Hear from a Pelvic Floor Physical Therapist on UTI management

Hear from a Pelvic Floor Physical Therapist on UTI management

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Written by: Heather Fraebel, PT, DPT

Meet Heather Fraebel, a pelvic floor physical therapist practicing out of Boulder, Colorado. We sat down with Heather to understand how pelvic floor therapy can factor into UTI treatment and management, and how to know if pelvic floor PT is right for you.

Written by: Heather Fraebel, PT, DPT

Meet Heather Fraebel, a pelvic floor physical therapist practicing out of Boulder, Colorado. We sat down with Heather to understand how pelvic floor therapy can factor into UTI treatment and management, and how to know if pelvic floor PT is right for you.

How did you get into your specific field of interest?

While dealing with UTIs and my own pelvic health concerns that really catapulted me into the field of pelvic health physical therapy. However, I already was interested and involved in it before that. It really began in graduate school. In our whole physical therapy education, we only received 1-hour long lecture about pelvic health that was put in a light of “okay, let’s just get through this guys” and “try not to laugh about this”. That enraged me. This was a whole field of physical therapy and an enormously underserved field of health care — pelvic health, and it was just being brushed off. This was the start.
I made it my mission to talk about and promote this field from that point on. And I fell more in love the more I got into it. Peeing, pooing, and having sex are the most fundamental and intimate functions of humans and helping others get control of those functions again is SO empowering.

What advances in women’s health are you most excited about?

Women’s health is becoming acknowledged! There really has been a shift in the past 5-10 years where women themselves and our culture are really talking about women’s health more, normalizing it, and improving care. I am especially excited about the changes in women’s health physical therapy. As a profession, we are evolving to be about so much more than just Kegels! Pelvic physical therapists are treating a broader range of dysfunctions and treating them in more innovative and successful ways. Those in the business world acknowledge the untapped market women’s health is as well and have really been coming out with exciting products. So I’m just excited in all the growth and awareness of women’s health in general in our country.

If someone is dealing with UTIs, how do you know if pelvic floor PT is right for them?

European guidelines acknowledge that the first line of treatment for recurrent UTIs is not prophylaxis antibiotics, but pelvic physical therapy. The U.S. is so behind with this. So I think EVERY woman that has recurrent UTIs (3 or more in one year) should see a pelvic floor PT. I have had patients that have come to me for recurrent UTIs and upon thorough exam, we really don’t find any pelvic dysfunction contributing to it. But that one and done pelvic PT appointment is still so incredibly valuable. Even if there is no pelvic dysfunction, at least that can give all the medical providers on a patient’s UTI team this info so that they can know to look into other systems further.
UTI patients that definitely should go to pelvic PT include those that concurrently experience any of the following: fecal or urinary incontinence, prolapse, pelvic pressure, pelvic pain, pain with intercourse, GI issues, constipation, painful periods. All of these things can be impacting UTI and can be addressed by pelvic PT.

What is your approach to managing recurrent UTIs with your patients?

In reference to the answer above, if a patient presents with any of those symptoms or dysfunctions, we first address those. There really is no one size fits all treatment for these issues of for UTIs. For some it involves a ton of pelvic floor relaxation and release of tension, for others it involves pelvic floor strengthening. Everyone gets a lot of education on lifestyle habits to improve bladder and pelvic floor health, education on posture, learning proper coordination of pelvic floor muscles during urinating and having bowel movements, stress management techniques, and a full body evaluation to screen for other musculoskeletal deficits that may be contributing to pelvic dysfunction. So almost no UTI patient of mine gets Kegels, it’s so much more than that!

What’s your biggest piece of advice for women dealing with urinary tract health issues like UTIs?

Find good care! In my own UTI journey, I often would feel discouraged and hopeless, but realized it was simply because I didn’t have the care I needed or wanted. Everyone deserves a team of professionals that they are comfortable with, feel are competent, and don’t give up. I ran through a few providers before I found a urologist, primary care, and pelvic physical therapist that were good fits for me, cared, and really empowered me.
I do feel that this is the most challenging aspect of UTI care, finding a good provider. So shop around a little and never feel committed to only one provider for your care. It will save you a lot of long-term time and suffering to establish a good team.

As a pelvic floor physical therapist, do you also see patients with other urinary tract issues other than UTIs?

Yes! There are a ton of other urinary dysfunctions I treat as a pelvic PT. Some of these include: urinary incontinence, urinary frequency, urinary urgency, bladder prolapse, interstitial cystitis, urinary retention, and more! Many of these issues have some musculoskeletal component to them!

Is there anything you’re working on, or researching, that you are particularly excited about?

Currently I have been most jazzed up about working for a small new company, Mend Physical Therapy, in Boulder, Colorado. At this company we are really revolutionizing the standard of care for physical therapy in this country. We spend way more time with patients and get them better quicker, do community outreach and education, and continue to grow and learn as professionals. We are a small company just getting our pelvic health PT off the ground and it is so rewarding to be a part of that. I feel the healthcare world can be a brutal area to work in with all the restrictions that arise from insurance companies, and that leads to less than ideal standards of care. I love being able to work for a company that is trying to change that and start actually putting patients first again.
I’d love to get into more research in the future, there is a big lack of pelvic health research. But for now, I am content empowering patients from my community every day.

What do you like to do for fun?

In my free time I love to run, especially on trails and I am currently training for my first marathon in October! You can follow my journey of how I’m optimizing my pelvic health while marathon training at my Instagram account: @yourpelvicroots_


This article is not intended to replace medical advice given to you by your doctor.

About the author

Dr. Heather Fraebel PT, DPT is a passionate pelvic health physical therapist in Boulder, Colorado at a clinic called Mend. She treats women and men addressing a variety of pelvic health dysfunctions involving the urinary, bowel, and reproductive systems. She has a special interest in UTIs as she has battled with recurrent UTIs herself.