Recurrent urinary tract infection (rUTI): How Women’s Health Physio can help

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.


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


Women are 8x more likely than men to suffer from UTI due to anatomical differences. Simply put, women have shorter urethras allowing easy access for bacteria to reach the lower urinary tract. Since the urethra lies close to the anus, faecal matter can easily migrate. If left untreated, this can lead to kidney infection, and in the worst-case scenario, sepsis.

Whilst the mainstay of treatment for acute UTI is the prescription of antibiotics (ideally prescribed based on a urine culture), clinical care varies because of a lack of evidence and best practices guidelines (Brubaker et al. 2018). Often, the use of antibiotics can deplete our gut and vaginal flora and fauna, predisposing us to further insults of gut imbalance or thrush.


So you’ve been back to the doc, had a negative culture, you are placed on yet another course of antibiotics anyway, as a precaution, but your symptoms persist. Then what? You’ve tried every diet or supplement under the sun, but it just keeps coming back?

Women experience rUTIs for a host of different reasons. These include genetic predisposition, anatomical anomalies, change in sexual partners, diabetes, certain medical conditions that require self-catheterisation, spinal cord injury, multiple sclerosis, prolapse, pregnancy or post-menopause (Scholze et al. 2000; Raz 2001).

Post-menopausal women are at a higher risk because the changing hormones also change the vaginal pH and reduce the good bacterial flora that naturally exists in the vagina.

More than 90% of UTIs are caused by E. coli. The presence of infection triggers a neuro-immune response. Initially, there will be a migration of inflammatory cells to help solve the problem (cue: heat, swelling, fever, feeling unwell…). However, this also triggers a muscle guarding response (ever had a tummy ache, then felt your stomach spasm?). These muscles (aka pelvic floor muscles) are now in protective mode. So, what started as an infection is now PFD or pelvic floor dysfunction (i.e. they didn’t get the memo and are still on a stakeout even though there is no active infection). You may experience difficulty emptying your bladder fully, which may mean you are unable to fully flush out the bacteria and it accumulates, triggering another infection.


It’s hard to tell without a full history and examination. But dyspareunia or painful intercourse is really common with pelvic floor dysfunction. It can also cause low back pain, constipation or GI upset, or general pelvic pain.

With pelvic floor dysfunction, you may also notice difficulty in relaxing the pelvic floor muscles enough to actually go to the bathroom. Many patients experience the strong urge to go, rush to the bathroom and then have trouble actually starting or maintaining a stream once they sit down – this is all evidence of pelvic floor dysfunction.


Absolutely not – you should never do Kegels (the voluntary contraction of the pelvic floor) with pelvic pain or UTI. In fact, Kegels can definitely make the pain worse or prevent the bladder from fully emptying. Those muscles are already working overtime and are irritated. Asking them to repeatedly contract is the exact opposite of what we would want to do. We want to help the pelvic floor muscles relax, releasing pressure on the pelvic nerves and reducing pain.


Now, not all UTIs are pelvic floor dysfunction. And as already mentioned, antibiotics are the first line of treatment with an acute UTI. However, by working with your Women’s Health Physiotherapist we can

  • help to identify signs of pelvic floor dysfunction
  • educate you on what’s happening
  • restore normal muscle function
  • teach you to connect and relax your pelvic floor
  • teach you how to fully empty your bladder and flush the waste completely to prevent recurring UTIs
  • educate you on self-management strategies and
  • put a plan in place

If you would like to know about rUTIs and pelvic floor dysfunction, please call/WhatsApp on 9780 7274 or get in touch over email to learn how we can work together.

You can also visit our website to learn about other women’s conditions we treat through physiotherapy and how we can help you.



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.

Geerlings SE. Clinical Presentations and Epidemiology of Urinary Tract Infections. Microbiol Spectr. 2016 Oct;4(5).

Gupta K, Trautner BW: Diagnosis and management of recurrent urinary tract infections in non-pregnant women. BMJ 2013; 346: f3140.

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.

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.

Raz R. Postmenopausal women with recurrent UTI. Int J Antimicrob Agents. 2001;17:269–71.

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