As a pelvic health physical therapist (physio) I see many women struggling with recurrent bladder infections (rUTIs), and often the cause of the bladder infection is not what my lovely ladies think, let me explain why…
Bladder infections in women are incredibly common, it’s estimated that the risk of developing an infection (UTI) is over 50% globally and of that group 25% of women will have recurrent UTIs. Frequency, urgency and painful urination are the most common signs of a bladder infection. Other signs include dark, cloudy urine that often has an unpleasant odor.
Some women, especially older ladies, will not have pain but instead will only get the bladder frequency and urine changes. So if you suspect an infection, but don’t have pain, it’s a good idea to also inspect your pee. If left untreated these infections can lead to more serious kidney infections, so if you suspect you have one or develop one it’s serious and not to be ignored.
The gold standard for diagnosing infection is a urine culture.
A urine culture involves sending the sample to a lab to grow the bacteria. This is done so that the specific bacteria can be identified. Unfortunately this process can take time and is not the kind of thing you want to hear when you are in pain.
That’s why many clinics will do a quick dipstick test to check for bacteria, give you an antibiotic and then send the sample off to be cultured. Once the culture comes back and the bacteria is identified adjustments in appropriate antibiotics can be done, if needed.
If you end up with another infection within six months or if you’ve had three or more infections over the year, you are considered to have recurrent bladder infections or rUTI. These ladies are sent to me for help and they are understandably frustrated that their urinary symptoms persist.
As a result I often hear the comment, ‘I must have held my pee too long’.
Here’s why that is simply untrue. There is a common misconception that delaying urination, in other words holding your pee will cause an infection. When in fact, there is no research that points the finger at holding too long.
In fact the more urine in the bladder the more dilute the urine is likely to be, which is a good thing. If on the other hand you are not emptying well and a residual amount stays in the bladder, that gives bacteria the chance to multiply and cause problems.
I explain that the cause of most bladder infections is not holding too long but instead not emptying your bladder well.
And here’s the reason why. To fully empty your bladder the pelvic floor muscles need to fully relax. These are the muscles that make up the perineum, the area between vagina in the front and the anus in the back. The relaxation of these muscles allows the urethra to open and the bladder to fully contract and empty.
If your pelvic floor muscles are not able to fully relax, it is likely that your bladder will not get the chance to fully empty. What remains in the bladder, called urinary retention or post-void residual urine, then has an opportunity to become concentrated and may develop into an infection.
So why aren’t the pelvic floor muscles able to relax?
Many women have toileting habits that make bladder emptying difficult. These include the habit of rushing to pee, hovering over the toilet and stopping the urine stream early to get it done quickly. These are lifelong habits that develop innocently, with women thinking that the less time it takes in the bathroom the better.
Why are these behaviors a problem?
Because they prevent the pelvic floor muscles from fully relaxing. When this happens urine can reflux back into the bladder or remain in the bladder. Either way, your bladder is not emptying well. If that’s the case you could be next in line for a nasty bladder infection.
What if your bladder infection is related to sexual activity?
If you are getting recurrent bladder infections (rUTI’s) because of sexual activity, you will still benefit from the techniques listed below, but it’s not the whole answer. This is a big topic and one I will be taking it up in the near future, so stay tuned!
So how do I get my bladder feeling better and get back on track?
The first step is re-learning how to relax on the toilet, and there is a specific posture for peeing. Sitting (not hovering) on the toilet seat, breathing and taking your time to pee are key to getting it all out. Once you are fully relaxing your pelvic floor muscles and empty well, your bladder will start feeling MUCH better.
Want to know the step-by-step method I teach for better bladder emptying? Check out my ‘Tips for a Happy Bladder!’ and grab your free printable here.
Next is realizing that holding is not the enemy!
Your bladder is ideally designed for holding, and it’s OK to hold beyond the first urge. Without expansion, the bladder becomes smaller, more sensitive and often irritated by all the bathroom breaks. And a smaller, more sensitive bladder is more likely to give you urgency, and so the cycle continues.
The use of a bladder journal (with instructions) helps you to slowly increase the time between bathroom breaks, this technique is also called bladder retraining and can really be helpful. Using a bladder journal helps keep you accountable and enables you to see all your amazing progress.
Want to know what’s the normal number of times per day to void? Check out my blog post on ‘What is normal for bathroom breaks?’ here.
Sometimes bladder urgency is a problem, that’s a sudden strong urge to go that’s hard to control especially when walking to the toilet. It’s very common and definitely a symptom that can be corrected with the proper techniques.
As a bladder specialist, I teach urge suppression techniques to hold off bathroom breaks when needed. To learn more tips on how to handle bladder urgency check out my blog on the subject. Once you are able to hold more and empty better, your bladder will become MUCH calmer.
And a calm bladder is a happy bladder! 
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Happy Bladder wishes,
~ Tami
Tami Lines is a licensed Physical Therapist with certifications in Pelvic Rehabilitation and Women’s Health Coaching. She is the founder of Pelvic-Health-Matters. Tami has over 15 years of experience with expertise in bladder Health, and pelvic floor muscle dysfunction for adolescent and adult women. She is also a mom of two wonderful young adults working their way through college.
Abdullatif A., Kamran A., Iftikhar Z., Muhammad SK., Prokar D., (2015) Recurrent urinary tract infections in women. Int Urogynecol J, 26: 795-804.
Scharp D., (2020) Hypertonic Pelvic Floor Muscle Dysfunction and Urinary Tract Infection: A Comprehensive Approach to Diagnosis and Treatment. Urologic Nursing J. 40(5) 225-238.
