Urinary Tract Infections and the Pelvic Floor

Many people are unfortunately quite familiar with the typical symptoms of a urinary tract infection.  Most commonly, they include pain or burning while urinating, increased frequency and urgency of urination, cloudy or strong smelling urine, abdominal or low back pain and possibly blood in the urine.  Urinary tract infections are caused by bacteria entering the urinary tract, and infections can occur in the urethra, bladder, or kidney.  There are many different types of bacteria that can cause urinary tract infections but the most common is Escherichia coli (E. coli).  E. Coli is found in our digestive systems and can spread (often from the skin or rectum) to the to urinary tract and cause infection.  The presence of urinary tract infections are typically identified by taking and testing a urine sample. The urine sample will be analyzed for the presence of bacteria, red blood cells and white blood cells. Sometimes the urine sample is also sent for a lab culture, which will help identify which type of bacteria is causing the infection.  A course of antibiotics is the typical treatment for urinary tract infections.  With an uncomplicated infection, symptoms should clear up within a few days of taking the prescribed antibiotics. 

When urinary tract infections don’t go away…

A chronic urinary tract infection can occur when the infection persists beyond the typical timeline for treatment.  This can happen as a result of a recurrence due to re-infection, or because the original infection was not resolved with treatment.  Typically, a chronic urinary tract infection is diagnosed when someone has tested positive for infection three times in a 12 month period, or twice in the span of six months.  This can be called recalcitrant cystitis or urinary tract infection; meaning “frequent or recurrent symptomatic infection which is not adequately managed with standard therapeutic approaches”.   Additionally, chronic low level urinary tract infections may go undetected by routine urine testing, which complicates the situation even further!  In some cases, doctors will diagnose chronic urinary tract infection if symptoms are present and a urine sample is positive for a certain concentration of white blood cells (pyuria) but not necessarily bacteria.  Management of recurrent or chronic urinary tract infections (once identified) can include a low dose long term (up to 6 months) course of antibiotics, or access to prophylactic, or preventative, antibiotics to use if something specific is triggering recurrence, like penetrative intercourse. 

How the pelvic floor is impacted… and how a pelvic floor physiotherapist can help! 

In response to infection – especially if chronic over an extended period of time – the pelvic floor muscles can become impacted.  Symptoms associated with urinary tract infections can lead to pelvic floor muscle tension or tightness. Feeling constant urgency to go and being in acute pain causes the body to clench and tense up the surrounding muscles.  After dealing with an infection, especially if it was present for a long time, your pelvic floor muscles may have a tendency to remain in a state of tension and have difficulty relaxing.  This can contribute to some symptoms similar to urinary tract infections persisting even though the infection itself has been cleared.  Pelvic floor muscle tightness can contribute to increased urinary frequency and urgency, and pelvic and abdominal pain.  Once the urinary tract infection has been addressed and properly resolved with the appropriate antibiotic treatment, pelvic floor physiotherapy can be helpful to address any pelvic floor muscle dysfunction that occurred in response to the infection.  A pelvic floor physiotherapist will assess the tissues of the pelvis externally and internally to identify any dysfunction or muscle tightness.  Interventions like soft tissue release, stretching, and education on breathing strategies and pelvic floor muscle relaxation can help to return the pelvic floor muscle tone to normal and therefore improve symptoms. Additionally, behavioural strategies like bladder retraining, urgency delay techniques, and analyzing and improving hydration habits can help to return bladder function to normal. 

To summarize, urinary tract infections are unfortunately a common issue that many individuals will experience at some point in their lifetime. Sometimes urinary tract infections are straightforward and clear up quickly with a course of antibiotics, but sometimes they can be persistent and not respond to treatment as we would hope.  In these cases, it’s important to get a proper diagnosis and make sure the infection is treated so that it fully resolves.  With persistent or chronic urinary tract infections, it is possible that pelvic floor muscle dysfunction will develop as a response to the ongoing issue.  Pelvic floor physiotherapy is a helpful option to manage pelvic floor muscle dysfunction and alleviate symptoms once the infection is cleared. 

Resources:

1) https://www.medicalnewstoday.com/articles/322185

2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004281/

3) https://cutic.co.uk/patients/treatment-options-chronic-uti/

4) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3749018/

5) https://www.nhs.uk/conditions/urinary-tract-infections-utis/

6) https://www.utivahealth.com/blogs/resources/how-to-manage-your-urinary-health-through-pelvic-floor-physical-therapy#:~:text=Even%20a%20small%20urinary%20tract,they%20can’t%20relax%20anymore.

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