Your Pelvic Floor: Why you have UTI symptoms but still test negative

Author: Karen Bumpus, DPT & All Wellness' Pelvic Floor Specialist

 Here are a few stories that I frequently hear from patients who are coming in for pelvic floor physical therapy:

            “I keep having UTI-symptoms. I have urinary frequency, urgency and pain, but every time I am tested, I am negative for infection.”

Or

            “I had a terrible urinary tract infection that lasted weeks, but now, even though I have cleared the infection, I still feel like I have a UTI all of the time.”

Or

            “I have a history of recurrent UTIs and now it seems like I can have symptoms and test positive, get treated with antibiotics and feel okay for a bit...and then the symptoms return, but I test negative. The symptoms feel the exact same, but I am only positive for UTI some of the time. I never know if I should actually go to the doctor or not because I never know if the infection is real or not!”

These are essentially different versions of the same story. Women feel all of the agonizing symptoms of a urinary tract infection, without actually testing positive for a urinary tract infection. Often, they are perplexed as to why they have been referred to physical therapy for something that seems completely unrelated. So here is where things get interesting: some pelvic floor muscle dysfunctions can mimic the symptoms of urinary tract infections.

In the stories listed above, these women can actually be considered lucky. They are beginning pelvic floor physical therapy and are likely on the road to recovery and healing from their pelvic floor muscle dysfunction. For many others it can be a long road of testing, retesting, scans, referrals to every specialist imaginable and sometimes even after all of this they still lack the answers they crave. To be clear, I do not mean to say that doctors or specialists are inept at making an accurate diagnosis when it comes to pelvic floor dysfunction. There are many doctors who recognize and assess for this condition. However, the lack of awareness of the presence of pelvic floor muscle dysfunctions that is seen within the general public does extend to the medical community as well, so it is not always enough to assume that if you have a pelvic floor dysfunction your physician would have diagnosed it by now.

So, why might your pelvic floor dysfunction feel like a UTI?

“UTIs are a bacterial infection occurring anywhere along the urinary tract (urethra, bladder, ureters, kidneys). Infections are considered a serious threat by our immune system, so not only will we get an influx of immune system inflammatory cells to the area, but we will also often see muscle guarding of the pelvic floor (specifically the urogenital diaphragm which has attachments to the urethral sphincter).

So even though we may be infection free, the muscles are still in protection mode. And because we have muscles in the urogenital diaphragm which can have small attachments to the urethral sphincter, they can actually mimic all of the UTI symptoms. Hence, what may have started as a real infection is now an overactive muscle dysfunction causing the same symptoms.” As the Pelvis Turns, Pelvic Health & Rehab Center Blog (follow the Pelvic Health and Rehabilitation Center on twitter)

If you are experiencing UTI symptoms, it is important that you see a physician first to be sure you do not have an active infection, or to treat you if you are experiencing an active UTI. If you have additional questions or would like to learn more, contact me at karen@allwellnessvt.com.