It’s not a UTI???!!!

Picture this-it’s been weeks of urinary urgency and frequent urination and pain while peeing. You’ve tried every over the counter supplement and old wive’s tale remedy, and nothing is helping. You finally make it to your doctor, and he tells you that your test came back negative for a urinary tract infection. What is happening?! 

Symptoms that can look very similar to a UTI, including urinary frequency and urgency and pain with urination, can sometimes be caused by pelvic floor dysfunction and impaired bladder/brain connection. With a little bit of help from your pelvic floor physical or occupational therapist, you may find relief from your symptoms. You’ll feel empowered if these symptoms ever return, knowing that you have tools in your toolbox to address the discomfort. 

Bladder irritants: You are what you drink

If the inner lining of your bladder detects urine concentrated with certain irritants, it will try to release the urine as quickly as possible, leading to the sensation of increased urgency. Common bladder irritants include coffee/caffeine, carbonated beverages, and alcohol. Note! “Carbonated beverages” include seltzer! If you need your spicy water to stay hydrated, try creating a “water sandwich”: have a little bit of water, then some seltzer, and then some more water. This will help dilute the seltzer, as well as any other bladder irritant you might be consuming. 

Additionally, dehydration can be a bladder irritant. It’s common for people experiencing urinary urgency to cut back on water intake in an attempt to control frequency of bathroom visits. It’s important to keep hydrated, however. Working with a pelvic floor physical or occupational therapist will help you to create strategies on how to better manage the uncomfortable sensation of urinary urgency. 

Pelvic floor hypertonicity

If the fascia around the bladder and urethra is overactive, or hypertonic, this can confuse the signals between the bladder and the brain, leading to sensations of urgency that aren’t caused by a full bladder. Additionally, inability to lengthen the pelvic floor can result in more difficulties in emptying the bladder. Urine will then be retained, which could then increase the likelihood of feeling urgency again soon. A pelvic floor physical therapist can help assess if the discomfort you’re feeling might be connected to over recruitment of the pelvic floor musculature. 

Bowel Habits

Your GI system health can be intimately connected with feelings of urinary urgency, frequency, and pain with urination. If you’re someone who experiences chronic constipation, this can lead to hardened stool building up over time in the rectum. Because of the proximity of the rectum to the bladder, this can place pressure onto the bladder, contributing to the sense of urgency. 

Additionally, experiencing chronic diarrhea can also lead to general inflammation and irritation of the pelvic floor tissue. Because one of the main functions of the pelvic floor is to ensure you don’t leak urine or feces, the pelvic floor muscles can overrecruit when they sense liquid stool in the rectum. This over-recruitment of the pelvic floor musculature can contribute to higher tone of the musculature surrounding the urethra, which could lead to feelings of urgency and pain with urination, as described above. 

Interstitial Cystitis/Painful Bladder Syndrome

Interstitial Cystitis, or Painful Bladder Syndrome, is a diagnosis that may include inflammation of the bladder, urinary frequency and urgency, pain with sex, and bladder pressure. Often, these symptoms can be caused by or contributed by pelvic floor dysfunction and over-recruitment. If you have IC or PBS, and you present with hypertonicity in the pelvic floor, it would be helpful to seek out support from a qualified pelvic floor occupational or physical therapist. A trained specialist will help teach you how to lengthen these muscles overtime, hopefully decreasing urinary urgency and frequency. 

If you have UTI symptoms with no discernible UTI or other medical cause, it may be time to consider pelvic floor physical therapy or occupational therapy! Using manual techniques, bladder retraining exercises, breathwork, and stretches, your pelvic floor therapist can help guide you towards reducing symptoms and gaining your life back.