Note from the editors: We recently caught up with Heather Fraebel, a physical therapy graduate student in Ithaca New York who aspires to specialize in women’s health physical therapy. Heather is a Uqora customer, which is how we originally met her, but she’s also a wealth of knowledge. We asked Heather to explain how physical therapy can play a role in long-term UTI prevention, in addition to other benefits. When we first talked about it, Heather said, "Sorry if this is long, it gets me jazzed up!” Don’t you love that? It gets us jazzed up too!
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 limited, the theory works like this: The urethra, vagina, and anus are all housed in the same band of muscle in the pelvic floor. Despite being told we all should do Kegel’s to strengthen our pelvic floor, the majority of women actually have overtoned, 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. 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 along with stretching, relaxation, and breathing exercises incorporated into treatment helps improve blood and nutrient flow to the area. Better circulation is good for the vaginal flora as well as the muscles and could help fight off bacteria. Improved circulation will also 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.
In some cases, we might be involuntarilypeeing wrong, an issue termed “dysfunctional voiding.” When urinating, some of us activate pelvic muscles that are actually unnecessary during urination. 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.
Now, a bit more about overdoing it with Kegel’s. Kegel’s are key for men and women who are struggling with a weak or overstretched pelvic floor. Butsome medical experts suggest that it’s not a one size fits all. Many women are facing a different issue with their pelvic floor—over-tightening. If you already have a tight pelvic floor, then working these muscles will only make your pelvic floor muscles tighter, which can make your pelvic floor muscles worse. If you’re dealing with urinary pain or urgency and frequency, consider seeking advice from a physical therapist before assuming you have a weak pelvic floor, since there may be more to it.
Physical therapy can help with other issues that are exerted by recurring UTIs. For me personally, this made a big difference, and I’m sure it can likely apply to many other women as well. We all know that getting recurring UTIs is extremely uncomfortable and embarrassing, and can also play a big role in sex. After getting enough UTIs, I began to associate sex with unpleasantness. Over time, my pelvic floor began to physically tighten up in response to sex, affecting natural lubrication, too, making sex increasing uncomfortable. Physical therapy works to desensitize nerves in the area, relax tightened muscles, and re-train the area to tolerate touch and stimulation.
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. But the logic is sound, and it’s made a difference for me. I started taking Uqora at the same time I started physical therapy, and I’ve stayed UTI free!
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. If you’re struggling with recurring UTIs and the fallout that comes with it, I recommend you look into physical therapy too.