Recurrent Urinary Tract Infections: the proverbial ring of fire

In Female Pelvic Pain by Stephanie Prendergast9 Comments

Urinary tract infections (UTI) are considered to be the most common bacterial infection in humans, costing the US health care system about $1.6 billion dollars per year.  These infections plague millions of people at some point or another throughout the lifetime. In fact, some research suggests that a female’s lifetime risk of getting one is as high as 1 in 2. And merely having one UTI means that we are more prone to getting another one! According to a 2008 article by Hooton and Gupta: about 20 percent of women who become diagnosed with an initial urinary tract infection will experience a recurrence. And 30 percent of those people will get diagnosed with a third. AND, 80 percent of those who have had three UTIs will get a fourth, et cetera.

But I am getting ahead of myself, let me first explain the basics. A urinary tract infection (UTI) is a bacterial infection that is found anywhere in the urinary system: kidneys, ureters, bladder, urethra. The majority of infections involve the lower urinary tract, the bladder and the urethra, and are treated with antibiotics. Bacteria, e.g. E. coli, that is found in fecal matter can migrate toward the urethra and then bladder, and if the infection isn’t treated, it can continue up the urinary tract to infect the kidneys.

Common symptoms of a UTI include:

  • burning/pain with urination
  • urinary urgency/frequency
  • low back or abdominal pain
  • cloudy, dark, bloody, or strong smelling urine
  • feeling tired or shaky
  • fever or chills (a more serious sign that the infection may have reached your kidneys)
  • voiding frequent, small amounts of urine

Why do UTIs happen? Let’s think about the anatomy: the urethra is located really close to the anus. Both men and women can get UTIs, however women are especially prone to getting UTIs due to having shorter urethras, which allow bacteria easier access to the bladder. (Ladies, see Rachel’s blog on vulvar anatomy if you need a refresher about what is going on down there).

If you suspect you have a urinary tract infection, get in to see your doctor right away. You will need to give a urine sample, which will be tested for the presence of UTI-causing bacteria. The first line of treatment: antibiotics. *Antibiotics can be a extremely effective treatment for bacterial infections, however they can also wreak havoc on the gut and vaginal flora (aka good bacteria). I always recommend talking to the prescribing physician about ways to best maintain the health of our good bacteria while taking a course of antibiotics.*

Men, I haven’t forgotten about you. Men can experience these same symptoms however it is often diagnosed as prostatitis. For more information on this issue, read Malinda’s most recent post.

Some women will experience recurrent UTIs for a variety of reasons: genetic predisposition, anatomical issues, new sexual partner, diabetes, pregnancy, multiple sclerosis, and anything that affects urine flow, such as kidney stones, stroke, self-catheterization, and spinal cord injury.

As I mentioned above, if you are experiencing any of the listed symptoms consistent with a UTI, make an appointment to see a physician immediately. UTIs, when left untreated, can lead to serious medical complications.

So what happens if you take the prescribed antibiotics and the symptoms persist? You go back to your physician, leave ANOTHER urine sample, which is cultured and the results are negative for infection. Often the physician may prescribe another course of antibiotics. More antibiotics can lead to a further decrease in our good bacteria which can sometimes lead to bowel irritation and vaginal yeast infections.

In a different scenario-you are experiencing the maddening symptoms associated with a UTI, but you go to the doctor and they find nothing. In this case, they will often write you a prescription for antibiotics anyway, as a precaution. You take the antibiotics, nothing happens, and you are left wondering where to go from here.

If this sounds like you and you are consistently getting negative urine cultures when tested, it is time to think about trying pelvic floor physical therapy. These are extremely common presentations that the therapists at PHRC help their patients deal with on a daily basis.

As I mentioned above, UTIs are a bacterial infection occurring anywhere along the urinary tract (urethra, bladder, ureters, kidneys). Infections are considered a serious threat by our immune system, so not only will we get an influx of immune system inflammatory cells to the area, but we will also often see muscle guarding of the pelvic floor (specifically the urogenital diaphragm which has attachments to the urethral sphincter).

So even though we may be infection free, the muscles are still in protection mode. And because we have muscles in the urogenital diaphragm which can have small attachments to the urethral sphincter, they can actually mimic all of the UTI symptoms. Hence, what may have started as a real infection is now an overactive muscle dysfunction causing the same symptoms.

Does any of this sound familiar? Last month I blogged about recurrent yeast infections which can result in pelvic pain/dysfunction by an almost identical mechanism. And as we’ve blogged about before: tight muscles can lead to myofascial trigger points, pudendal nerve irritation, connective tissue restriction, and decreased blood flow to the involved tissues. This leads to a further influx of inflammatory chemicals, causing even more pain and muscle dysfunction. As a result, the self perpetuating cycle of pelvic floor muscle dysfunction caused by a UTI is in motion.

The bottom line is that if you are experiencing some or all of the symptoms that I have listed in this blog post, and you have been through all of the first line steps but are STILL having issues, get evaluated by a physical therapist that specializes in pelvic floor dysfunction. Your symptoms may not actually be a UTI but may be the pelvic floor muscles masquerading as such. Here is a link with some tips to find a pelvic floor physical therapist in your area.

*Fact: It is due to the risk of getting a UTI that women are often taught to wipe from front to back.

Readers we want to hear from you!  Have you experienced any complications after a UTI? Please share in the comments section below!

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  1. Again SO TRUE! The reality is that women with LUTS have, for years, been placed in a narrow category of recurrent UTI or, worse, OAB. If that patient does not have a positive culture, then other potential sources of those symptoms MUST be considered. Screening for a UTI is the first logical point but, then, a pelvic floor assessment can and should be performed at the same appointment before other more invasive diagnostic modalities are considered. Yes, that patient could have a rare resistant E-coli infection and yes that patient could have interstitial cystitis… but I’d bet that the majority of these cases really are pelvic floor dysfunction that could have been identified far earlier in their care.

    1. Author

      Hello Jill,

      You are correct, all too often we meet patients who could have benefited from a pelvic floor examination way before they consented to other examinations and/or procedures. PHRC hopes to change that by providing excellent care, and sharing information with patients and the medical community.

      All my best,


  2. just wondered if you have found any holistic approaches that can help with this very difficult problem? Things such as clear-track or other natural supplements that are purported to help?

  3. What specific muscles and/or connective tissue does the PT work on for a UTI infection that is resolved by antibiotics but spirals into this? You said “we will also often see muscle guarding of the pelvic floor (specifically the urogenital diaphragm which has attachments to the urethral sphincter).” What specific muscles and connection tissue does this encompass and what is the best way to quiet it down?

  4. From your blog on yeast infections one takeaway is that histamines may play a role.

    Do histamines play a role in UTIs and the following feeling of having a UTI even after the bacteria are gone?

    One last question – Would using something like pyridium right away when getting a UTI help keep the pelvic floor from reacting so badly to it and help keep the muscles from getting hypertonic and making the pudendal nerve act up? Thanks.

    Thanks again!

    1. Hello Susan,

      Histamines are a part of an immune response to infection/pain/dysfunction. So it is possible that they are having an impact on your pelvic floor in the absence of bacteria. You should discuss taking pyridium with your physician or physical therapist-but it can be a great tool to avoid engaging in the pelvic floor symptom cycle.



  5. Hello,
    I usually get uti symptoms but no bacterial growth but positive wbc leucocytes could that be pelvic floor dysfunction???

    1. Hi Mimi,

      It sounds like you may have a pelvic floor disorder. Unfortunately we cannot make specific recommendations without evaluating you. We would be happy to evaluate you in one of our locations or you can use our website to find a pelvic floor physical therapist in your area that can help.


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