Pelvic organ prolapse (POP) and urinary tract infections (UTIs) are both common conditions, frequently affecting women throughout their lives. Roughly 14% of women will require surgical intervention for POP, and about 40% of women will experience a UTI at some point. Understanding how these two conditions might be linked is important for those who experience symptoms of either or both. Pelvic organ prolapse can indeed increase the risk of developing a UTI by altering the normal function of the bladder.
The Confirmed Relationship Between Prolapse and Infection Risk
Pelvic organ prolapse occurs when weakened pelvic floor muscles and connective tissues cause organs, such as the bladder, to shift out of place and bulge into the vagina. The form of POP most directly impacting the urinary tract is a cystocele, or bladder prolapse. A cystocele happens when the wall separating the bladder and vagina weakens, allowing the bladder to sag into the vaginal canal. This anatomical change elevates the risk of UTIs.
The physical displacement of the bladder interferes with its ability to fully empty. This incomplete voiding creates an environment where bacteria can thrive, leading to recurrent infections. Studies identify a cystocele as a specific risk factor for recurrent UTIs, especially in postmenopausal women. Restoring the pelvic anatomy is often a goal in reducing this persistent infection risk.
How Prolapse Leads to Urine Stasis
Incomplete bladder emptying, known as urinary retention or urine stasis, is the core link between prolapse and UTIs. When a cystocele forms, the dropped bladder portion can create a pocket or a bend in the urethra. This structural alteration prevents the complete release of urine during voiding. The urine remaining in the bladder after urination is called post-void residual (PVR).
Residual urine is problematic because it provides a warm, nutrient-rich environment for bacteria to multiply. Stasis allows bacteria like E. coli to colonize the bladder lining, whereas regular flushing normally removes potential pathogens. Elevated PVR levels, often defined as over 30 mL, are recognized as an independent risk factor for UTIs. Managing the prolapse to ensure better bladder drainage is essential for infection prevention.
Identifying UTI Symptoms When Prolapse is Present
A classic UTI typically causes acute symptoms such as a burning sensation during urination (dysuria), increased urinary frequency, and a strong, sudden urge to urinate. Other signs include cloudy or foul-smelling urine, and sometimes fever or back pain. However, identifying a UTI is challenging when prolapse is present because some symptoms overlap.
Prolapse itself causes pelvic pressure, incomplete bladder emptying, and frequent urination, mimicking UTI symptoms. This overlap can result in a “phantom UTI,” where the individual feels burning and urgency due to pelvic floor dysfunction or irritation, but no bacterial infection is present. Therefore, any change in symptoms, such as the sudden onset of pain or fever, must be confirmed with a urine culture for proper diagnosis and treatment.
Strategies for Reducing UTI Risk
A key strategy for reducing infection risk is ensuring the bladder is as empty as possible during each bathroom visit. Double voiding is highly recommended; this involves urinating normally, waiting 20 to 30 seconds, and then attempting to urinate again. Leaning slightly forward at the waist while sitting can also help optimize the bladder’s position for a complete void. It is important to avoid straining, as this puts excess pressure on the pelvic floor and can worsen the prolapse.
Proper fluid intake and hygiene practices also aid prevention. Drinking two to three liters of water daily helps flush the urinary tract and dilute bacteria concentration. Hygiene steps include wiping from front to back and voiding immediately after sexual activity to wash out bacteria. For postmenopausal individuals, topical vaginal estrogen therapy can improve tissue health around the urethra, making them more resistant to infection.
For long-term risk reduction, medical interventions that manage the prolapse are often considered. Non-surgical options include pelvic floor muscle training and the use of a vaginal pessary, which is a device inserted to physically support the dropped organs and restore normal anatomy. If these conservative measures are not effective, surgical repair to permanently restore the pelvic anatomy may be necessary to address the root cause of the incomplete bladder emptying and the associated recurrent UTIs.