Elsewhere on #AskEvvy, we’ve discussed the basics of pelvic health physical therapy and how it can help people with a variety of pelvic and vaginal symptoms. We noted that people who experience frequent vaginal infections often live with other pelvic floor problems, like chronic pelvic pain, which pelvic PT can address.

“But I don’t have chronic pelvic pain,” you may be thinking. “Is pelvic PT even worth my time?” It may be! Pelvic PT can do more than reduce pain: let’s learn more about the many ways it can help people with vaginal symptoms related to recurrent infections.

How can pelvic PT help people with recurring vaginal infections?

Great question! The short answer is that it depends. Let’s consider three common situations in which pelvic PT can be a helpful component of care for people with infections that persist or keep coming back.

You have all the symptoms of an infection, but your tests don’t detect disruptive microbes 

Picture this: you feel the symptoms of another urinary tract infection coming on. It stings when you pee, and even though you just went to the bathroom 15 minutes ago, you already feel like you have to go again

You make an appointment with your primary care provider and pee in a cup…but your urine culture results come back negative. Your provider is perplexed. They offer to prescribe another round of antibiotics “just in case”, but you’ve tried that before without results. Hoping to find an answer, you order an Evvy test, but your results indicate a healthy, protective vaginal microbiome

As pelvic PTs, we hear this story all too often. Many people come to us reporting symptoms reminiscent of a UTI–painful urination, incomplete bladder emptying, frequent urges to pee—but they have no active infection, and their symptoms don’t respond to antibiotics. 

In many cases, these people are living with a condition known as urologic chronic pelvic pain syndrome (UCPPS). UCPPS can affect people of all sexes and genders, and it is characterized by persistent pelvic pain, typically accompanied by urinary symptoms that can mimic infections. In people born with vaginas, other common names for UCPPS are interstitial cystitis (IC) and painful bladder syndrome (PBS).

Most folks with UCPPS will exhibit significant tightness and tension in their pelvic floor muscles (PFM). Like overly tight muscles in other areas of the body, spasming PFM can cause pain with activity and at rest. If these muscles can’t relax fully, it becomes difficult to completely empty one’s bladder and bowels.

UCPPS is a complex condition that can affect multiple areas of one’s physical and mental health. It usually requires a team approach to care, and pelvic PTs play a key role in that team. If you have UCPPS, your pelvic PT can help you address muscle and nerve problems that contribute to pain and dysfunction. Your PT can also teach you strategies to manage symptom flares and improve your bladder function.

You struggle to fully empty your bladder, and as a result, you get UTIs easily/often

Maybe you get urogenital infections, particularly UTIs, quite often. Your medical tests come back positive for an active infection each time, and you treat them with antibiotics…but a few weeks or months later, your symptoms are back again.

Your medical provider has counseled you to pee after sex and to avoid holding your pee for extended periods. You’ve been trying to stick with these habits, but you can’t seem to empty your bladder properly: it always feels like there’s a little more left inside, or you have to make several bathroom trips in close succession.

Incomplete bladder emptying is a known risk factor for UTIs that keep coming back. 

Urinating flushes bacteria out through the urethra. This helps prevent bacteria from lingering in the urinary tract and causing an infection. If you aren’t peeing completely, your urethra may be retaining harmful bacteria.

It’s normal for your bladder to retain a small amount of urine after you pee: generally, less than 50 mL to 100 mL. However, if your bladder is holding back larger volumes of urine each time you pee, your risk of developing a UTI increases.

One study of women of all ages found that those who retained more than 30 mL of urine (enough to fill a shot glass) had an increased risk of developing a UTI.

People can develop urinary retention for a number of reasons. In many cases, it is related to incoordination of the muscles that control bladder emptying. Fortunately, pelvic physical therapy is uniquely suited to address coordination issues.

A pelvic PT can teach you exercises and techniques to retrain your muscles, making bladder emptying smoother and easier. This can enhance the flushing effect of urination, helping your body clear potentially infectious bacteria.

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You’ve had vaginal/pelvic infections in the past, and even though the infections are gone, you now live with chronic pelvic pain

In a perfect world, the symptoms of vaginal infections would disappear completely after treatment. Unfortunately, some people are left with persistent pain even after the triggering infection has cleared.

Pelvic inflammatory disease (PID) is an infection of the upper genital tract in people with uteruses: it affects the uterine lining, fallopian tubes, ovaries, and the tissues surrounding these organs. It usually occurs when bacteria pass through the cervix to reach the upper reproductive organs.

PID typically develops as a consequence of another pelvic infection: STIs like chlamydia and gonorrhea are the most common triggers, but some BV-associated bacteria are also associated with PID. 

Approximately one-quarter of people with PID report pelvic pain that persists after their infection has been treated. If your medical providers are confident that an infection is no longer present, but you’re still experiencing pelvic pain, it’s worth consulting with a pelvic PT. 

The inflammation of PID can cause your muscles, nerves, and other pelvic tissues to become extra-sensitive. When this sensitivity lingers after the infection clears, this can lead to persistent pain. In pelvic PT, you’ll learn strategies to reduce this sensitivity and decrease the intensity of the pain you experience.  

Most of the research in this area focuses on chronic pain after PID. However, people who have experienced other types of recurrent infections, like chronic UTIs or BV, will often report pain that persists even after their infections have cleared. For example, some research suggests that the chronic pain condition interstitial cystitis (aka painful bladder syndrome and or UCPPS above) may arise as the result of a previous urinary tract infection.

How do I know if pelvic floor therapy will help with my recurring vaginal infections? 

This is the tricky part: every body is unique, and what works for one person may not be as effective for another.

Here’s a general rule of thumb: if any of the three aforementioned situations apply to you, there’s a high likelihood that pelvic PT would be quite helpful! However, even if those three patterns don’t exactly reflect your symptoms, pelvic PT could still be a good fit.

The easiest way to determine in pelvic PT can help is to consult with a pelvic physical therapist. An initial evaluation appointment with a pelvic PT is the perfect opportunity to share your story and symptoms with a professional. Your PT will ask follow-up questions to gather more details, and they will perform a comprehensive examination to better understand your symptoms.

After the evaluation, your pelvic PT will tell you if they think that pelvic PT can help with your symptoms. They can provide an estimate of your expected time to improvement (aka the prognosis) and the types of interventions they expect to help you the most. As a team, you and your therapist can then decide if pelvic PT is the right fit for you, and if so, how to begin your care.

Remember: not all PTs specialize in pelvic health, so check out our other post on the subject here for tips on finding a pelvic specialist near you.

Regardless of how you decide to manage your symptoms, Evvy is here to help on your journey to better vaginal health. The Evvy Vaginal Health Test will help you better understand what’s happening in your vaginal microbiome and whether or not your symptoms are likely being caused by disruptive bacteria or fungi or it’s something more structural, in which case it could be beneficial to immediately pursue pelvic floor therapy.