Is it a UTI or Not?

A lot of individuals are unfortunately familiar with the symptoms of a urinary tract infection or UTI. That’s why when we notice that we’re making more trips to the bathroom than usual and have a painful burning while peeing we think “Uh oh, a UTI!” and book an appointment to see the doctor to get some antibiotics. However, these symptoms alone are not exclusive to UTIs and can be present when there is actually no bacterial infection. With this blog post, I hope to shed some light on UTIs and outline some of the other situations that can cause similar symptoms.

First of all, what is a UTI?

A UTI is an infection of the urinary tract, most commonly affecting the bladder and/or the urethra. Bacteria (usually from around the anus, vagina or penis) enters the urinary tract and causes irritation to the inner lining of tissue. This irritation can cause burning pain with urinating, and a strong urge to urinate frequently with only a small amount of output. The urine itself can appear cloudy and have an odour. UTIs are diagnosed through urinalysis – which is a lab test of a sample of urine. The urine sample is analyzed for bacteria and white blood cells, which are signs of infection. UTIs are treated by a course of antibiotics, and the symptoms typically resolve quite quickly as the bacterial infection is cleared.

But, what if the test comes out negative?

It is possible to have some or all of the hallmark signs of a UTI but have negative urine tests – which means no bacteria are identified in the urine. In these situations, even though the same symptoms can be present, they unfortunately would not resolve with antibiotics the way a UTI would. Below, I’ll outline some of the causes of UTI-like symptoms and explain how they occur.

Interstitial cystitis: interstitial cystitis is a chronic bladder issue that involves bladder pain, often with high urinary urgency and frequency. The cause is unknown, and it’s diagnosed after 3 months of urinary symptoms with negative urine tests. 

Overactive bladder syndrome: overactive bladder involves high urinary urgency and frequency.  Often this presents as a sudden and urgent need to urinate, with possible low urine outputs that seem disproportionate to the urge itself. This also can be associated with urinary incontinence. Overactive bladder can occur because of underlying medical conditions, medications, habits or behaviours, and dietary factors like the consumption of irritating fluids like coffee or alcohol.

Pelvic floor muscle dysfunction: the pelvic floor muscles surround the bladder and if they are too tight or overactive, they can contribute to bladder or urethral pain and frequent urination. Sometimes, the muscles become tight during an infection in response to the pain, but may not relax after the infection has cleared. Pelvic floor muscles can also become tight for a number of other reasons unrelated to infection, like pelvic pain conditions, injury, or even stress.

To summarize, although UTI’s are common, it’s not the only cause of the symptoms of urinary frequency, bladder pain, and pain with urination. If you have symptoms that could be a UTI, you should definitely see your doctor for a urine test. If the results are negative, discuss other potential underlying causes with your doctor to make sure you have appropriate treatment to manage the symptoms when antibiotics aren’t going to do the trick! The pelvic physiotherapists at Proactive Pelvic Health Centre can help you to manage symptoms of interstitial cystitis, overactive bladder, and pelvic floor muscle dysfunction.





4) Canadian Urological Association –


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