The Power of Pelvic Floor Physical Therapy for Preventing UTIs
Urinary tract infections are typically treated with antibiotics. But what happens when your symptoms persist or worsen after treatment? For this blog, we sat down with pelvic floor physical therapist, Dawn Scandalcidi, to discuss the relationship between UTIs and pelvic floor dysfunction - and how physical therapy could help.
What exactly is pelvic floor dysfunction?
The pelvic floor is a combination of muscles spanning across the pelvis and is responsible for supporting the pelvic organs, controlling urination and bowel movements, and contributing to sexual function.
Pelvic floor dysfunction (PFD) refers to a range of symptoms caused by the muscles in the pelvic floor functioning abnormally. When pelvic floor muscles behave abnormally, they can be hypertonic (overactive), hypotonic (underactive), or experience a lack of coordination.
PFD not only causes physical pain and discomfort, it often has far-reaching effects on women’s quality of life and relationships. However, the average pelvic pain patient doesn’t seek support for an average of 3-5 years after the onset of their pain. Dawn explains how this is likely due to shame surrounding intimate topics and a lack of awareness around what is considered ‘normal’ in pelvic health.
What are the symptoms of PFD?
Symptoms of PFD are unique to each individual, depending on the type of dysfunction they’re experiencing. Patients may experience one or a combination of the following:
Urologic: difficulty or pain urinating, bladder or urethral prolapse and incontinence.
Gynecologic: pain during sex, uterine or vaginal prolapse.
Colorectal: constipation, incontinence or prolapse.
General: pelvic pain, muscle spasms.
How is PFD related to UTIs?
The majority of people who treat their UTI with antibiotics will be back in good health after treatment - but this isn’t the same for everyone.
Muscles are susceptible to holding habits and patterns. For example, if someone has a UTI and experiences extreme pain urinating, their body can anticipate that pain and learn to pull in and tighten when using the bathroom instead of releasing fully. This can perpetuate the cycle of pain, leading to PFD and recurrent UTIs.
How can physical therapy help prevent UTIs?
When your pelvic floor muscles become tight, it can be difficult to empty your bladder fully. This is known as lower urinary tract dysfunction (LUTD). LUTD can increase your chances of infection in 3 ways:
You don’t flush out the urethra and any bacteria fully.
Residual urine can move back up towards the bladder, taking bacteria with it.
Your urinary microbiome and natural defenses are impaired.
So, working on your pelvic floor health with a physical therapist can help reduce your risk of recurrent UTIs by ensuring you’re emptying your bladder fully each time you use the bathroom and learning how to relax your PFM.
How do physical therapists approach PFD?
Dawn has been a physical therapist for 41 years, with a focus on pelvic health since 1993. She says that as a physical therapist specializing in pelvic health, you have to build a clear picture of your patient’s well-being - including their health, mental state and lifestyle habits.
‘To be a good physical therapist is to be a good historian’.
Dawn reminds us that the entire musculoskeletal system is connected via your deep fascial system - a layer of muscle that connects your tongue to your pelvic floor, all the way down to your toes. So, we have to look beyond the organ that is painful to identify wider issues or past injuries.
A bladder diary is a good place to start.
As part of her investigation, Dawn will often ask her patients to keep a bladder and bowel diary (find options in the NAFC website) detailing their diet , urinary and bowel frequency and pain levels. This helps to eliminate certain bladder irritants that could cause urinary frequency. Examples of bladder irritants include caffeine, fizzy drinks, acidic or spicy foods, or food dyes.
Education and advocacy are key to better pelvic health.
People who have lived with chronic pain for months or years can often lose sight of what is considered normal for their body. Dawn explains that more women need education on what is considered normal in pelvic health and the confidence to advocate for themselves.
To prevent pelvic pain from developing into a chronic situation, women need to ask the right questions, for example:
What if I still have pain after my antibiotic treatment?
What else can I be doing to support my pelvic health?
What other symptoms should I look out for?
Where can I seek more information and support?
Our key takeaway:
Ongoing pelvic pain after UTI treatment is not normal and you should seek support.
If you continue to experience pelvic pain or feel unable to empty your bladder after your antibiotic treatment, it’s important to seek follow-up support from your healthcare provider. Don’t be afraid to do your research, ask questions and request a referral for physical therapy.
You are your own best advocate!!
For more information on recurrent UTIs, their causes and how to manage them - check out MyUTI’s education center.
