Holistic Treatment

Pissed About Your Constant Utis? Try Physical Therapy

Photo: Getty Images/ Didier Robcis
I'm going to make a wild guess and say that if you're reading this article, you've had at least one UTI. And given that 40 to 60 percent of women will have a UTI in their lives, according to the NIH, you're definitely not alone in knowing how straight-up terrible they are. The burning, the constant need to pee—no thanks.

But often, getting a UTI is not just a one-and-done kind of deal. Twenty percent of women who get a UTI will get another one, and 30 percent of those people will get a third, because yay being a woman is amazing! And if you're a lucky member of the recurrent UTI club, you've probably tried every natural remedy and preventive method under the sun. Guzzling water and cranberry juice, taking supplements, sacrificing your first-born...you know, everything.

But here's one up-and-coming tactic you might not have tried: pelvic floor physical therapy.

Hold up: What is pelvic floor therapy?

First, a quick anatomy lesson. "The pelvic floor contains a group of muscles that attach to the pelvic and thigh bones," says Kecia Gaither, MD, MPH, FACOG, double board-certified in ob-gyn and maternal fetal medicine, "which provide support for the pelvic organs, are responsible for healthy sexual activity, and maintain control over bladder and bowel function." In women, these muscles are located near the bladder, bowel, and uterus.

Pelvic floor physical therapy is basically like any other form of physical therapy; it's just focused on strengthening your pelvic floor instead of, like, your back or hamstrings. People most commonly seek pelvic floor therapy if they have continence issues, painful sex, or chronic pelvic pain. But more and more people are trying it to help with their chronic UTIs. "This is common in other countries such as France, and is slowly gaining popularity in the US," says Dr. Gaither.

Can it actually help with UTIs?

Yes and no. "If it is an actual infection, no it cannot," says Rachel Gelman, DPT, PT and Branch Director at the Pelvic Health and Rehabilitation Center. Meaning: If you currently have a UTI, pelvic floor therapy won't make it go away. You should go see your healthcare provider ASAP.

However, pelvic floor physical therapy can help prevent future infections. One reason: You're peeing wrong. "It may seem simple, but some people don’t urinate properly," says Betsy Greenleaf, DO, FACOOG and urogynecologist. "The bladder is a muscular bag designed to push the urine out on its own. You are not required to push to empty." And pushing to pee, Dr. Greenleaf says, can cause "dysfunctional voiding" by activating pelvic muscles that you don't actually need to get the job done. The changes in pressure (from pushing to relaxing) can actually cause the last few drops of your pee to get "sucked" back up into your bladder, which puts you at a greater risk of infection, she says.

A pelvic floor physical therapist can work with you to help strengthen your pelvic floor, which will help you more effectively empty your bladder without pushing. The better you empty your bladder, the lower the risk of future infections. (Along with other good UTI prevention tactics, like peeing after sex and always wiping front to back.)

"As with any muscle, if you don’t use it you lose it." —Betsy Greenleaf, DO.

Dr. Gaither adds that if you have recurrent UTIs, sometimes the tissues around the urethra can remain "contracted and congested," creating sensations similar to UTIs (like having to pee really bad and pain) without actually having an infection. "Pelvic floor PT can address the pelvic floor muscles and surrounding structures that are dysfunctional," Gelman says. "Often they are in spasm or hypertonic (tight) and that can lead to the symptoms someone is experiencing."

What to expect at a pelvic floor physical therapy session

Obviously, the idea of going to a specialist to deal with such an intimate part as a pelvis feels daunting. I asked the pros what exactly you'd be getting into during pelvic floor physical therapy.

At your first exam, "the physical therapist will do an examination your back, hip, and leg muscles," Dr. Greenleaf says. "They may also do an internal pelvic examination like a gynecologist to assess your pelvic nerves and muscles."

After the exam, they'll come up with a treatment plan which could consist of strengthening exercises like squats, stretches, and lifting weights. All fully clothed, in case you were wondering (I was). Other treatment options may include pelvic tightening exercises, massages and stretches to improve posture and blood circulation, or "monitored internal care with probes that measure the strength of pelvic tightening," Dr. Greenleaf says.

"As with any muscle, if you don’t use it you lose it," adds Dr. Greenleaf. "Pelvic therapists can teach you techniques to keep your pelvic floor toned and healthy." And hopefully with that, less likely to get saddled with another freaking UTI.

Here are some more reasons why you keep getting UTIs over and over again. Also, PSA: everyone should pay more attention to their pelvic floors.

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