When is a bladder infection not a bladder infection?

Bladder infections are common.  Almost all women get at least one.  In general, we’re good at recognizing the signs of a bladder infection.  But I routinely see women in the office who have all the symptoms of a bladder infection but no bacteria in their urine.  So, when is a bladder infection not a bladder infection?

Common symptoms of a bladder infection.

The most common symptoms of a bladder infection are, needing to go to the bathroom frequently, pain with emptying,  needing to go urgently, and emptying small amounts.  In the clinic, we check a urinalysis to see if the urine looks infected.  This is a quick test but isn’t the best test.  A urine culture takes 2 days but will tell you what bacteria is infecting the bladder and what antibiotics will work.  A culture is the gold standard test.  And while a culture does not test for all bacteria, it does test for the most common bacteria.  In almost all situations, if the culture is negative, it means you do not have an infection.

Some women have all of the symptoms of an infection, but the culture is always negative.

These women should not be treated with antibiotics.  Bacteria are not causing their symptoms.  This isn’t a standard bladder infection.  But something is irritating the bladder in these women.

These women all deserve a careful history and physical.  While there are different conditions that can create this scenario, the most common reason is overactive pelvic floor muscles.  Your pelvic floor muscles support the bladder and the other pelvic floor organs.  When they contract, you store urine.  When they relax, you empty urine.  Sometimes they can become overactive or overly tight.  When this happens, they relax poorly.  This trouble relaxing can result in symptoms that are very similar to a urinary tract infection.

Lots of women carry their stress in these muscles and will develop overactive muscles.  It can also happen after an injury, surgery, or ergonomic stressors.  This is a common condition but one that is often overlooked.

The good news is that it is easy to treat this syndrome.  A few sessions with a good pelvic floor physical therapist will reverse this muscular dysfunction.  You just have to identify the problem!  And many insurances allow self-referrals to physical therapists.