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When it comes to preventing UTIs, you’ve surely heard about cranberry juice, and you’ve probably heard about antibiotics. But what about physical therapy?
Evidence says that, yes, physical therapy can help prevent recurring UTIs. Although research is still emerging, the theory works like this: the urethra, vagina, and anus are all housed in the same band of muscle in the pelvic floor, called the levator ani muscles. Despite being told we all should do Kegel’s to strengthen our pelvic floor, the majority of women actually have hypertonic, or too tight, pelvic floors. (More on this below.) Factors such as stress, sexual trauma, and even holding in our farts in public can increase this tone. The tighter that band of muscle, the closer the urethra, vagina, and anus are, leading to an easier transfer of bacteria and thus UTIs. Evidence has shown that a majority of women with recurring UTIs present with increased pelvic floor tone or decreased coordination (improper relaxation following contraction).
The goal of physical therapy is to relax and lengthen pelvic floor muscles to decrease tone that is drawing those holes close together.
Additionally, manual therapy is done by a physical therapist (working internally and externally on pelvic floor muscles) along with stretching, relaxation, and breathing exercises incorporated into treatment helps improve blood and nutrient flow to the area. Improved circulation to the pelvic floor can improve the vaginal flora, vaginal lubrication, and waste removal, helping fight off bacteria. Specifically regarding lubrication, improved circulation can help open up glands in the area to increase natural lubrication and the more lubrication the better (whether natural or artificial) in preventing UTI facilitating friction and microtears.
You can learn more about what to expect at your first pelvic floor physical therapy appointment here.
Increased tone and decreased coordination of contraction and relaxation of the pelvic floor is also associated with another factor contributing recurrent UTIs, dysfunctional voiding. In some cases, we might be involuntarily peeing wrong, an issue termed “dysfunctional voiding.”
To void, or pee, properly, our pelvic floor muscles need to relax. In the case of a hypertonic pelvic floor, when urinating, some of us activate rather than relax pelvic muscles, which can synch our urethra tight. That can cause a chain reaction that results in the last few drops of urine getting pulled back into your bladder, which is more likely to be contaminated and puts you at a greater risk of a UTI.
Physical therapy can help women overcome dysfunctional voiding through pelvic floor lengthening as discussed above, as well as proper positioning and relaxation while voiding.
Now, a bit more about overdoing it with Kegel’s. Kegel exercise, also known as pelvic floor exercise, involves repeatedly contracting and relaxing the muscles that form part of the pelvic floor. Kegel’s are key for men and women who are struggling with a weak or overstretched pelvic floor. But some medical experts suggest that it’s not a one size fits all.
While stated in the definition above, the relaxation after a Kegel contraction is often overlooked by women. Majority of women I see with pelvic floor dysfunctions can achieve a strong Kegel, but are unable to fully relax after each one.
Imagine your pelvic floor as an elevator. When contracting, you reach the fifth floor. But instead of returning to the main floor after that, many women only return to floor three before contracting back to floor five again. Without proper coordination or relaxation, many women develop hypertonicity, or over-tightening of their pelvic floor. If you already have a tight pelvic floor, then working these muscles, especially improperly, will only make your pelvic floor muscles tighter, causing them to fatigue and mimic a "weak" pelvic floor.
If you’re dealing with urinary pain or urgency and frequency, consider seeking a pelvic floor evaluation from a physical therapist before assuming you have a weak pelvic floor, since there may be more to it.
Let me start by saying that I have no ties or affiliations with any Kegel trainer companies.
Kegel trainers are a hot thing on the market right now. Some can even connect to an app on your smartphone to enable ‘vagina video games’. What a world we are in!
I recommend interactive trainers that connect with app feedback over vaginal weights due to the added element of awareness and active participation rather than passive strengthening that vaginal weights offer. In my experience with trialing a Perifit, I have found they are an extremely valuable tool for at home pelvic floor strengthening. Not only do they provide real instant feedback of contraction in the pelvic floor via an internal probe thus increasing awareness in your pelvic floor, they work all dimensions of pelvic floor strength. Games have you work on power, endurance, and quick flicks and require complete release/relaxation between them. Often you can even pick specific tracts whether you have incontinence vs post partum concerns vs trying to boost sexual function. And for all this, these devices are within the $100 range which is an incredible steal if you ask me.
Can this replace pelvic floor physical therapy? NO! First, realize, and I cannot say this enough as a pelvic floor specialist, Kegels are NOT for everyone! Certain pelvic floor dysfunctions could be made worse by Kegels. For those women, a Kegel trainer may never be appropriate.
Even if Kegels are warranted, in my experience I find that a majority of women do not know how to properly perform a Kegel or all the dimensions to a Kegel. For example, I had a patient once come to me saying “I do 300 Kegels a day, why do I still have leakage?” and it turned out she was 1) not performing them properly with a lift motion and without compensation from other muscle groups and 2) could not hold it for more than a fleeting second, indicating no endurance or strength of the slow twitch muscle fibers of the pelvic floor.
All of this to say, I highly recommend all women get at least an evaluation from a pelvic floor physical therapist first before starting on their own with a Kegel trainer. I feel Kegel trainers are an amazing tool to follow through after attending pelvic floor physical therapy to continue strength training independently and definitely worth the small investment.
Physical therapy can help with other issues that often coincide with recurring UTIs. We all know that getting recurring UTIs is extremely uncomfortable and embarrassing, and can also play a big role in our sex life, especially if that is your UTI trigger.
Our bodies will respond to our minds, so over time, my pelvic floor began to physically tighten up in response to the initiation of sex, decreasing my natural lubrication too, making sex increasingly uncomfortable. Physical therapy can address pelvic floor tightness, promote pelvic floor relaxation techniques especially during intercourse, desensitize overreactive nerves, improve natural lubrication, and retrain your body to tolerate touch and stimulation.After getting enough UTIs following intercourse, I began to associate sex with the unpleasantness that often followed. Our bodies will respond to our minds, so over time, my pelvic floor began to physically tighten up in response to the initiation of sex, decreasing my natural lubrication too, making sex increasingly uncomfortable.
Know that you are not alone if this sounds familiar to you, evidence finds that about half of women with recurrent UTIs reported sexual dysfunction (and maybe the others have stopped having sex all together).
Physical therapy can address pelvic floor tightness, promote pelvic floor relaxation techniques especially during intercourse, desensitize overreactive nerves, improve natural lubrication, and retrain your body to tolerate touch and stimulation. For me personally, this made a big difference, and I'm sure it can likely apply to many other women as well.
Like so many women’s health issues, there has not yet been enough research to say for sure that physical therapy is a game changer for UTI prevention. But the logic is sound, and it’s made a difference for me.
Outside of UTI prevention, I can definitively say that physical therapy has led to more relaxed pelvic floor muscles, increased lubrication, and pain-free sex. Above all, women's health physical therapy made me not feel alone and empowered me to use my own body to heal my body. If you’re struggling with recurring UTIs and the fallout that comes with it, I recommend you look into women's health physical therapy too.
Heather Fraebel, DPT is a women's health physical therapist in Denver, Colorado. Heather is also a Uqora customer, which is how we originally met her, but she’s also a wealth of knowledge.