How Pelvic Floor Therapy Can Help With Recurrent UTIs

If you’ve been getting urinary tract infections (UTIs) over and over, you may have a constant sense of dread, wondering when the next infection is going to strike. For some women, the missing piece of the treatment puzzle is addressing the pelvic floor.

“Some women have pelvic floor dysfunction, which sometimes leads to voiding dysfunction or urinary holding,” says Stephanie Gleicher, MD, a board-certified urologist and urogynecologist at Northwell Health in Long Island, New York. “These things can sometimes trigger UTIs.”

If that’s the case for you, pelvic floor physical therapy may help you develop fewer UTIs.

“The pelvic floor muscles play a crucial role in urinary and bladder function,” says Alexandra Hill, a pelvic health and oncology physical therapist in Jacksonville, Florida. “And they help with functioning and management of bowel and reproductive organs.”

When the pelvic floor isn’t working the way it’s meant to, it’s called pelvic floor dysfunction. Different types of pelvic floor dysfunction may contribute to UTIs or cause UTI symptoms, including:

Hypertonic Pelvic Floor

Pelvic muscles that are short or tight are referred to as overactive or hypertonic.

“Overactive pelvic floor muscles can prevent the bladder from fully emptying,” says Hill. “And if that urine isn't completely emptied out of the bladder, that could lead to bacterial growth and keep people in this cycle of having recurrent UTIs.”

The pelvic floor can tighten in response to UTI pain, she adds. For some people, that tightness doesn’t go away and can cause more pain, irritation, and a frequent urge to urinate. It could feel as if the UTI hasn’t gone away, even if it has.

“It’s similar to how the muscles in your neck get tense and can cause a headache,” says Hill. “The muscles at your pelvic floor, if they’re tight, can potentially mimic a UTI.”

Pelvic Organ Prolapse

Other Types of Pelvic Floor Dysfunction

Overactive bladder, urinary incontinence, and fecal incontinence are all types of pelvic floor dysfunction that occur in people with recurrent UTIs. Or symptoms could be so similar that the issue can be mistaken for a UTI.

When it comes to breaking the cycle of UTIs or UTI-like symptoms, Hill says pelvic floor therapy usually focuses on relaxing the pelvic floor.

What to Expect

Pelvic Floor Manual Therapy Hands-on treatments can help relax the pelvic floor by applying gentle pressure or massaging tense muscles internally or externally. Myofascial release is a manual therapy technique where trigger points are stimulated to release tension.

Pelvic Floor Retraining Your pelvic floor physical therapist may be able to teach you exercises to help you release your pelvic floor if the muscles are tight. “We can coach people through pelvic floor relaxation, so almost like the opposite of a Kegel or contraction,” says Hill.

Biofeedback This mind-body technique uses sensors to track muscle activity. “Biofeedback is an electrical modality, so when you contract and relax, you can actually see it on a screen, which can help with retraining,” says Hill.

Lifestyle Changes and Addressing Contributing Factors Your physical therapist will likely suggest lifestyle changes that could improve symptoms, such as “having plenty of water and avoiding bladder irritants like caffeine, carbonated beverages, alcohol, or acidic things,” says Hill.

In addition, you may work together to identify and address other factors that may be causing recurrent UTI symptoms, such as chronic constipation or menopause-related changes.

Hormonal changes can affect some of the protective properties of the vagina, making women in perimenopause or menopause more prone to UTIs. Vaginal estrogen cream is a generally safe and effective treatment, says Dr. Gleicher.

If you think pelvic floor physical therapy could be a helpful complement to your UTI treatment regimen, then it’s worth exploring.

Some signs it could be effective include:

• Your doctor has diagnosed you with pelvic floor dysfunction, such as hypertonic pelvic floor, incontinence, or pelvic organ prolapse.
• You’re getting what feels like UTIs but testing negative for bacteria in the urine.

Gleicher says most of her patients with recurrent UTIs usually have other concerns that can be helped by pelvic floor therapy.

“It’s definitely an option, too, for even just managing symptoms when you’re having a UTI episode — learning different techniques to eliminate some of the frequency, the urgency, the pressure,” says Gleicher. “I also think it is so beneficial just to understand this part of our body that does so much for us.”

• Recurrent UTIs can be disruptive and stressful. Pelvic floor physical therapy can be a helpful addition to your treatment plan if you struggle with pelvic floor dysfunction.
• Pelvic floor physical therapy includes a variety of treatments that relax and retrain the pelvic floor to provide relief.
• Your healthcare provider may recommend pelvic floor physical therapy if you have hypertonic pelvic floor, incontinence, pelvic organ prolapse, or another condition that affects your ability to completely empty your bladder.