What Causes Bladder Pain Without Infection? A Pelvic PT Explains
Introduction
Bladder pain is frustrating. It can be difficult to talk about and the first (and only) answer is usually: you must have a urinary tract infection (UTI).
I am here to tell you that bladder pain does not always mean there is a UTI. Tension in muscles, nerve irritation, and various bladder conditions can contribute to bladder pain without an active infection.
This blog will go over what causes bladder pain without an infection, ways to improve bladder pain, and when and where to seek help.
What Does Bladder Pain Without Infection Feel Like?
Urinary urgency - needing to find a bathroom soon after feeling a need to pee
Urinary frequency - going more than once every 2 hours
Vaginal burning and/or itching
Burning present with urination
Lower abdominal pain, especially with a full bladder
Pain while peeing
Pain with sitting, standing, or movement in the bladder or lower abdomen
Pelvic pressure or noticeable bladder pressure
Common Causes of Bladder Pain Without Infection
Pelvic Floor Muscle Dysfunction
Pelvic floor muscles have a lot of jobs to do and their ability to fully contract and fully relax is crucial. Muscle tension is a common problem and can lead to poor pelvic floor mobility. Major life events like pregnancy/postpartum, surgery, injuries, or general stress can all prevent your pelvic floor from moving easily as it did before. This tension can lead to pressure and irritation of the surrounding nerves, giving the feeling of bladder pain that is often mistaken for a UTI.
We are often helping women learn to relax their pelvic floor muscles and take pressure and tension off those irritated nerves. This helps with pain, but also improves bladder emptying to give you more time before needing another bathroom break.
Decreased Estrogen
In females, the vulvar tissue can be irritable if estrogen is low in the tissue. This is commonly present during postpartum (especially with lactating mothers) and around perimenopause. A lack of estrogen can cause frequent UTIs, vaginal itching, and a feeling of dryness or irritability. Topical vaginal estrogen is a prescription that can alleviate these symptoms.
Talk with a medical provider to see if vaginal estrogen is right for your specific concerns.
Interstitial Cystitis / Bladder Pain Syndrome (IC/BPS)
IC/BPS is typically diagnosed if bladder pain is present longer than 6 weeks and urine cultures come back negative. Some hallmarks of interstitial cystitis are pain when your bladder is filling or almost full, urinary urgency, and urinary frequency.
These symptoms can be similar and can have an underlying involvement of pelvic floor dysfunction, so it is important to work with your physical therapist and other healthcare providers to determine the correct diagnosis and treatment.
Pudendal Nerve Irritation
Pudendal nerve irritation comes with fewer urinary symptoms, but notable pain. Pain can be present in the vulvar or labial tissue, is usually worse with sitting, and can go into the buttock as well. It is typically described as a sharp, shooting pain into the pelvis and bladder. As with the other conditions, urine cultures will come back negative for infection.
Pudendal nerve irritation is very uncomfortable and a full pelvic exam is crucial to targeting the right tissues. There are many manual techniques and exercises to improve tension and increase blood flow to the pudendal nerve.
Endometriosis
Endometriosis can be one of the more difficult conditions to manage in the healthcare system. It results in pain and lower abdominal bloating that is cyclical in nature around the menstrual cycle. Pain is also present with sex, especially deeper penetration.
Good endometriosis care is out there, but can be difficult to find on your own. Let Revive Rehab help manage your symptoms and work with you to find the right specialists near Columbia for the best care.
Scar Tissue After Surgery
Scar tissue is present after any abdominal surgery and can cause muscle and nerve irritation, referring pain to the bladder, even if it wasn’t involved in the surgery.
Some common abdominal surgeries we see:
C-section
Endometrisosis excision
Prolapse surgery
Surgery around or on the bladder
Hernia repair
Chronic Inflammation or Sensitive Nervous System
One of the most commonly overlooked reasons for unexplained bladder pain is chronic inflammation leading to sensitive nerves around the bladder area. Although we don’t have a specific test, there are many total body symptoms that can point to this cause.
We often see bladder pain begin during a stressful time of life or see pain that increases with stress. Just like a headache, sometimes bladder pain can happen when your body is overwhelmed, especially if you have had bladder pain (for any reason) before.
If you notice that sleeping poorly worsens your pain, or if certain foods or drinks seem to trigger pain then you may be suffering from a sensitive nervous system related to inflammation.
Finally, sensitivity can develop in and around your bladder following an infection. If you have had a UTI that is now resolved but continue to have pain, one reason may be a lasting sensitivity of your nervous system.
Chronic or lasting symptoms are more common than you may think and the team at Revive Rehab has years of experience dealing with even the most complicated or unusual symptoms.
Why Are My Urine Tests Coming Back Negative?
If your urine test comes back negative when checking for a UTI, that only rules out a bacterial component to the pain. This does not mean the pain is all in your head, but leads us to believe that one of the other possibilities we talked about above may be contributing to your bladder pain. Bladder pain is not always an infection, so antibiotics aren’t always necessary.
In the clinic, we are able to answer what causes bladder pain without infection by doing a thorough assessment. If you think your bladder pain may be more than just a UTI, let our team talk with you and assess all the possible causes.
How Pelvic Floor Physical Therapy Can Help
You should consider seeing a pelvic floor physical therapist if your bladder pain persists without an active infection. Common symptoms that indicate you may need pelvic floor PT include:
Bladder pain lasting longer than 6 weeks
Pain with sex
Low back pain or hip pain with your bladder irritation
You also struggle with urinary leakage, urgency, or frequency
You stopped exercising because of symptoms
Symptoms return every time you try to be active
You want to prevent long-term bladder issues before it becomes chronic
A pelvic PT can assess:
Bladder mobility
Scar tissue mobility
Low back and hip strength and flexibility
Pelvic floor muscle mobility and sensitivity
Breathing mechanics
Core strength and coordination
Nervous system sensitivity
Daily bladder habits
Treatment may include:
Scar tissue mobility with cupping and/or dry needling
Pelvic floor myofascial work
Pelvic floor relaxation exercises
Bladder mobilizations
Bladder retraining
Deep core strengthening exercises
Nerve mobilizations
Hip mobility and strengthening exercises
Nervous system regulation
If you’re wondering “what causes bladder pain without infection” and can it be resolved? You are definitely not alone.
Pelvic floor physical therapy can help you get back to the things you love without bladder pain stopping you.
Revive Rehab in Columbia, Missouri, is a pelvic health practice that specializes in bladder and pelvic pain.
If you are in the Columbia, Jefferson City, Fulton, Boonville, or mid-Missouri area, we’d love to work with you! Click here to learn more about our in-person services.
We offer hour-long, one-on-one, individualized appointments with a physical therapist to get to the root cause of your concerns. We provide a holistic approach for your care. Click the link below if you’d like to book an appointment with us, we’d love to help support you!
