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Symptoms that mimic a urinary tract infection

Symptoms that mimic a urinary tract infection

An irritated bladder accompanied me and my endometriosis all throughout my 20s, right after I became sexually active. When I experienced symptoms of unrelenting burning and frequent urination for the first time, I headed to the doctor. My urine culture confirmed I had a urinary tract infection — a bacterial infection, usually caused by E.coli that enters the urethra. But as time passed and my sex life continued, my painful symptoms persisted — often without any bacteria in my pee.

My doctors were at a loss for why I would have UTI-like symptoms if it wasn’t an infection. But as it turns out, many women feel like they have persistent UTIs without a positive urine culture, says Dr. Christina E. Lewicky Gaupp, a urogynecology and pelvic reconstructive surgeon at Northwestern Memorial Hospital in Chicago. She explains that there are several other possible conditions that cause UTI-like symptoms, like pelvic floor dysfunction and dehydration.

Thankfully, there are treatments that can help resolve your constant (non-UTI related) bathroom runs. Here are five reasons why you might feel like you have a UTI when you don’t — and what to do to feel better.

Pelvic floor dysfunction

The pelvic floor is a group of muscles that support all the organs inside the pelvis, including the bladder, bowel, and uterus. When those muscles are too tight or they spasm, women can experience a series of symptoms including painful intercourse, problems emptying the bladder, or a frequent, sometimes painful, need to urinate.

Women with a pelvic floor disorder can benefit from physical therapy that relaxes their muscles, but they’re often treated as if they have recurrent UTIs, says Dr. Lewicky Gaupp. “Most physicians are focused on treating the end organ — the bladder,” she explains. That’s not treating the underlying root cause, which tends to be this muscle spasm.”

Avoid kegel exercises if you have a pelvic floor disorder. They can make your spasms even worse, says Dr. Lewicky Gaupp.

Inflammatory conditions

Both endometriosis — a disorder where cells similar to what lines the uterus grow elsewhere — and interstitial cystitis (IC), also known as painful bladder syndrome, are inflammatory conditions that can mimic UTIs. Painful and frequent urination can be a symptom for anyone with endometriosis,* but sometimes symptoms show up because the rogue cells can be found directly in or on the bladder.*

The risk factors and causes of IC aren’t fully understood, but symptoms are often caused by pelvic floor dysfunction itself, explains Dr. Lewicky Gaupp. She says that both conditions can benefit tremendously from pelvic floor therapy.

Can I get a UTI after sex?

The female urethra is not very long, so it’s not uncommon for women to get a UTI after intercourse — 1 in 5 women* will experience a urinary tract infection at least once in their life. While it’s not completely understood why some women are more prone to getting them than others, research shows the vaginal microbiota plays a part in recurrent infections.*

But penetrative sex can also aggravate muscles near the vagina. The nerves in the pelvic floor are interconnected, so if you’re having sex and your pelvic floor is in spasm, it’s going to magnify your symptoms.

“Any insult to the genital-urinary tract — whether it’s endo, a history of UTIs, or intercourse — all of that can beget more muscle spasms,” says Dr. Lewicky Gaupp.

Can dehydration cause a UTI?

When you don’t hydrate, your urine gets concentrated and can aggravate the bladder lining. While it’s good to keep up on your water intake on a daily basis, if you notice that you have bladder or urinary pain because of dehydration — perhaps after a night of drinking or a bout of food poisoning — Dr. Lewicky Gaupp says loading up on water can dilute the urine and relieve some of the irritation.

Even if you’re not dehydrated, alcohol, caffeine, and some foods — like acidic citrus fruits — can exacerbate symptoms in those with a sensitive or overactive bladder.

What to do if you have UTI-like symptoms

If you’re experiencing frequent urination or painful bladder symptoms, go to a doctor to check your urine for an infection first. If that’s not it, know that urinary symptoms are often tied to the pelvic floor or conditions like endometriosis, and a urogynecologist or pelvic floor therapist can offer more specialized help — minus surgery and antibiotics.

“The default for non-specialists tends to be, ‘Oh, it’s an infection every time,’” says Dr. Lewicky Gaupp. “It could be an infection every time, but more often than not, it’s just a flare of that muscle problem.”


  • Ive have horrific, very aggressive reoccurring utis for years even though I do EVERYTHING to prevent them. Once initial symptoms begin, within hours I am peeing bright red blood and can’t get off the toilet due to excruciating pain. Last time it happened I went to the dr and was given a course antibiotics (and handed in a urine sample).. and it cleared up in a few days. HOWEVER when I went and checked the pathology results a week later there was no infection detected!!? How was it sooo terrible if there was no bacteria, or at least not enough to be detectable? Drs can’t give me answers and I’m worried this reoccurring problem will eventually take a toll on my bladder/kidneys etc. Anyone else have this problem? Need help please 🙁

  • Hi – no mention of peri/post menopausal vaginal atrophy. Everything gets grumpy, and I often had the burning undercarriage ‘prior to infection’ feeling, but no infection. An oestrogen based vaginal ring and lots of coconut oil reduced both vaginal atrophy burning AND the amount of UTIs I was getting (age45-55) If only the doctors had thought to mention it!

    • I think I have the same problem. Its horrible it just started 4 weeks ago. I feel like I’ve had 3 UTIs, waiting for my test results on Monday. I have a hormone Deficiency now for 15 years And have gotten hormone replacements. But I’m behind on my treatments I feel like it has something to do with what’s going on. Any suggestions?

    • Oh how so very true this, wonder why it wasn’t mentioned. Glad i have coconut oil then, i have been using for a few weeks now but now ive developed what feels like Thrush but burns about 5 minutes after emptying bladder and burns when havn’t as well , just sitting down is causing discomfort atm moment , im sure i read that gps wont prescribe women thrush treatment if post menopausal is this true i wonder?

      • Do not use anything on ur vagina oils and all that I have pelvi floor disorders so feels like have constant utis and pain with sex also going frequently and the burn n pain to go with it o went to get some pelvic injections cause my walls and inner muscle are tight it helped while I was doing them but know I still have these uti like feelings this sucks and my heart goes out to any woman going thru this but my advice keep moving around try different therapy and pray love ♥❤

        • I constantly tested negative for UTIs and gluten, grains and dairy have turned out to be the major cause. I was told it was IC (Interstitial Cystitis), but if you dig deeper (there is not enough research formally done yet), there are many anecdotal stories about inexplicable bladder pain with no infection and (typically) how quitting gluten, grains and lactose in particular has really resolved totally or partially, the bladder pain.

          You have a mucosal lining in your bladder just as you do in your intestines, throat and everywhere else – it may be inflammation from diet (which may be coming from pesticides, to be determined by more research).

          I hope this helps! My quality of life is way better now.

  • Last night when I went to pee,I experienced a sharp pain while peeing and the urine color’s was red.
    I thought it was my period,I had to put on a pad. But i didn’t see any stain of blood up til now.
    I still experience the pain while peeing,but the pain has reduced a little and the color of the urine is getting brighter.
    I called my doctor,he said it’s dehydration,I should take more fluid.
    But I still think it’s something serious, based on my research. Like kidney stone,UTI etc.
    What do you think? Is my doctor right?

  • I would like to add that genital herpes causes painful urination as well. Very important detail that was missed. Get tested for STDs.

    • Hysterectomy does not cure endometriosis. You need to have the endo lesions excised by an endo specialist. Hormonal birth control will mask the symptoms, but it will still spread. Hysterectomy ONLY cures adenomyosis which can go hand in hand with endo… at which point they would have done a biopsy of the tissue to confirm diagnosis. Excision is the only tried and true method for long term relief.

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