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I was treated for a urinary tract infection, so why am I having symptoms again?
Some people continue to experience bladder pain or a frequent urge to urinate even after taking antibiotics.
In some cases, patients are initially treated for bacterial cystitis, but subsequent urine tests show no bacteria.
However, the symptoms persist.
- My bladder feels heavy and sore.
- I feel a stinging or burning sensation in my urethra.
- Even after I go to the bathroom, I still feel the urge to go again.
- Even after receiving treatment for pelvic floor muscle issues, the discomfort keeps coming back.
- On days when constipation or abdominal bloating is severe, bladder symptoms also worsen.
At this point , it isimportant to determine whether the symptoms are a recurrence of bacterial cystitis or whether the bladder pain and frequent urination are due to causes other than infection.
This is because similar symptoms can also occur in conditions such as bladder pain syndrome, pelvic floor dysfunction, and problems with the nerves surrounding the urethra.
And there is something else we need to check during this process.
Specifically, bowel movements and stool consistency.
How are the intestines, bladder, and pelvic floor muscles connected?
Inside the pelvis, the bladder, rectum, and reproductive organs are located close to one another.
The pelvic floor muscles located beneath it support the pelvic organs and play a role in urinary and bowel functions.
Because of these structural and functional relationships, the condition of the intestines and bladder symptoms may influence one another.
In particular, if you suffer from severe abdominal bloating and constipation, you should check to see if your bladder symptoms change when you experience intestinal discomfort.
If your bladder expands, could you feel the urge to urinate more quickly?
The original video presents a study conducted in 2011 that involved 30 women, in which their bladders were distended to observe changes in bladder sensation.
The results shown in the video are as follows.
| Observation Items | Changes During Uterine Expansion |
|---|---|
| Bladder volume at the first urge to urinate | A decrease of approximately 46% |
| Bladder volume at which a strong urge to urinate is felt | A decrease of about 33% |
| Maximum bladder capacity | A decrease of about 26% |
※ The figures above are based on the information provided in the video script; further verification is required to confirm that they match the exact bibliographic information and full text of the paper.
This study suggests that the expansion of the uterus may affect bladder sensation.
However, gas caused by experimentally expanding the rectum is not the same as gas or constipation that occurs in daily life.
Therefore, one should not conclude that constipation directly causes cystitis or that intestinal bloating is the cause of all frequent urination.
The important thing to note is that for people with persistent bladder symptoms, it’s also worth checking the condition of their intestines.
How do constipation and straining during bowel movements affect the pelvic floor muscles?
If you have severe constipation, you’ll end up sitting on the toilet for a long time and straining.
At this point, as intra-abdominal pressure increases, it can also place strain on the pelvic floor muscles.
The pelvic floor muscles support the pelvic organs, such as the bladder and rectum, and are involved in the contraction and relaxation necessary for urination and bowel movements.
Repeated straining may be associated with pelvic floor dysfunction in some patients.
The original video presents a study that followed 3,729 women for approximately 10 years and explains that women with constipation had a higher risk of developing certain lower urinary tract symptoms.
According to the video, the association was approximately 1.94-fold for urinary urgency and approximately 1.78-fold for difficulty initiating urination.
However, while these observational studies demonstrate an association between constipation and urinary symptoms, they do not prove that constipation is the direct cause.
Why Discomfort Returns Even After Pelvic Floor Muscle Treatment
Patients with excessively tense pelvic floor muscles may require treatment to promote relaxation and restore function.
However, if other factors that strain the pelvic floor muscles persist, additional care may be needed in addition to muscle therapy.
For example, this refers to situations where the following occurs repeatedly, even while undergoing treatment for pelvic floor relaxation.
- I haven’t had a bowel movement for several days.
- I strain for a long time in the bathroom.
- I experience severe abdominal bloating after meals.
- When I have an upset stomach, my bladder pain also gets worse.
- Pelvic pain varies depending on stress or tension.
In such cases, it is advisable to assess not only the condition of the pelvic floor muscles themselves but also bowel habits and gastrointestinal symptoms.
What aspects are checked during a medical examination?
If you experience recurring bladder pain and pelvic floor discomfort, the following questions may be helpful.
First, determine when your bladder symptoms worsen. Note whether the pain is worse when your bladder is full or after urination, and whether frequent urination and a sensation of incomplete emptying occur together.
Second, check bowel habits. Note the frequency of constipation, the consistency of stools, the amount of straining during bowel movements, and the amount of time spent on the toilet.
Third, we assess abdominal bloating and digestive function. We check whether you experience gas after eating certain foods and whether your bladder symptoms change on days when you have severe abdominal bloating.
Fourth, we assess the function of the pelvic floor muscles. Based on the patient’s current condition—such as excessive muscle tension, pain, or difficulty relaxing—we determine the appropriate evaluation and treatment plan.
This assessment process describes a clinical approach that may be considered when bladder and pelvic symptoms recur, rather than focusing on the treatment outcomes for a specific patient.
Why We Examine the Intestines Along with the Bladder and Pelvic Floor Muscles
At Dugeun Dugeun Korean Medicine Clinic, we consider an approach that evaluates both the intestines and the pelvic floor muscles depending on the condition of patients with persistent bladder symptoms.
1. Traditional Korean Medical Assessment of Gastrointestinal Condition and Gallstone Accumulation
If you experience recurring abdominal bloating, indigestion, gas, or constipation, you may want to review your eating and bowel habits and undergo a traditional Korean medical diagnosis.
In traditional Korean medicine, the concept of “damjeok” is sometimes used to explain these digestive symptoms.
However, “damjeok” is not a modern medical diagnosis that refers to the actual accumulation of waste products in the intestinal mucosa.
Therefore, rather than explaining that cystitis is cured by removing intestinal waste, it should be addressed through a traditional Korean medical approach that manages both digestive symptoms and bowel habits.
2. Assessing the Tension and Function of the Pelvic Floor Muscles
If the pelvic floor muscles are overly tense, exercises to strengthen them are not always appropriate.
Depending on the symptoms, relaxation and functional control may be prioritized, and, if necessary, a specialized pelvic floor evaluation and physical therapy may be considered.
3. Access to the tissues surrounding the abdomen and pelvis and to the lymphatic system
The lymphatic system is involved in the movement of body fluids and immune function.
In traditional Korean medicine, practitioners assess tissue tension and discomfort in the abdomen and pelvic area based on the individual’s condition and determine whether to apply manual therapy or herbal acupuncture.
However, there is not yet sufficient clinical evidence to support the claim that this treatment improves lymphatic circulation to cure cystitis or restore pelvic floor muscle function.
Therefore, treatment options should be chosen carefully, taking into account the symptoms and the results of the physical examination.
4. Bowel Habits and Lifestyle Management
If you experience recurring constipation, we’ll take a comprehensive look at your bowel movement frequency, stool consistency, diet, fluid intake, and physical activity levels.
If you have a habit of straining excessively for long periods of time while using the restroom, it’s important to try to control this.
In particular, people with bladder pain syndrome or pelvic floor hypertonicity should identify management methods tailored to their symptoms rather than simply holding their urine for long periods or repeatedly doing Kegel exercises.
If you think you might be experiencing recurrent cystitis, start by distinguishing between these conditions
Just because you have bladder pain and feel the need to urinate frequently doesn’t mean the cause is always the same.
If it is a bacterial cystitis, proper evaluation and treatment of the infection are important.
Conversely, if pain persists for a long time even though a urine test does not reveal an infection, it is necessary to investigate other possible causes, such as bladder pain syndrome or pelvic floor dysfunction.
In particular, if you experience both constipation and abdominal bloating, check your bowel movements and bowel health.
If you are only treating your bladder but the discomfort persists, you should also have the muscles around your bladder and the condition of your intestines examined.
If you’ve been experiencing discomfort from bladder pain and frequent urination for a long time, please take the time to carefully review your current symptoms and any contributing factors,
and determine the appropriate course of treatment. I’ll be happy to help.
