Many of us are familiar with UTI (urinary tract infection) symptoms: burning, pain with urination, increased urge and frequency, low back pain, sometimes a fever etc.
UTI's are no joke, as they can come with their own consequences if not taken seriously. For example, a kidney infection and kidney / mid-back pain can send you to the emergency room if the infection spreads upwards.
What happens when you frequently get the symptoms of a UTI but the cultures continue to come back negative? Some providers might place you on antibiotics anyway, however best practice is to keep digging for what else might be causing your symptoms. After all, antibiotics have their own consequences for our GI tract and immune system so we don't want to be taking them without a purpose.
So what are the other causes of bladder pain?
The hint is in the name, painful bladder syndrome. This is also known as interstitial cystitis, however recent literature has been moving towards utilizing the former name as it is more encompassing. The International Continence Society identifies painful bladder syndrome as:
Complaint of suprapubic (above the pubis but below the belly button) pain related to bladder filling
Absence of proven urinary infection or obvious pathology; accompanied by other symptoms
Increased daytime frequency
Increased nighttime frequency
But not all causes of burning pain are painful bladder syndrome / interstitial cystitis. Other causes can be vulvodynia and vestibulodynia, endometriosis, vaginismus (read our blog on this topic), or pudendal neuralgia. Pain can exist without a diagnosis as well, so don't worry if you don't feel like you check any of these boxes.
Pain is often a common consequence when we hold ourselves in so much tension all day long. If you think about squeezing your fist as hard as you can for as long as you can, overtime that wrist joint and the structures around it would really start to ache. We are less aware of constant tension in our pelvic floors than we are of it in our hands, neck, or jaw, but it doesn't mean that tension isn't wreaking havoc anyway.
Why could tight muscles be causing burning, urgency, and frequency?
Our pelvic floor is made up purely of muscle and soft tissue. If you want to learn a little bit more about it you can read our blog on it here.
These muscles wrap around the urethra, vagina, and rectum to help keep us continent. While incontinence, or leaking urine, often times is caused by a weaker pelvic floor, it isn't always the case. A tight muscle wrapped around the urethra doesn't allow it to slide and glide as it should. A hypo-mobile urethra can tug on the bladder, simulating bladder pain, urgency, and frequency so that we might feel as if we had an infection. Picture a too short string on a balloon; that tugging on the string is going to impact the balloon a lot more than if we had a nice, lengthened (relaxed) string.
What about burning pain? Arguably the most uncomfortable, stressful pain because we feel like we are literally on fire. Think about how painful a sunburn would be on our vulva, that's essentially how burning nerve pain feels. Some burning pain can be caused from tissue irritation, such as concentrated urine irritating the vulnerable skin around the urethra. Other burning pain can be caused from our nerves sending that perceived signal to our brain because they're compressed or irritated. Let's picture again how each muscle is innervated by a nerve or branches of several nerves. Those nerves weave themselves in and around the muscles, so holding a lot of tension can be one huge contributing factor to those nerves saying "hey I'm trapped, let me go, I'm on fire."
In Pelvic Floor Physical Therapy, there are many techniques utilized to help relax and lengthen the soft tissue structures surrounding the urethra (for example) to alleviate the pain. Just because you may have pain now doesn't mean that it's forever, that it'll only go away with surgery or medications, or that you're broken. On the contrary, really.
At home tips for bladder pain
The purpose of this blog is not to take place of medical care and getting your symptoms checked. Whether this means a urinalysis from your primary care physician, or being evaluated in person by a urologist, gynecologist, or pelvic floor physical therapist, you should utilize this blog as an adjunct.
That being said, let's review a list of things you can do at home to help alleviate some (if not all) discomfort.
Drink enough water
Drink enough water
This really shouldn't be a surprise to anyone, but the majority of adults in the United States do not get the recommended daily intake of water (6-8 glasses). Another way to gauge your needed intake is 1/2 ounce of water per body weight in pounds.
Why exactly does drinking water help, though? The inside lining of your bladder can become irritated or inflamed, especially with painful bladder syndrome or even a UTI. Water can provide a protective barrier between harmful, irritating components in your urine and the bladder lining itself. For example, alcohol may be a bladder irritant for you, and can often increase symptoms. Drinking water before and after a glass of alcohol can help prevent those symptoms from flaring.
Recommendation: As soon as you feel the urgency or discomfort coming on, increase your water intake and do it gradually (or in sips). If you have a known bladder irritant (read more below), sandwich it with a glass of water before and after consumption.
Modify your diet
Have you ever heard of a bladder irritant? Bladder irritants are certain foods and beverages that, when consumed, can lead to irritation of the bladder lining and therefore you feel pain, frequency, urgency, and burning.
How do you know if the foods you're eating or beverages you are consuming are causing bladder irritation? The only way you'll truly know is if you track your habits daily and note whether or not you experience an uptick in symptoms following consumption of said item.
Once you've identified a culprit you believe to be contributing, the next step would be to remove that item from your diet for a week or two. Did your symptoms improve? Or did they not, and in that case your afternoon green tea might not be the answer. Don't worry, though, if you find something that it really hard to give up! As mentioned earlier, performing a water sandwich can help reduce pain and irritation on that bladder lining.
Recommendation: Evaluate your daily habits for any food or drink items that could be causing irritation, remove them temporarily and note any resolution of symptoms. If you really want to keep eating / drinking that item, sandwich it with water to help reduce its effect on your bladder.
PSA: Not everyone experiences pain or symptoms with food and drink. Don't get pushed into removing them if you truly don't notice a difference. There was never any research conducted on bladder irritants. A long time ago, the medical community asked those in pain what bothered them the most food wise, and put those on a "bladder irritant" list. That's it. That is all the thought that went into it.
Heat or Cold Therapy
Whether you prefer ice or heat is up to you, but trying both may be useful. Heating pads have long been known for their pain management properties, as they help bring blood flow to the desired area. Blood carries with it natural pain relievers in the body and can help clear away debris that commonly causes inflammation.
Cold, however, works best when you're experiencing burning pain. The science is simple and brilliant behind cold therapy. The nerves in your body that tell your brain you're experiencing painful burning are the same nerves that tell your body that something is cold. These two signals compete with each other, as they cannot both be active at once. Utilizing cold to calm down / stop that burning signal from reaching your brain is very helpful when the burning pain is on the outside of your body for this reason. It is a popular modality for burning pain along the perineum (the skin between the vagina and anus) and the vulva.
Recommendation: If using heat, keep on skin until the area is warm and slightly pink itself, but not hot or burned. If using ice, use a protective barrier around the ice so it isn't directly on skin. A gel cold pack is a perfect alternative.
Over-the-counter supplements
Treading lightly here, it's important to ensure you seek medical care and advice prior to relying on OTC supplements to solve your problem or improve your symptoms.
That being said, the following supplements might provide relief:
Calcium glycerophosphate (Prelief) can be taken before you eat an acidic food. This ties back to the discussion on modifying diet and recognizing bladder irritants that bother you. Acidic foods are a common cause of irritation, but you don't want to rely on a supplement for every meal to negate their effects on the bladder.
Phenazopyridine (Azo Bladder Pain Relief Tablets/Pyridium) can be used for mild pain relief. This applies to known UTI pain as well, however you don't want to consume Azo prior to a urinalysis as it does discolor urine.
Nutraceuticals (CystaQ, CystoProtek, and Desert Harvest Aloe) can be helpful as an alternative to traditional prescription medications. Speak with your medical provider about these options prior to purchasing them.
Stress Management
This could truly be a whole book, and many have written on the topic of stress and its physical impact on our bodies. A favorite recommendation of one such book: Burnout: The Secret to Unlocking the Stress Cycle by Emily Nagoski and Amelia Nagoski.
A certain amount of stress in our lives is normal, but if you're living with a high amount of unnecessary stress that can make symptoms way worse.
Stress can have both physical impacts as well as psychological, but the reality of psychologic impacts of stress is that they turn into physical anyway. The mind and body are very much connected, as the brain is the epicenter of control for all things living and moving inside.
Each area of the body talks to the brain and the others through a highway of nerves via the nervous system. Nerves are not immune to stress, rather they tend to be the most affected by them. Nerves can become hyper-sensitive to signals overtime, so rather than going numb to something like pain the nerves end up amplifying the pain. When nerves are consistently in pain, they often illicit symptoms of burning, stabbing, tingling, itching, weakness, and changes in sensation. Overtime, whatever was once causing our pain will heal at a cellular level. But the nerves may not always, so they continue to send signals as if you were still injured. This is the reason why a lot of individuals with chronic pain hear, "well your scans and tests look fine, so nothing is actually wrong with you."
To avoid the length of a novel, I'll leave you with this parting thought: If you're always clenching your teeth and jaw when stressed, guess what else you're clenching?? Your mouth and anus are connected by one long tube. Just like how your neck and shoulders get tight with a clenched jaw, your pelvic floor and surrounding muscles get tight with stress.
Muscle Relaxation
The above section blends well into this subject, learning to relax our muscles. We really may not realize overtime just how much tension we carry in our body, or at least not until it causes pain. Jump back to the section above on why tight muscles and soft tissue can cause pain if you missed it.
A great way to work on relaxing the muscles is to start with diaphragmatic breathing. It sounds like a cheesy answer, but you cannot relax and destress if your body is in state of "I'm ready to flee from the next threat that walks around the corner".
If you're struggling to get a relaxed, diaphragmatic breath down, you're not alone! It is truly one of the hardest, yet simplest, things to learn. The majority of my clients require 1-2 sessions almost entirely devoted to relearning how to breathe. It is the foundation of all movements, and therefore the most important to get right.
From there, once you've learned how to breathe after working with a physical therapist (if you haven't gotten the technique down already), you can start relaxing the muscles with stretching and gentle movements. Contrary to common thought, stretching isn't the only way to calm muscles down in the long run. Loading the muscles, meaning progressively strengthening them after they've been lengthened and soothed is the long term solution to help prevent a return to unnecessary tension.
Bladder Training
Timed urination can be helpful when trying to get rid of urgency and frequency, as long as it does not increase or cause pain. If holding in the urine for longer to help calm urgency causes pain, we don't want to head down that route yet. But sometimes this is exactly the ticket to help get rid of urgency and frequency for good. If you have a lot of that annoying urgency, feeling like the commercial of "gotta go, gotta go", then read more about retraining your bladder on our blog here.
Emotional Support
Long term pain can quickly lead into anxiety and depression, or vice versa. This again goes back to the discussion on the psychological link of pain. The importance of getting professional help and guidance to deal with the anxiety and depression could not be highlighted enough. Support groups help as well, especially if dealing with a condition that ends up being (nearly) life-long like endometriosis.
Of course close family and friends are vital as well. Having a strong base of emotional support around you can help make dealing with this pain more achievable. No one should suffer in silence.
Avoid Known Triggers
One such example as this is tight clothing. Sometimes burning pain on our vulva is very sensitive to touch, so any firm pressure on our pelvic floor can illicit pain. This is where you must have understanding that tight clothing may be your trigger, so you alter your wardrobe a bit to avoid that. Other triggers known can be food or beverage related, so if coffee 100% always triggers you it may be worth finding out what other caffeinated drink you'd be able to consume in the morning.
More helpful tips:
Wear clothing, especially underwear, made from 100% natural fibers such as cotton, silk, or linen. New clothing can be contaminated with pesticides, chemicals, and dyes; so be sure to wash all new clothing before wearing. Loose fitting and comfortable clothing are best, especially when the pain is at its worst.
Use the mildest laundry detergent you can find, and use the extra rinse cycle on the washing machine to ensure all soap residue is removed. Avoid fabric softeners or dryer sheets because they leave a chemical residue that can trigger irritation. Try using an herbal laundry sack instead dryer sheets, or dryer balls that help fluff clothes while being environmentally friendly.
Bubble baths, bath salts, and strong soaps can trigger irritation of the urethra, vulva, perineum, and rectum. Mild, unscented soaps such as Basis, Dove, and Very Private Body wash are recommended. Make sure, too, you're only cleaning the inside of your vulva with warm water and nothing else. Our vaginas are self-cleaning ovens, they don't need anything else messing with their delicate pH balance.
TLDR
Not all burning, frequency, urgency pain that resembles a UTI is caused by a UTI. If you continue to experience these symptoms but your cultures continue to come back negative, there may be another cause. These can be, but are not limited to, painful bladder syndrome / interstitial cystitis, pelvic floor dysfunctions, and nerve pain.
Getting your symptoms evaluated is important to getting to the bottom of the pain. Physical Therapists are trained to look at the entire picture of who you are and what's going on, including screening other body parts / systems to make sure nothing is missed. If you're feeling stuck, and are unsure of where to go with this type of pain, consider reaching out to a Pelvic Floor Physical Therapist.
Try these at-home tips to help manage your pain as an adjunct to in-person care:
About the Author:
Caroline Gamwell, DPT is a Doctor of Physical Therapy specializing in Pelvic Health and Orthopedics. Dr. Gamwell earned her doctorate at Northwestern University in Chicago, IL with a focus on chronic pain rehabilitation. Dr. Gamwell owns Worth It PT, LLC, a boutique physical therapy practice based in Denver, CO focusing on all things Women’s Health. She holds post-graduate certifications in Pelvic Floor Physical Therapy, as well as in treating pregnant and postpartum athletes. Her strongest passions lie with helping others conquer their chronic pain and achieve their intimacy goals.