UTI like symptoms but testing negative on Urine tests?
UTIs are the worst. Anyone who has ever had one remembers the misery. They can cause a constant urge to urinate. They can trigger severe urinary frequency. And then there’s the pain. Fortunately, most of the time, UTIs aren’t too tricky to treat. You have UTI like symptoms, see your doctor for a urine test, get the right antibiotics and *poof* go your symptoms.
But what if that’s not the case for you?
In fact, what if you have all of those incredibly frustrating and uncomfortable symptoms but when you go to the doctor for your urine test, they give you the all clear? OR what if you’ve taken the antibiotics but the symptoms keep coming back and though you had an infection previously, now you’re testing negative? No UTI to be found?
In this blog post, I’ll be diving into an often overlooked contributor to frequent UTI like symptoms: the pelvic floor. But first, definitions. There are a lot of words to describe UTI like symptoms, with the most commonly used terms including urinary urgency, urinary frequency, overactive bladder and bladder pain syndrome. Let’s briefly define each of these so we’re speaking the same language as we move on.
Urinary urgency: The strong, sudden urge to urinate. Most of us have experienced this after drinking a few beers too quickly. Urinary urgency may be normal when you drink a large volume of liquid, quickly. That’s not really a symptom, that’s just your body doing it’s thing. Urinary urgency is more likely to be a symptom when the strength of your urgency doesn’t to match up with the actual need to pee, or the amount you’ve had to drink. For instance, getting a strong urge to pee and when getting to the toilet not having a whole lot to actually empty.
Urinary frequency: The need to urinate frequently. Average urinary frequency for an adult is 6-8 times in a 24 hour period. This can vary based on fluid consumption. Urinary frequency becomes a symptom that you may want to treat when your urinary frequency interferes with your daily activity, or when your urinary frequency doesn’t reflect your fluid intake. For instance, having to pee 5 times after drinking a cup of water.
Overactive Bladder (OAB): OAB is used to describe a bundle of urinary symptoms including urinary urgency and urinary frequency. This is often used as a garbage bag diagnosis for unexplained urinary symptoms.
Bladder pain syndrome (BPS): BPS is often used as a synonym for interstitial cystitis (IC). BPS is defined by the International Continence Society as “Persistent or recurrent chronic pelvic pain, pressure or discomfort perceived to be related to the urinary bladder accompanied by at least one other urinary symptom such as an urgent need to void or urinary frequency. Diagnosed in the absence of any identifiable pathology which could explain these symptoms.”
Oftentimes, folks experiencing symptoms like urinary urgency and frequency will experience a barrage of medical testing. Testing can include simple urine strips to test for signs of infection, or more invasive procedures like cystoscopies. While a urinary tract infection can absolutely trigger the symptoms previously mentioned and it’s always important to rule out a potential UTI, it’s not uncommon for these tests to all come back negative. So why is it that some folks will have all of these symptoms but get the all clear from their medical tests?
Enter the pelvic floor. The pelvic floor is a bundle of muscles that sits at the base of your pelvis. These muscles also wrap around your urethra, the tube you pee out of. Because of their location, when the pelvic floor muscles are tight or spasmed they can cause urethral and bladder pain while mimicing UTI-like symptoms. Pelvic floor muscle tension can contribute to almost every symptom of a UTI.
These muscle spasms can cause urinary urgency, urinary frequency, bladder pain, urethral pain and difficulty emptying your bladder. And to make matters even trickier, sometimes a UTI can trigger pelvic floor muscle spasms, thus allowing these symptoms to continue long after the actual infection has been treated.
So, what can you do about these symptoms?
See a physician to rule in or out any underlying UTI or other underlying medical cause of symptoms. Particularly when symptoms suddenly onset, this is the first place to start. Before taking an arbitrarily prescribed antibiotic, make sure you get a urine culture so if there is an infection, your provider knows what they’re treating.
See a PT to determine whether your musculoskeletal system or bladder habits are contributing to your symptoms. If you’ve seen your physician and a UTI has been ruled out, or if you’ve taken antibiotics and your symptoms persist, it’s time to consider pelvic floor PT. Pelvic floor PTs can help you determine if the muscles surrounding your bladder and urethra are contributing to the symptoms you’re experiencing. They can treat your muscle spasms to help manage your pain and educated you on better bladder habits as well as home exercise so you can reduce the risk of your bladder pain returning.
Sip your water throughout the day instead of chugging water. Click here to learn about drinking water, correctly.
Stop drinking water a few hours before bed. This is particularly important for those who wake up at night to pee, or have a hard time going to sleep without peeing multiple times.
Cut out or reduce consumption of bladder irritants including caffeine, alcohol, carbonated drinks, spicy foods. More water and less of the other stuff makes for a happier bladder.
Stay hydrated. Dehydration can contribute to bladder irritation.
Pee when you need to pee. Don’t pee when you don’t need to pee. Try to reduce the “peeing just because”. Read this blog post for better bladder habits.
Try urgency drills. When you get hit with a sudden need to pee, or if your body is telling you that you need to go but you know you don’t, instead of rushing to the bathroom try taking 5-10 big, slow, deep, belly breaths. Try your best to relax and unclench your body, even though this feels counterintuitive. Breathing and relaxing can help calm your brain and your bladder and make you more comfortable as you find your way to the bathroom.
Lastly, if this is a long standing problem or you. Consider reading Dr. Nicole Cozean’s book IC Solution. This book is an incredible resource for anyone trying to get a better understanding of their bladder pain and available treatment options.
If you’re experiencing annoying urinary urgency, urinary frequency, bladder pain or overactive bladder symptoms, contact us here to learn more about how working with our pelvic floor physical therapists can help you.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.