Why do I keep getting urinary tract infections (UTIs)?
Frustrated by recurrent UTIs? Learn common causes, how to distinguish infection from muscle tension, and strategies to treat and prevent them.
Table of Contents
There are few things more annoying — and painful — than the burning, urgent need to pee that signals a urinary tract infection (UTI). But when that infection clears up, only to return a few weeks or months later, annoyance can turn into exhaustion and anxiety. You may plan your day around bathroom breaks or worry that every twinge of discomfort is a sign of another infection.
Recurrent UTIs are a frustrating reality for many people. While anatomy and genetics play a role, your pelvic floor muscles and daily habits also influence your bladder health. "We see people who feel stuck in a cycle of symptoms," says Karla Arevalo-Alas, PT, DPT, a pelvic health physical therapist at Hinge Health. "Understanding the connection between your pelvic floor and your bladder can sometimes be the missing piece of the puzzle."
Ahead, learn more about what causes recurrent UTIs, how to distinguish them from other pelvic issues, and how to treat and prevent them. We’ll also look at how pelvic floor exercises recommended by Hinge Health pelvic health physical therapists can help support bladder health.
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What are recurrent UTIs?
A urinary tract infection (UTI) occurs when bacteria enter the urethra — the tube that carries urine out of the body — and infect the urinary tract. While anyone can get a UTI, they are most common in women and people with vaginal anatomy. This is largely due to having a shorter urethra, which means bacteria have a shorter distance to travel to reach the bladder.
Recurrent UTIs are usually defined as experiencing:
Two or more infections within six months, or
Three or more infections within one year
Recurrent UTIs are frustrating, but they often point to a pattern that you can change. Taking a closer look at your lifestyle habits and pelvic health may help you break this cycle and find relief.
Symptoms of recurrent UTIs
The symptoms of a recurrent UTI are typically the same as an isolated infection. Common signs include:
Strong, persistent urge to urinate
Burning sensation when urinating
Peeing often, but only a small amount comes out
Urine that appears cloudy, red, bright pink, or cola-colored (signs of blood)
Pelvic pain, especially in the center of the pelvis and around the area of the pubic bone
Low back pain
Is it a UTI or a pelvic floor issue?
"There is a significant overlap between UTI symptoms and pelvic floor dysfunction," says Dr. Arevalo-Alas. "We often see people who have urinary frequency, urgency, and even burning or pelvic pain, but when they get a urine culture, there is no bacteria present."
If you have UTI-like symptoms but your lab tests keep coming back negative, you may be dealing with a tight (hypertonic) pelvic floor. "Tight muscles around the pelvic floor can press on nerves and send confusing signals to your bladder, mimicking an infection," says Dr. Arevalo-Alas. In these cases, antibiotics won't help, but pelvic floor physical therapy can.
Causes of recurrent UTIs
A few factors can lead to recurring urinary tract infections. Beyond anatomy and hormonal changes, your daily bathroom habits matter more than you might think. Some common causes include:
Anatomy. Women have a shorter urethra than men, shortening the distance bacteria must travel to reach the bladder. Similarly, structural abnormalities, like kidney stones or other urinary tract issues, can trap urine and UTI-causing bacteria.
Incomplete bladder emptying. When you don't empty your bladder completely, it’s harder for your body to flush out bacteria. This can happen if you rush or don’t sit comfortably on the toilet. “Hovering over public toilet seats can make it difficult to empty your bladder completely,” Dr. Arevalo-Alas says. “Squatting to hover requires your muscles to contract when they should be relaxing.” Sitting down fully allows for better relaxation and more complete emptying.
Holding urine for too long. Ignoring the urge to pee allows bacteria to multiply. "We see this a lot in nurses and teachers who wait six or more hours to use the bathroom," Dr. Arevalo-Alas says. "Waiting that long isn't great for bladder health."
Hormonal changes. Lower estrogen levels (common during menopause or while breastfeeding) can cause changes in the urinary tract that make you more vulnerable to infection.
Chronic stress. Research suggests that chronic stress may play a role in lower urinary tract problems and could complicate UTI symptoms, potentially by affecting your immune system's ability to fight off infection.
Sexual activity. Because the urethra is located close to the bowel area, sex can naturally shift bacteria from one to the other. This is a common occurrence due to anatomy, not hygiene. This is one reason why it’s always so important to urinate after having sex.
Birth control methods. Diaphragms can press on the urethra, making it harder to empty your bladder completely. Spermicides can also affect the balance of healthy bacteria that protect against infection.
Genetics. Research shows that some people are born with cells in their urinary tract that act like a magnet for bacteria. This makes it easier for bacteria to stick and cause an infection.
Weakened immune system. Certain health conditions — including diabetes, autoimmune conditions (like lupus, rheumatoid arthritis, or IBD), depression, and chronic pain — can change how your body defends itself. For instance, higher blood sugar levels can weaken the immune system, making it easier for bacteria to cause infections. Diabetes can also affect the sensitivity of the nerves that control your bladder, making it harder to sense when you need to go or to empty your bladder completely.
Certain medications. Some medicines — such as long-term steroids or those used for autoimmune conditions — can affect how your immune system works. This can make it harder for your body to fight off infections like UTIs. If you’re concerned that a medication might be playing a role in your symptoms, talk with your doctor.
Pelvic floor tightness. Your pelvic floor muscles need to fully relax to let your bladder empty. If these muscles are tight or uncoordinated, they may prevent the bladder from emptying completely, which can allow bacteria to linger and grow.
Treatments for recurrent UTIs
Treating recurrent UTIs often requires a mix of strategies. The first step is seeing your doctor. While a quick office test can confirm an infection, it’s essential to ask for a follow-up bacteria culture test. Unlike the quick urine dip test, a culture identifies exactly which bacteria is the culprit and tests which antibiotic will fight it best. This is critical because bacteria can build resistance over time — meaning an antibiotic that worked for you in the past might not work this time. Ensuring you have the right prescription helps clear the infection effectively so you can focus on pain management and prevention.
Whether or not your symptoms are related to an infection, it’s helpful to explore your pelvic floor health. Pain from an infection can often cause muscles to tighten or work inefficiently (pelvic floor dysfunction), so addressing these muscles with exercise is a powerful way to support your recovery.
Take antibiotics as prescribed. If testing confirms an active bacterial infection, a course of antibiotics is the standard treatment. Always finish the full course your doctor prescribed to ensure the infection doesn’t come back. (In some more challenging cases, doctors may recommend that you stay on preventative antibiotics indefinitely.)
Try over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain when you have UTI pain. Phenazopyridine (Azo) is an OTC medication that specifically targets UTI pain by temporarily numbing the bladder and urethra. Even if this improves your symptoms, antibiotics are still needed to treat the root cause of the infection. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are safe to take.
Apply heat therapy. Using a heating pad on your lower back can help soothe the muscular aches and cramping that often accompany a UTI. "I recommend placing heat on the low back rather than directly over the bladder during an active infection," says Dr. Arevalo-Alas. "This offers relief for muscular pain without potentially increasing inflammation in the bladder." (Note: low back pain should also be evaluated by a doctor for possible kidney infection.)
Ask your doctor about vaginal estrogen therapy. For postmenopausal women, topical estrogen can help restore healthy bacteria in the vagina and reduce infection risk.
Try physical therapy and targeted exercises. If your symptoms are related to muscle tightness (or if the pain of UTIs has caused you to tense up), physical therapy exercises can make a big difference. “Learning how to relax your pelvic floor muscles through breathing and stretching exercises can help alleviate the tension that makes it hard to empty your bladder completely — a contributor to UTIs — and soothe infection-related pain,” says Dr. Arevalo-Alas. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.
Bladder retraining. If your infection is gone but you are still running to the bathroom constantly, your bladder may have developed a habit of urgency. "After the infection is cleared, if you still have frequency, we want to retrain the bladder to hold urine for a more normal range of two to five hours," says Dr. Arevalo-Alas. This involves using a bladder diary and relaxation techniques to gradually extend the time between bathroom visits. Note: Do not try to hold your urine during an active infection — your body needs to flush out the bacteria. Read more here about bladder retraining.
Consider supplements. While data is mixed, some people find relief with over-the-counter options. D-mannose, a natural sugar found in fruits, may help prevent bacteria from sticking to the bladder walls. Cranberry products (supplements or juice) may also help stop bacteria from attaching to the bladder lining, though they are most effective for UTIs caused by E. coli. It’s always a good idea to talk to your doctor before starting any supplements.
Physical therapy for pelvic floor tension
You might be surprised to hear that physical therapy is a key treatment for symptoms that feel like a recurrent UTI — especially when test results show no active infection.
“Pelvic floor issues can lead to UTI-like symptoms," says Dr. Arevalo-Alas. Sometimes, this is a response to past infections — your muscles may tighten or "guard" to protect you from pain. But tension can also arise from other factors, such as stress or bathroom habits. Regardless of the cause, this persistent tightness can irritate nerves and the bladder, creating a cycle of urgency, frequency, and discomfort that mimics a UTI even when no infection is present. Pelvic floor physical therapy can help break this cycle.
A pelvic floor physical therapist can evaluate your symptoms to see if muscle tightness is a contributing factor. "If there’s tension in this area, we want to work on relaxation and calming the nervous system rather than strengthening these muscles," says Dr. Arevalo-Alas.
Treatment plans for pelvic floor muscle tension often include:
Relaxation techniques. Learning to release tension from the pelvic floor muscles using diaphragmatic breathing and reverse Kegels exercises (more on this below).
Bladder retraining. If you have developed a habit of going to the bathroom "just in case" or every hour, a physical therapist can use bladder diaries and behavioral strategies to help you comfortably extend the time between bathroom visits back to a normal range.
Manual therapy. A PT can use gentle internal tools or external techniques (like a pelvic floor massage) to help relax muscles and reduce sensitivity.
You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit. Some exercises they may recommend can be found below.
Exercises for pelvic floor tension
Want expert care? Check if you're covered for our free program →- Diaphragmatic breathing
- Seal stretch
- Pigeon pose
- Seated adductor stretch
- Reverse Kegels
Whether you’re recovering from a UTI or dealing with pelvic floor tightness that mimics one, pelvic relaxation is key. "With pain and burning, muscles tend to guard and tighten," says Dr. Arevalo-Alas. "We want to focus on down-training that tension with the above exercises.
The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.
Pelvic floor physical therapy is more than just kegel exercises. Various exercises tailored to your symptoms and needs are key to getting relief. Pelvic floor PT can relieve many different pelvic issues, such as pelvic pain, painful sex, and urinary incontinence.
Members of the Hinge Health pelvic health program experience an average 67% reduction in pelvic pain and 54% reduction in urinary incontinence within the first 12 weeks. Learn more*.
How to prevent a UTI
You can't always prevent a UTI, but these strategies from Hinge Health pelvic floor physical therapists can help.
Urinate after sex (and toy use). You likely know to pee after intercourse, but the rule applies to everything. "If you are introducing anything to your vaginal area — whether it's a partner, a dilator, or a vibrator — it’s a good idea to urinate afterward to flush out potential bacteria," says Dr. Arevalo-Alas.
Sit fully on the toilet seat. Try not to hover. Sit directly on the seat, padding it with toilet paper or a cover if you don’t feel comfortable. This allows your pelvic floor to fully relax so you can empty your bladder completely.
Stay hydrated. Drinking plenty of water helps dilute your urine and ensures you pee frequently enough to flush out bacteria.
Avoid bladder irritants. Caffeine, alcohol, and spicy foods can irritate the bladder lining and amplify symptoms.
Practice good hygiene. Always wipe from front to back to keep fecal bacteria away from the urethra. Consider using a peri bottle or bidet to rinse with water after using the toilet, which can be gentler than wiping alone. Additionally, clean any toys or pelvic floor tools (like wands or dilators) with warm, soapy water or according to manufacturer instructions before and after use. “Avoid using internal tools like dilators if you have an active infection to prevent introducing more bacteria,” says Dr. Arevalo-Alas.
Rethink your bathing routine. While warm baths can help relax tight muscles, showers are often recommended to help prevent bacteria from entering the urethra. When cleaning, use gentle, fragrance-free soap on your vulva and avoid pre-moistened wipes, which can irritate the skin’s natural barrier.
When to see a doctor
UTI symptoms often improve with antibiotics and simple, at-home treatments like OTC medications and pelvic floor exercises. However, prompt management is key to preventing the infection from spreading to the kidneys or blood. It’s smart to see a doctor for every suspected UTI to get a urine culture and ensure you're on the right treatment path. If your symptoms don’t improve as expected — or if infections keep coming back — partnering with your provider on a long-term plan is especially important.
PT tip: Stay active to support your bladder
When you’re navigating pelvic discomfort either from a UTI or pelvic floor dysfunction, it can feel counterintuitive to exercise — but that’s Dr. Arevalo-Alas’s top tip. "When people sit for long periods — whether working at a desk or binge-watching TV — they often forget to go to the bathroom or ignore the urge,” she says. This can lead to holding your urine in for too long, which increases UTI risk. Regularly taking movement snacks throughout the day reminds you to check in with your body and empty your bladder often.
How Hinge Health can help you
If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.
The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.
See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.
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