What Causes Bladder Pain Without Infection?
Written by Dr. Karah Charette, PT, DPT, RYT
Understanding Bladder Pain
Do you feel like you constantly have to pee?
Does it hurt or burn to pee?
Do you feel like you always have a UTI but your tests come back negative?
These are all common complaints for someone who has bladder pain but no infection. How is this possible?
In this blog you will learn 7 reasons why you can have bladder pain but no infection
and
3 ways you can start to effect change now.
Learn how to stop taking unnecessary antibiotics and
heal your bladder through movement!
Possibility Number 1: Over-recruited Anterior (Front) Muscles of the Pelvic Floor
The reality is that your bladder and urethra (the tube you pee out of) are surrounded with and influenced by fascia and muscles of the pelvic floor.
If you are unsure what the pelvic floor even is, you may benefit from checking out this blog here to learn more.
When you look at the anatomy of the pelvic floor muscles, you will notice that there are muscles in the front of your pelvis called the urogenital triangle. These muscles specifically connect to the urethra to help keep it shut when you do not want to pee, and also to relax and open up when we do want to eliminate urine.
For many individualized and different reasons, these muscles can get over recruited and tight. When this happens, the muscles can pull on the urethra and irritate it or create the false sense of urgency and even urethral burning with urination.
You might be wondering why these muscles can get over-recruited in the first place. The reasons can be unique to the individual and this is why a pelvic floor physical therapy assessment is always best practice.
However, one reason this can occur can actually be connected to your feet. If you bear weight more in the forefoot (front of the foot) throughout the day, this has been shown to correlate with the frontal pelvic floor muscles being more activated. There is a deep foot to pelvic connection and playing with the weight in your feet can make a difference in how your pelvic floor absorbs tension and shock.
Possibility Number 2: Over-recruited Obturator Internus
There is a specific muscle at the back wall of your pelvic floor called the obturator internus. This muscle is also a hip external rotator. This muscle is a big part of why there is a hip to pelvic floor connection.
There is a deep fascial connection that directly connects the obturator internus to the bladder and urethra. As a clinician, I have been able to recreate people’s bladder symptoms by pressing on this muscle. I have also witnessed symptoms decrease when this muscle is addressed and treated.
This is important because once again it shows that you can have bladder symptoms that are driven by neuromusculoskeletal components, not infection. Rather than constantly taking antibiotics for an infection that does not exist and risk upsetting your gut microbiome, it would be much easier to address this pain through movement patterns and biomechanics.
If the obturator internus is driving your bladder symptoms, this muscle can be downtrained in skilled pelvic floor physical therapy. It would also be important to assess your hip range of motion and gluteal coordination patterns so that you can stop over-recruiting this muscle in the first place.
Possibility Number 3: Over-recruited Abdominal Wall
If you are someone who is constantly holding tension in their abdomen or “sucking in” to engage your core, it is possible this could be driving your bladder symptoms. If you are someone who participates in constant intense abdominal exercises, this can contribute as well.
Your bladder as an internal organ sits in the pelvic bowel and is also connected to fascia in the abdominal wall. If the fascia and musculature near the bladder is constantly tight and engaged, it can decrease blood flow. Nerves love blood flow. If nerves get irritated by lack of blood flow, this can cause bladder sensitization.
This increase in tightness can also create more pressure on the bladder, which in turn can sensitize the area and create more symptoms.
Learning strategies on how to relax the abdominal wall can significantly reduce bladder and urethral irritation.
Possibility Number 4: Poor Pressure Management
Similar to how a tight abdomen can place pressure on the bladder, if you have a posture that increases pressure downwards toward your pelvic floor, this may also increase your bladder symptoms.
Postures such as forward head, rounded shoulders, and rounded mid back can increase pressure downwards. Even moreso, if this posture continues or worsens when you are loading your core (lifting weights, bending over to pick something up, pushing something heavy, etc…) the amount of pressure will increase on the bladder and pelvic organs which can contribute to fascial holding patterns and sensitivity.
Having your pressure management strategies assessed is essential when dealing with bladder symptoms.
Possibility Number 5: History of Chronic Infections
If you are someone who identifies as having a history of real chronic infections at the bladder and urethra, but now your tests are coming up negative, you may have developed neuromuscular sensitivity at this part of your body.
When the body deals with real infection (especially when it is chronic), there will be changes in the physiology of how your body perceives pain in that area. When there is ongoing inflammation due to infection or other causes, immune cells in the affected area release various molecules that can sensitize pain sensing fibers that are called C-fibers. When C-fibers become more sensitized, normal stimuli that would not be interpreted as pain begins to feel painful for the body. In other words, your body builds up defenses to be more alert for “dangers” to the system, but even when the infection subsides, the sensitivity can still remain.
This is important as it shows the neurophysiology of how the nervous system can get involved after pathology and infection. This is not saying “it is in your head”. It is saying that nervous system states contribute to how we experience pain. Somatic approaches to physical therapy work with the nervous system first to address these changes and allow for your body to experience physiological safety from a felt place.
Possibility Number 6: Non-optimal Bladder and Bowel Habits
Do you identify with any of the following:
Pushes to pee
Urinates every hour or more frequently
Involuntary leakage
Drinks mostly coffee, tea, or seltzers
Stream is shorter than 8 seconds
Struggles with constipation
Has bowel movements every 4 days or more
Strains to eliminate bowel movements
If you said yes to any one of these, it is possible that you have non-optimal bladder and bowel habits that are contributing to the sensitization of your bladder and urethra.
Many aspects of the bladder and its function are tied to the nervous system and reflexive behaviors. Therefore, we can train the bladder to have good habits, or we can train it to develop habits of urgency, frequency, and discomfort. Addressing these behaviors can significantly change the symptoms you have with your bladder.
Possibility Number 7: Neck and Spinal tension
At the end of the day, the reason you feel symptoms in any part of your body is because the nerves are transmitting that information to your brain. All the nerves that innervate your bladder (and any other part of your body) come from the spine.
If there are any restrictions along the neural system (think starting from the nerve root leaving your spine all the way to the bladder tissue) that can cause neural tension. Neural tension can contribute to why nerves get irritated and sensitized.
Because nerves start at the spine, it is important to be assessed to see if there are areas in your spine or neural pathways that contribute to your symptoms. If there are findings, then they are in need of more mobility and degrees of freedom. This can be created through specific and targeted movement.
What Can You Do Now?
Learning all of this information can be overwhelming. You are not expected to know what is the clear driver of your symptoms. That is the job of a trained physical therapist. It is more important that you feel empowered through information and understand there are many potential factors that can contribute to your bladder symptoms beyond just an isolated infection. Knowing the different factors can allow you to explore different options.
In the meantime, here are 3 exercises you can do right now to try to change your bladder symptoms without infection:
Diaphragmatic Breathing: Try placing your hands at the sides of your rib cage and breathing gently into that space. Rather than breathing into your belly, can you let your belly be soft and ride the wave of your breath without straining?
Child’s Pose: If accessible, try kneeling on the ground with your feet together, knees apart, and your butt to your heels. If your butt does not reach your heels, place a pillow underneath your hips. Let your arms reach out long and let your belly contact the floor. If it does not contact the floor, again use a pillow or blanket to bring the floor to you.Try to do the deep rib cage breathing and imagine your pelvic floor expanding. What do you notice?
Somatic Imagery: If it feels safe for your body, explore touching or even hovering over your bladder (right below your belly button) and notice what colors, temperature, or textures show up for you. What would it be like to imagine your bladder as a supple sea creature, like a jellyfish, gently moving with each breath? Pause and notice.
These are just three quick and easy ways to begin to regulate your nervous system specifically around the fascia and tissue of your bladder. If they work for you- great! If not, do not despair. Everyone’s body is unique with its own experiences, beliefs, images, and holding patterns. It is important to honor that individuality. A one-on-one session with a skilled pelvic floor specialist may help support you in that journey of finding what works for you.
Reach out today to learn how to manage bladder pain without infection.
Bodyful Physical Therapy and Wellness is located in Oakland, CA and can help anyone in the Bay Area with an in person visit. Telehealth is a great option for those in the state of CA who cannot come in person. Virtual Somatic Wellness visits are available to folks outside of CA.
