Anne and Vonny – friends for 47 years! Good health starts with good friendships which bring joy, regular exercise and a focus on the whole woman from health professionals
Friday 8th September was World Physiotherapy Day and it’s always plonked right in the middle of Women’s Health Week. Why would I forget this I hear you ask? I ask myself the same question. Since I have started my blog in 2011, I have always written about these two events and yet it was only at 11pm last night that I saw a post about it (on vibrators yay) and thought: “Crap I’ve missed it this year altogether!” I had a close call last year but managed to get it in before the end of the day, but last night in bed I just couldn’t bring myself to get out and write something, just to get the 8th September date stamp.
So here on 9th September I am writing a blog about Women’s Health and Physiotherapy – two things very close to my heart. I have seen an extraordinary number of patients in the past two weeks with recurrent UTI’s and so I thought I would write some hints to help manage them. Recurrent urinary tract infections affect the quality of life for women in many ways. They can suffer with pain, days off work, urinary urgency and frequency and repeated bladder infections may affect their relationship if they become fearful about getting UTIs if having sex.
Recurrent Urinary Tract Infections (RUTIs)
Recurrent Urinary Tract Infections are defined as having a history of at least three symptomatic
and medically diagnosed UTIs in the previous 12 months. The previous UTIs should have resolved prior to a further UTI being diagnosed. One of the common causes of RUTIs is when the woman suffers with chronic urinary retention. This is when there is a repeated inability to empty the bladder completely, despite the ability to pass some urine. Chronic urinary retention may also result in the frequent passage of small amounts of urine or urinary incontinence and a distended bladder.
It is important to understand that a pelvic health physiotherapist should be an early port of call to seek treatment for RUTIs. There is so much that we can help you with. If the physiotherapist has a real time ultrasound, they can help with a diagnosis as you will be instructed to come with a full bladder, be scanned and then taught how to void completely and re-scanned to see if there is a residual left.
Pre/post void scan is an important assessment tool to help decide why these RUTIs are happening
Urinary tract infections can :
- Be related to sexual intercourse.
- Follow gynaecological repair surgery.
- Be due to the menopause where the vascularity of the urethra is altered and the loss of plumpness can allow easier entry for bacteria (drainpipe urethra).
- Be seen in women with faecal incontinence.
Here are some helpful bladder hints and preventative treatment strategies:
- Urinate 5 to 7 times a day for drinking 2 litres of fluid (from when you get up out of bed in the morning to when you go to bed at night) and zero to 1 at night. You will need to go more often if you drink more fluid.
- Drink an adequate fluid intake including plenty of water.
- Always use the correct position to urinate, taking your time and never strain to void. Always completely relax your tummy and pelvic floor.
- Never strain to empty. Relax your tummy and pelvic floor completely and let the bladder do the emptying.
- If there is a significant prolapse that is causing the incomplete emptying of the bladder, the physiotherapist may fit a pessary to reduce the residual urine.
- When finished urinating wipe from your front to back. Teach your daughters this at a young age.
- If post-menopausal, local oestrogen helps bladder function and vaginal discomfort. Speak with your doctor.
- Wear underwear with a full cotton gusset to limit vaginal/perineal irritation and wash the underwear with a ‘sensitive’ laundry liquid.
- Wash your perineum (urethra, vagina and anus) with a non-soap cleanser rather than soap or even plain water which can be drying for the vulva. (eg QV Wash or Dermaveen Soap Wash).
- If you are prone to recurrent urinary tract infections (UTI’s) reduce or avoid having frequent baths because of risk of irritation of the urethra and UTIs. If you need a bath for relaxation, shower first, then bathe and avoid using bubble baths and bath ‘bombs’.
- If prone to recurrent UTIs that are related to sexual intercourse, urinate before and after intercourse and use a good lubricant to improve comfort and reduce friction with prolonged penetration. There is evidence that a preventative dose (1 to 2 tablets only) of an antibiotic taken after intercourse may prevent UTI’s. Discuss with your doctor. There is also evidence that drinking 1.5 litres of water after sex decreases the risk of UTIs in those women prone to recurrent UTIs. This is a significant amount of water (or other fluid) to drink at one time but if you are plagued by recurrent UTIs you may like to try it.(1)
- Cranberry tablets have been shown to be nearly as effective as long term low dose antibiotics for UTI prevention in women (and do not contribute to antibiotic resistance). (2) Have breaks if using cranberry to prevent UTIs as long-term use can be linked with increased production of kidney stones.(3)
What to do:
Try the hints above and also make sure you speak with your doctor about your symptoms. Be aware that you can have symptoms that mimic a urinary tract infection, but the urine is repeatedly not showing any signs of bacteria. You may be given a diagnosis of IC/BPS or Interstitial Cystitis/ Bladder Pain Syndrome and you will require a completely different treatment plan.
(1) Infectious Diseases Society of America. (2017, October 5). Women who get frequent UTIs may
reduce risk by drinking plenty of water. ScienceDaily. Retrieved February 8, 2018 from
(2) Jepson R, Williams G, Craig J (2012) Cranberries for preventing urinary tract infections.
Cochrane Database System Review Oct 17; 10: CD001321.
(3) Terris M, Issa M, & Tacker J (2001). Dietary supplementation with cranberry concentrate
tablets may increase the risk of nephrolithiasis. Urology, 57(1), 26-29. 10.1016/S0090-4295(00)