Magazine 29 November 2022

Cystitis and pelvic floor: let’s get clarity


Cystitis after intercourse is more common than you might think.
Yet little is still said about one of the main causes: a pelvic floor dysfunction.

That is why today we want to clarify once and for all the correlation between cystitis and pelvic floor. We will do this in a special way, enlisting the help of a professional in the field-Dr. Francesco Callipo, a physical therapist specializing in pelvic floor rehabilitation.

Let’s get started!

Postcoital cystitis: what does it have to do with the pelvic floor?

Most women who suffer from post-coital cystitis do not know what it is and/or what role the pelvic floor may play.
“No one has ever told me about pelvic floor” is the response we receive most from people who write to us to find a solution.

Today we want to shed some light and rely on Dr. Callipo to pass you the correct information about the role of the pelvic floor and the link it can have with cystitis.

So many women contact us every day about the same problem: cystitis after intercourse. This is a widespread phenomenon that leads many women to be afraid of intimate moments or, worse, to abstain from relationships. What is the link between post-coital cystitis and the pelvic floor?

Ah, here I attack one of my theoretical but simple-to-understand pippos.
One of the most glaring examples to understand that we are dealing with pelvic floor dysfunction are recurrent infections.
This point concerns women more, and I am quite certain that the most used, and dare I say abused, term is cystitis.
Now, let me be clear, this is not to say that the term cystitis is misused, however, it is not always so clear cut.
Without going into the specifics of terminology, with the term cystitis most people commonly associate that whole range of conditions for which, “I go pee a lot, I can’t always empty well, I get burning during or after peeing, I have spontaneous pain or burning at the perineal level,” and other similar things.
To best summarize a picture that may be useful to you, let’s start with the concept that cystitis can be divided simplistically into two categories: bacterial and abacterial.

When cystitis is bacterial, this is confirmed by the positivity of a laboratory investigation (be it, for example, a urinoculture or a positive swab): but how do these bacteria get into our vagina or bladder? Simple, always considering the general terms of this explanation, which can never be so specific as to encompass everything and replace the quality that an evaluation with a* specialized professional can give in terms of framing symptoms, unless there has been sexual transmission, there tends to be a tendency for these bacteria to come from a poorly working gut.
Now, imagine the gut as an endless expanse covered with billions of bacteria representing the very famous bacterial flora. When a gut is working poorly, this defense army that also helps us absorb nutrients and in so many other things at the metabolic level, begins to alter, promoting the reduction of that part of the bacteria that is favorable to us and predisposing the proliferation of those bad bacteria, which depending on their taste begin to migrate to other tissues of the body, even ending up in the vagina or bladder. We have bacterial infection and cystitis here.

What then is the abacterial one? An abacterial cystitis is that condition whereby “I pee a lot, it stings,” and all that we said before, the cause is not the presence of an infection, but a dysfunction of the pelvic floor that in its distressed state participates in making one feel a range of symptoms virtually superimposed on those of a bacterial cystitis.

Are there any symptoms/signs, beyond post-coital cystitis, that a woman can pay attention to in order to hypothesize the presence of pelvic floor dysfunction?

Of course we do, and we repeat them continuously through our online and social outreach, @ilovepelvicfloor on IG if you don’t follow yet.
As long as there is still at least one woman in the fog of confusion that often traps and does not make one find the right path of resolution.

To summarize: altered urinary frequency (about every 2-3h) and fecal frequency (from twice a day, to twice a week), difficulty in bladder and/or fecal emptying, difficulty in voluntarily holding pee and poop, pain during intercourse, pelvic pain (often present during menstruation).
These are the main bells and whist encountered in one’s path suggest a specialized evaluation.

How does it take place and how long does the average pelvic floor rehabilitation course last?

A rehabilitation course first involves an evaluation, which must occupy at least 90 minutes to have a qualitative basis.
The course, as you can well imagine, is subjective: it depends on the condition, the compliance (the ability to adapt and respond to therapeutic indications) of the patient, and the physiological response of tissues and organs to the treatment.
Just as for S. it took only one monthly appointment for 5 months to resume trouble-free penetrative activity, so for G. it took 8 appointments within 3 to regain the ability to contain the pee that he was losing at school during his professional activity.

The variability of these treatments is also related to the characteristics of the practitioner: an example is in the management of chronic pelvic pain, for which the properly trained practitioner also has the opportunity to define the basis of a PNE (Pain Neuroscience Education) to define together with the patient the basis of a behavioral strategy aimed at managing pain processing at the level of the Central Nervous System.

In the end, it is not as important how long a rehabilitation course is, but how much more specialized the referring professional is, so that a treatment is more effective, integrated and multisystemic.
I’ll stop with the big words, but you get the idea, right?

How can one avoid going back once pelvic floor rehabilitation is completed?

Dry answer: the ‘efficacy of a rehabilitative course is measured by the level of awareness one accrues about one’s pelvic floor, one’s body, and the lifestyle to be defined in order for these to be in the best state of health.
If you choose the right professional, and work well along the way, the results will persist.


We thank Dr. Callipo for his time and valuable contribution.
Dr. Francesco Callipo receives in Salerno and Battipaglia. Follow his Instagram profile for more insights (@ilovepelvicfloor).

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