Urinary Tract Infections and the Pelvic Floor

Urinary Tract Infections (UTI) are relatively frequent, but pinpointing an exact cause is often difficult. Since UTIs are commonplace, we may often observe ourselves overlooking the insidious signs indicating a more serious underlying cause, such as pelvic floor dysfunction.

But first, what is a Urinary Tract Infection?

A urinary tract infection (UTI) is an infection to any part of the urinary system. This can include the kidneys that make the urine, or the bladder that stores it, down to the urethra which releases the urine.

Many cases of UTIs have no symptoms and resolve on their own. However, if you find yourself with one of the symptoms below, it might be an indication of a urinary tract infection:

A burning sensation when you pee
An urgency to pass urine
Increased frequency of pee breaks
Pelvic pain or discomfort
Changes in the color and smell of urine

While having cloudy or blood-stained urine might be considered a sign of underlying infection, it is not always present among UTIs.

More serious signs of an infection higher in the urinary tract can include back pain, fever, chills, and vomiting. These signs should prompt you to receive immediate medical assistance.

How common are UTIs?

People with vaginas are at a higher risk of developing a urinary tract infection, primarily because of their physical anatomy. It's estimated that about 60% of these people might experience a UTI in their lifetime. This is due to the easy passage of bacteria from the perianal region to the urinary tract. The risk of infection increases significantly following sexual intercourse, making it the number one risk factor contributing towards the development of a UTI.

While we often associate hygiene practices with UTIs, there's not a significant link between the two. However, a strong association between bladder emptying and the risk of UTIs has been observed. This means not urinating when you feel the urge to do so, especially after intercourse, dramatically increases your risk of developing a UTI.

Other contributory factors include diabetes, a history of previous UTIs, a family history of UTIs, and estrogen deficiency.

Most UTIs resolve on their own in a week or so. The most effective way to manage a UTI is through a course of prescribed antibiotics.

How are UTIs and the pelvic floor linked?

The pelvic floor is essentially a barrier that separates and protects the inner organs from their outer passages. It provides support for the pelvic organs such as the bowel, bladder, vagina, and uterus, along with maintaining sphincter control for both urination and defecation. In essence, it has several voluntary and involuntary functions it performs throughout the day.

The inability of the pelvic floor to perform its usual function which is to contract and relax during both urination and defecation can suggest underlying pelvic floor dysfunction.

People who have pelvic floor dysfunction might often experience an inability to control the action of their sphincters. A sign of this is the inability to urinate when required, or at the opposite end, the leaking of urine.

When reviewing the overall picture, pelvic floor dysfunction can limit your ability to completely evacuate your bladder and bowels. This could then result in UTIs since bacteria thrive in the incompletely evacuated urine.

Since the signs of pelvic floor dysfunction can overlap with those of a UTI, diagnosis can be delayed. Both conditions can present with recurrent bouts of painful urination, leaking of urine, pain during intercourse, and pelvic discomfort. This can form a vicious cycle and management might only be aimed at the recurrent UTIs, and not the underlying cause, which is pelvic floor dysfunction.

Talk to your doctor if you think your recurrent UTIs could be hiding something else.

Managing UTIs Related To Pelvic Floor Dysfunction

Along with urine tests that assess underlying infection, your healthcare provider should test the pelvic muscle strength, muscle strain and use a perineometer to assess pelvic floor strength.

If your recurrent UTI has been associated with a pelvic floor dysfunction, you might benefit from pelvic floor training. By doing pelvic floor training, you will regain pelvic floor strength and the ability to control the sphincters that in turn will be able to empty your bladder and bowel all the way.

By far the best course of management for pelvic floor dysfunction is physical therapy. Pelvic floor therapy focuses on both mindfully contracting and relaxing the pelvic floor. Physical therapy also works to tackle stress, encourage effective breathing and gradually improve pelvic floor strength.

Written by Dr. Michelle Frank, a healthcare consultant from India.