UTIs, Recurrent UTIs, and Pelvic Floor Muscles
So you feel the burning discomfort and the intense and frequent urge to urinate-all signs point to a urinary tract infection (UTI).
A UTI is an infection in any part of your urinary system - kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract - the bladder and the urethra. Research suggests that
at least 40-60% of women will develop a UTI during their lifetime. Recurrent UTIs (rUTI), defined as three or more UTIs in 1 year or two UTIs within 6 months. Recurrent UTIs are also more common after menopause. Up to 15% of women over 60 will develop frequent UTIs, 20% for women aged >65 years.
The commonly believed narrative of UTIs goes like this: bacteria invading a previous sterile bladder causes infection, and then antibiotics are used to destroy the bacteria in the bladder. However, research tells us this narrative is simply not true. The bladder is actually home to lots of good bacteria that help maintain the health of the urinary tract. And it is the disruption of the balance of normal bladder bacteria that result in UTI symptoms.
In post-menopausal women, the reason why they tend to suffer from rUTIs more often may be related to the changes in the bacteria that live inside the vagina. Like the bladder, the vagina also contains many types of bacteria that typically maintain a healthy vaginal environment. The vaginal flora, as these bacteria are called, maintain a mildly acidic pH in the vagina that helps protect against infection. However, as women go through menopause, lower estrogen levels raise the vaginal pH which changes the makeup of the vaginal bacteria. And the overgrowth of "bad bacteria" (ie, Escherichia coli and Enterococcus) living inside the vagina then move to its close neighbor - the urethra and bladder. The first line of defense against these "bad bacteria" is the bladder lining. However, similar to what happens in the vagina, decreased levels of estrogen also have a negative effect on the bladder lining. Together, these factors increase the prevalence of UTI in menopausal women.
UTIs are nearly always treated with antibiotics. However, side-effects and antibiotic resistance are making healthcare providers search for alternative treatments and preventative measures elsewhere. Topical estrogen is an interventions that has been supported by research for preventing UTIs in postmenopausal women. Applying estrogen cream locally to the vaginal region has been shown to not only increase the good bacteria in the vagina but also to clinically reduce rUTI episodes.
pelvic floor physical therapy can help. The muscles of the pelvic floor are responsible for controlling the flow of urine. They remain moderately engaged in order to stay continent, and then relax when it's time to urinate. If these muscles are overactive, it can be difficult for them to relax enough to urinate properly. Many people with recurrent UTIs feel like they can't fully empty the bladder and have to push to urinate. The mechanism of pushing can actually cause the last few drops of the urine to remain in the bladder, which increases the risk of infection. A pelvic floor physical therapist can help to strengthen or relax the pelvic floor muscles as needed and to regulate intra-abdominal pressure, which will help to effectively empty the bladder without pushing. The better one can empty the bladder, the lower the risk of future infections.
Besides pelvic floor physical therapy and estrogen cream, you might have also heard of other preventative measures such as cranberry juice, probiotics, Vitamin C and D-Mannose. However, the scientific jury is still out on whether these are actually effective for preventing UTIs.
Additionally, pelvic floor physical therapy might be the answer to your struggles in the not-so-rare cases where UTI symptoms are present but urine cultures keep coming back negative. Because both the bladder and the urethra are closely surrounded by pelvic floor muscles, when these muscles are too tight or when they spasm, it can result in symptoms including pelvic pain, problems emptying the bladder completely, frequent, sometimes painful, urge to urinate. A pelvic floor PT can train those muscles to release in order to relieve the symptoms.
There's a lot more that can be done for UTIs or UTI symptoms beyond antibiotics. There can often be an underlying pelvic floor dysfunction in these cases. And for women who are menopausal or post-menopausal, it can be helpful and informative to discuss hormonal influences with your doctor. Maintaining a healthy urinary tract is important for us all.