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Physiotherapy and UTI Recurrency

“Clean from front to back.”

“Don’t eat sugar.”

“Pee as soon as you feel the urge.”

“Pee after sex.”

“Drink lots of water.”

“Drink cranberry juice.”

“You need antibiotics”

Do these sound familiar? These are probably what you hear when it comes to avoiding urinary tract infections or UTIs. Let’s talk about it!

It is estimated that 60% of women will encounter a UTI in their lifetime (Foxman 2014), and up to 50% of these women may experience a second infection. Furthermore, 25-50% of those individuals may go on to experience a third UTI (Geerlings et al. 2016; Gupta et al. 2013).

A UTI is a bacterial infection that can occur anywhere in the urinary system, including the kidneys, ureters, bladder, or urethra. A recurrent UTI (rUTI) is defined as two or more UTIs within six months or three or more within a year.

Common symptoms of a UTI include:

  • Urinary urgency
  • Burning or pain during urination
  • Voiding frequent, small amounts of urine
  • Cloudy, dark, bloody, or strong-smelling urine
  • Pelvic, lower back, or abdominal pain
  • Feeling run down
  • Fever or chills

ANATOMY AND UTIS

It is estimated that 60% of women will experience a UTI in their lifetime (Foxman 2014) and up to 50% of these women will go on to experience a second. Another 25-50% of those will experience a 3rd…(Geerlings et al. 2016; Gupta et al. 2013).

A urinary tract infection (UTI) is a bacterial infection that is found anywhere in the urinary system including the kidneys, ureters, bladder and urethra. A recurrent UTI (rUTI) is defined as two or more urinary tract infections over the course of six months, or three or more in one year.

Common symptoms of a UTI include:

  • urinary urgency
  • burning/pain with urination
  • voiding frequent, small amounts of urine
  • cloudy, dark, bloody, or strong-smelling urine
  • pelvic, low back or abdominal pain
  • feeling run down
  • fever or chills

ANATOMY AND UTIS

Women are eight times more likely than men to suffer from a UTI, due to anatomical differences. Simply put the shorter urethras that women have allow easier access for bacteria to reach the lower urinary tract. Additionally, having the urethra close to the anus, faecal matter can easily migrate. If left untreated, this can lead to a kidney infection, and in more severe cases, sepsis.

While the primary treatment for acute UTI is antibiotics (ideally prescribed based on a urine culture), clinical care varies due to a lack of evidence and best practice guidelines (Brubaker et al. 2018). Oftentimes, the use of antibiotics possibly depletes gut and vaginal flora, potentially leading to issues like gut imbalance.

 

BUT IT KEEPS COMING BACK…

After visiting your doctor and receiving a negative culture, or being prescribed another round of antibiotics, your symptoms persist.

Despite trying various diets and supplements, and lifestyle changes, the issue lingers. What do you do?

You may be one of the women who have recurrent UTIs. Women face recurrent UTIs for various reasons, including genetic predisposition, anatomical anomalies, changes in sexual partners, diabetes, certain medical conditions requiring self-catheterization, spinal cord injury, multiple sclerosis, prolapse, pregnancy, or post-menopause (Scholze et al. 2000; Raz 2001).

Post-menopausal women face a higher risk because changing hormones alter the vaginal pH and reduce the natural presence of good bacterial flora in the vagina.

Over 90% of UTIs are caused by E. coli. The presence of infection initiates a neuro-immune response. Initially, there is a migration of inflammatory cells to address the issue, resulting in symptoms like heat, swelling, fever, and a general feeling of being unwell. However, this response also induces a muscle-guarding mechanism (similar to the sensation of stomach spasms during a tummy ache). These muscles, known as pelvic floor muscles, enter a protective mode. Consequently, what initially began as an infection can lead to pelvic floor dysfunction (PFD), where the muscles remain in a vigilant state even in the absence of an active infection. This dysfunction may manifest as difficulty fully emptying the bladder, potentially preventing the complete flushing out of bacteria, leading to bacterial accumulation and the onset of another infection.

IS IT UTI OR PFD?

Knowing whether it’s a UTI or PFD will be difficult without a thorough history and examination. Dyspareunia, or painful intercourse, is a common symptom of PFD. Additionally, those with PFD may experience lower back pain, constipation or gastrointestinal upset, and general pelvic pain.

People with PFD may have difficulty relaxing the pelvic floor muscles to urinate. Some patients feel a strong urge to use the bathroom, even hurry to get there, only to struggle to urinate once seated—this is an indication of pelvic floor dysfunction.

SHOULD I DO KEGELS WITH A UTI OR PELVIC PAIN?

Performing Kegels (voluntary contractions of the pelvic floor) is strongly discouraged with pelvic pain or a UTI. Engaging in Kegels can prevent the complete emptying of the bladder. Since the pelvic floor muscles are already overworked and irritated, repeatedly contracting them is counterproductive. The goal should be to let these muscles relax, relieve pressure on the pelvic nerves, and minimise pain.

HOW CAN WOMEN’S HEALTH PHYSIOTHERAPY HELP?

Not all UTIs are connected to pelvic floor dysfunction. As mentioned earlier, antibiotics are the primary treatment for an acute UTI. However, working with your women’s health physiotherapist can offer several benefits:

  • Identify signs of pelvic floor dysfunction.
  • Educate you about the underlying issues.
  • Restore normal muscle function.
  • Teach techniques to connect and relax your pelvic floor.
  • Instruct on fully emptying your bladder to prevent recurring UTIs.
  • Provide education on self-management strategies.
  • Develop and implement a personalised plan for your well-being.

If you would like to know more about rUTIs and pelvic floor dysfunction, please call or WhatsApp us at 9780 7274, or email us at help@embracephysio.sg.

Feel free to look through our website, where you can learn about other women’s health conditions we treat. This is a safe space where we can discuss how we can help you with physiotherapy.

Note: While I am a physiotherapist, I am not your personal physiotherapist. The contents of this website are for informational purposes only and are not intended to serve as individual medical advice.

Reference:

  1. Foxman B. Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infect Dis Clin North Am. 2014 Mar;28(1):1-13.
  2. Geerlings SE. Clinical Presentations and Epidemiology of Urinary Tract Infections. Microbiol Spectr. 2016 Oct;4(5).
  3. Gupta K, Trautner BW: Diagnosis and management of recurrent urinary tract infections in non-pregnant women. BMJ 2013; 346: f3140.
  4. Brubaker L, Carberry C, Nardos R, Carter-Brooks C, Lowder JL. American Urogynecologic Society Best-Practice Statement: Recurrent Urinary Tract Infection in Adult Women. Female Pelvic Med Reconstr Surg. 2018 Sep/Oct;24(5):321-335.
  5. Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 2000;182:1177–82.
  6. Raz R. Postmenopausal women with recurrent UTI. Int J Antimicrob Agents. 2001;17:269–71.
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I chanced upon Embrace after a brief search on Google. The all-female staff and physios is what made me decide to book an appointment. You can see all their smiley faces on the website and I sent a message through watsapp immediately. Efficient response within a few hours and the rest is history. I am fortunate to be served by both Brenda and Preet. To be honest, my experience there for almost a year do not feel like a typical consultation or rehab session. They are client centric and all ears to your needs. I had great conversations while being comfortable discussing about my pelvic floor health. You don’t have to be shy asking questions when you want to make the best out of every session. You are in good hands with their knowledge and experience. I have benefited and improved the quality of my pelvic floor health by following a well devised plan. I went in from almost a prolapse and weak PF. Now, i feel my best getting back to running and strength training. Look no further if you want to be in the best of hands for your pelvic floor health. Thank you Embrace!

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April 28, 2023

I had a wonderful experience with Brenda throughout my post partum recovery. She is very friendly and experienced and it definitely shows as she is able to make me feel at ease and comfortable as she navigates me through the exercises and steps to get me back to where I want to be. Appreciate the help and for making it easy especially with motherhood alr being a challenge. Thanks 🙂

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March 31, 2022

Went for physiotherapy (with Preet) and postpartum exercise classes (with Brenda). Embrace is an awesome place to recover after birth, and seeking their help after birth was probably one of the best self-care choices I've made. Preet is extremely professional, approachable and friendly. She goes above and beyond, and did a comprehensive check on me, even though my initial main concern was DR. Brenda's sessions are engaging and fun. Not too tough for the postpartum mum but not a walk in the park either (especially the first few classes). The sessions allowed me to feel more in control of my body (and stronger) after birth. They also helped me ease back into strength training. The client experience team is also amazing, so shout out to them. Highly recommend all postpartum mums to seek Embrace out!

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October 13, 2022

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