bacteria are present. This helps determine what the best treatment/medication will be.  Some people are more susceptible to UTIs including:
– people with diabetes
– weakened immune systems
– spermicide use
– pregnant
– prolapse
– urinary incontinence
– post-menopausal women.   

Many of the women we see have menopausal symptoms due to decreased estrogen.  Decreased estrogen can make the vulvovaginal tissue more frail, itchy, and more susceptible to e. coli infections.  This is one of the reasons that one of the first lines of defense for recurrent UTIs is vaginal estrogen.   

The pelvic floor muscles respond to pain and irritation from a UTI by tightening or guarding.  The muscles can then have difficulty relaxing or elongating. This tension can make it difficult to fully empty the bladder, creating a perfect opportunity for bacteria to grow and cause an infection. 

A bladder prolapse or cystocele is also common. Cystocele can form a pocket or area in the bladder that is difficult to empty. This can also cause that same retention in the bladder, giving bacteria the opportunity to grow.   

Pelvic floor PT should be part of your health care team if you are having UTIs and especially recurrent UTIs.  The pelvic floor muscles will have difficulty elongating or relaxing in response to pain or prolapse.  It is important to assess what is happening in your system. Pelvic PT will palpate the muscle to release trigger points, work on coordination of the pelvic floor, and improve urination techniques.  Pelvic floor PT can also assess for a prolapse, fit for a pessary if needed, and help to address the strength and abdominal pressure symptoms that may contribute to UTIs.   

When treating any pelvic infection, it is important to treat more than just the infection.  The pelvic floor muscles respond to any irritation or pain by becoming upregulated.  When this happens, it can become harder to relax the muscles due to higher muscle tone which can contribute to poor bladder emptying.  We want to break that cycle and help to prevent continued infections. 

If you are struggling with UTIs, ask your provider for a referral to pelvic floor PT. In most states you can come to PT without a referral, and see a PT who can diagnose your pelvic floor, to determine if it is contributing to continued infections. We offer free 15 minute phone consultations to answer questions and help you determine if we are the right fit for you.