Why does it feel like I have a UTI, if I don’t actually have one?

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Why do I feel like I have a UTI, if I don’t actually have one?

And what do my pelvic floor muscles have to do with it?

A whole lot, it turns out.

Why does it feel like you have a UTI, when you don’t?

The fire down below.

The aching tummy and back. The frequent, strong urges to pee…then you sit down and the burning stream of a few drops of pee 🙁 There’s nothing quite so bad as a UTI.

Except UTI symptoms…
when you don’t actually have a UTI.

Yep. That happens. And when it does, it is the pelvic floor muscles to blame.

A UTI (full name: Urinary Tract Infection) is due to bacteria (usually e-coli), that finds its way into the urethra, bladder or ureters (the ‘urinary tract’, get it?). Your first UTI-like symptoms in life are usually a for-real UTI. But sometimes, individuals continually get these symptoms, and when their urine is cultured, it is actually negative for bacteria.

So what is up with that? Let me tell you what can often happen in these cases.

UTIs are very painful. Occasionally, in response to an initial UTI (or a pelvic trauma, or a wild night of intimacy, or with dehydration), the muscles of the pelvic floor enter a state of spasm.

It’s called the “Pain-Spasm Cycle”

Something hurts, so certain nearby muscles spasm, or tighten. Other muscles can be inhibited by pain, but due to the ‘private’ nature of our pelvic floor muscles, they will tend to spasm in response to pain, to protect us. It’s kind of them, actually.

illustration of pelvic floor muscle spasm with red lightning bolts coming away and word OUCH! nearby. Pain in the abdomen, hips and low back (as well as pelvic floor itself) can cause these muscles to spasm. Persistent spasm can worsen local pain, cause radiating pain into abdomen or legs, and even mimick symptoms of a UTI.
Why does it feel like have a UTI if I don’t? Spasm in the Pelvic Floor Muscles can cause local, or radiating pain. The spasms commonly cause burning sensations, or bladder irriation, making it feel like you have a UTI, even if you don’t!

Anyhow, so these muscles in the pelvis floor spasm. This, in turn, leads to irritability of the urethra and bladder.  Remember that the pelvic floor live down near the outside of our body, and they circle the bottom portion of our urethra. Pelvic floor spasm can happen no matter what your anatomy is, but it more commonly leads to UTI-like symptoms in people with vaginas.

illustration of front and side view of pelvis with vagina. The orientation is a VERY short tube, the urethra, from the bladder to the outside world, and the pelvic floor muscles, which are about 1cm thick at this region, surround that urethra.
The pelvic floor muscles surround the descending urethra. Spasm in the pelvic floor muscles can irritate the urethra and bladder, leading to intensification of symptoms of urgency. Over time, this can lead to such aggravation that you feel like you have a UTI, even though no bacteria is present.
illustration of sideview of pelvis of a person with a penis. The testicles are in front, at the bottom, within the scrotal sack. The penis is just above that, the bladder above the penis in the center of the pelvic cavity. Rectum is in back, ending in anus. Prostate gland lies between bladder and penis.
Sideview of Pelvic Floor With a Penis! Pelvic spasm in people with penises leads to constipation and pelvic pain moreso than UTI-like symptoms.

This spasm can be bilateral (both sides of the pelvic floor) or unilateral (just one side—how many of you knew you had 2 sides of the pelvic floor, just like you have 2 legs and 2 arms?!  SO COOL!). 

When this spasm occurs, the muscles of the pelvic floor compress the urethra (where pee comes out), and irritate it, and generally irritate the whole pelvic region, such that outbound sensory signals are magnified.  This often leads to pelvic pain, incontinence, urgency, as well as common symptoms of burning and itching!  In fact, it is this spasm of the pelvic floor muscles that is at the base of many pelvic floor complaints.

Wow. Cool. But won’t antibiotics make it go away?

Nope. Sorry, Sally, Stan and Svetlana. If it is not a bacterial infection causing your urinary urgency, frequency and burning, then antibiotics won’t help it a dang bit.

So…what can I do about it?

Do you really need to ask me that?!?!

Try Pelvic PT, Genius!!

Pelvic PT’s are the EXPERTS in treating musculoskeletal causes of pelvic pain, including burning, itching symptoms that mimick a UTI, but when the urine is cultured, it is negative for bacterial infection.

This is seriously SUCH an easy diagnosis for us to treat. We love seeing you come in, becuase with a brief behavioral training and muscle reeducation session, we can get you feeling significantly better in a relatively rapid amount of time.

But Dr. Kelly, I REALLY think it’s a UTI…

Well dang, then FOR SURE get to your primary care provider and have a urine culture ran (quick test AND longer test, please). But if both of these are negative, please consider pelvic PT. You’ll be glad you did 🙂 🙂

Thanks for Reading!

Check out my Pelvic Floored Signature Lecture Series for a much more in depth training of how posture could be contributing to your pain, incontinence, constipation, or pelvic organ pressure complaints!

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Thanks for reading!

xoxo, Dr. Kelly

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