You should all thank Dr. Oz for serving as my muse.

Yesterday I was reading Fit Pregnancy magazine when I came upon Dr. Oz’s monthly article on pregnancy — a physiological state which I’m sure was covered extensively by his training in cardiothoracic surgery.

Anyhow, it was his answer to “why women get more UTI infections during pregnancy” that got me. I cannot post what he wrote verbatim because I threw the magazine away shortly after. His answer was basically: the pregnancy hormone relaxin causes the pelvic floor to loosen (so the baby can slide out!) which allows more bacteria in the body.

As if the pelvic floor creates an impenetrable seal to the body. As if the hormone relaxin affects muscle. As if you know what you’re talking about, Dr. Oz.

P.S. That “baby slide out part” wasn’t my add. It was in the article.

After posting something along these lines as my Facebook status, I got a lot of comments asking about UTIs. So, let me do a little splainin’ of the often-overlooked inner workings of the urinary system.

Setting the rare incidence aside, let’s talk about the more frequently occurring UTI. If you’ve got chronic bladder or UTI infections, this post is for you.

Here is a fabulous drawing of your urinary tract, starting with the kidneys and ending with the bladder.

It’s even more helpful shown from the side (upper image). Wait. Is that a woman or a snowman?

The lower pic in the drawing above is most important though. This image shows how the ureter interfaces with the bladder. Urine moves down from the kidneys, through the ureter, where it empties into the bladder. The urine, before it enters the bladder, is sterile.

Here’s the section called: Alignment has very little to do with Fitness or Sport, and more to do with HEALTH and if you’re helping people with their HEALTH you should learn the mechanics that drive the body’s functions.

Like bones and muscle, organs have their own neutral position. Their function depends on physical forces like gravity and pressure. You change their relationship to the force of gravity, you change their behavior. We don’t think we’re moving our organs around that much, but remember they are housed in the trunk of the body. Using the bladder as an example, when you tuck the pelvis, the organs inside it come with. Your postural preferences can screw with, for example, the fluid dynamics of the UTI system.

At the end of the ureter is a one-way valve that prevents upward flow. This valve, similar to the valves in the veins in your legs, is designed to take a certain amount of pressure from the bladder.

Using my high-tech software to rotate the picture a little,

you can (hopefully) see that now the angle of the ureter-bladder interface has changed, which creates a slight overload to the valve.  Just like the valves in our lower legs fail under excessive pressure over time (the mechanism of varicose veins) the ureter valve can also fail and allow backflow. The movement of urine from the bladder to the ureter (opposite to the biological norm) is called vesicoureteral reflux. Vesicoureteral reflux gets a big thumbs down.

The reflux is problematic if there are any bacteria in the bladder, as moving unsterile urine into the more-sterile area of the ureter can cause an infection. And no, bladder bacteria cannot be reduced by doing super-kegels.

I’d hypothesize that during pregnancy,  the pregnant woman tends to post tilt more than her norm, usually under some instruction to do so, creating an even-less favorable angle and greater pressure on the valve. Add the pressure of the heavier uterus on the bladder and you’ve got a greater quantity of upward urine-streaming, increasing the chance of bacteria spread.

If anyone asked me, I’d say that in conjunction with whatever your Dr. tells you to do for your UTI (hoping and praying you aren’t seeing Dr. Oz), consider this to-do list:

1. Understand and then work on establishing a neutral pelvis to help normalize your organ position.

2. Take a probiotic to help your body maintain the correct flora. I know the bladder is presented as sterile, but as researchers take a closer look, it turns out that this isn’t the case.

3. Consider Mayan Abdominal Massage and reach out to a local practitioner to aid you in organ positioning.

4. Put “A BUTT” on your wish list. And then get one. Why? Read up on uterine ligaments here: (click)

5. Don’t “hold it in” when you have to pee. Bladder fullness can increase valve pressure.

6. Pee before movement classes and watch your valsalva. Bearing down during exercise (especially during core work done in conjunction with pelvic floor contraction) can also send an upward stream into the ureter. Imagine that much pressure on the bladder while keeping it closed! High-pressure habits can damage the valve over time.

7.  Squatting, yo. You want the bladder to drain completely and research shows the squatting position offers the most complete void.

Now can I please have my own TV show, magazine column and a million dollars?

(And, I figure that Dr. Oz didn’t even write that article. I’m sure he has a staff of health writers do it. But if you’re going to put your name on it, I’ve got to tag you, sir.)

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25 thoughts on “UTIs

  1. Thanks Katy, important stuff.
    Sterile urine is an oxymoron IMO. If you have ever had a bladder infection or UTI and looked into the cup at the docs office after they requested your “sample”, or peed into a clear cup and looked at it with backlighting @ home, you will see all kinds of flotsam in there. That be bacteria folks. Might I also add that a good long pee after sex helps clear out the bacteria that get pushed around during all the fun (meaning: drink lots of water). Having suffered repeated bladder infections as a result of fun times and un-fun times, I can attest to the pelvic neutrality as being critical (during fun times and the un-fun times)…in addition to the above hydration and probiotic recomendations. I think I need to go visit the ladies room now. :o)

  2. Thanks for the explanation! For your sanity’s sake, I hope this is the only entry you have to make in the “dr oz foolery” category. 😉

  3. But this would more so explain an infection in the ureters or kidney, than the bladder, wouldn’t it? What about women (eg me) who have had say 40+ UTIs? My osteopath (she’s taking your course) was saying something along the lines of the bladder being lower than the urethra because of my alignment / posture can’t remember? So old pee doesn’t all come out, just sits there and festers and then I get a bladder infection (but haven’t gotten one any farther up the UT). Would that be correct?

    1. Yes! There are actually more things going on that I didn’t have time to add, but bladder emptying is also position related and plays a specific role in bladder-only infections! Squatting to pee is a great help 🙂

      1. Erica’s question/comment helps answer my curiosity, too, as I am always thinking about UTIs as more frequently occurring in the lower tract — urethra/bladder. I was wondering if there was a similar mechanism at play — thanks Erica’s osteopath and KB. (Totally time for me to sign up for the WBA course!! Bladder alignment?? Heaven!!)

        These seem like important suggestions for preventing UTIs, but also for clearing them up more quickly.

        UTIs are another FANTASTIC reason for me to talk about pelvic alignment with my mamas. Thank you!

    2. Erica–I’m not sure if this is helpful or not, but I got diagnosed with a ton of UTIs and saw about 8 different doctors before finding out that I wasn’t having UTIs at all, but instead was having pelvic floor muscle pain that feels just like UTIs. They were never culturing my urine–instead it just turned up positive on the dip stick. When I finally got to a doctor which used a catheter and cultured it, it turned out I wasn’t getting UTIs I’m assuming you know for sure if you are getting UTIs–but just in case, make sure they are taking the urine sample with a catheter and actually culturing it. Anyway, if they are already do that, then please disregard this.

  4. the picture i see is that her pelvis is ant. tilted, due to the weight placement and the baby is headbutting the bladder ,which could, indeed rotate? the bladder and kink the ureter valve

  5. You know that if it was up to me I would certainly give you your own TV show, as well as a regular column in The Reader’s Digest. Appropriate compensation would follow.

  6. Feeling über concerned about my “retroverted” uterus now …. Especially since I’ve been flattened and in bed for 2 months with hyperemisis. It all makes such sense when you explain it. Looking forward to when I can start getting back on track. Thank you thank you.

  7. This is my very favorite line: “Dr. Oz’s monthly article on pregnancy — a physiological state which I’m sure was covered extensively by his training in cardiothoracic surgery.”

    Great post!

  8. What about males who are unable to fully remove all of the contents of their bladder in one sitting? Is squatting the answer? Less pelvic floor lifting and more neutral pelvis? Thanks.

    1. Read the hypertonic pelvic floor articles (or forward them to those that might be interested) and yes, squatting helps as does everything else recommended on this site for hypertonic PFs!

  9. I knew this post would come out soon since I saw your fb post. You are a rock star Katy! I’d give you your own talk show!

  10. I follow you on Twitter, and for some weird reason, I had chosen to follow Dr. Oz. There is sooooo much misinformation out there. Thanks to you, my knees no longer hurt, and I am finding I love to squat! Wow, who would have thought… certainly not all the doctors/chiropractors I went to! I am a Katy groupie too

  11. Hi Katy,
    Thanks, I always end up with a smile on my face when I read your blogs. Great information on bladder alignment! This also made me think about why older people (ladies especially) seem to get bladder/UTI infections – increased sitting, often gradually poorer alignment etc.
    I know from experience (my 88 year old mum) that low level bladder infections can often result in mis-diagnosed dementia (once the infections were brought under control, she was as bright as a button). The carers at the home where she now lives often tell the ladies to sit down as they may fall, when I think they should always be encouraging them to move and stand tall….but perhaps I digress…

  12. Thanks, nice article and love the wording of it. Good reminder of another reason to find the neutral pelvis on top of finding out recently that keeping my pelvis in neutral when lying down helps relieve itchyness down there.

  13. My daughter was born with stage 4 vesicouretal reflux or bilateral reflux as they called it. Her ureters were just genetically way larger than normal and thus her valve system was screwed up. We didn’t find it, though, until she was 6 months old and “failing to thrive.” A blood test revealed pseudohypoaldosteronism due to the massive reflux she was experiencing, thus she had no appetite. I’m still amazed that I managed to keep nursing her for 27 months. At 11 months old, she had a renal scan that revealed a half-dead right kidney. I cried so hard. We held further infections at bay with 2 1/2 years of antibiotics, stronger and stronger ones that she kept building immunity to. Whenever I missed a dose, she ALWAYS got a kidney infection. Talk about pressure. When she was finally dry through the night, she went off antibiotics, but when she was 4 1/2 she got another massive infection, and finally had surgery to splice and re-insert her ureters into both her bladder and kidneys. At the time of surgery, she was a stage 3 on her left side and a stage 4 on her right. Last year, she was officially released as a urological patient, and she’s a healthy 7 yo girl now. I harp on her all the time about drinking water, and now I’ve got even more reason to watch her alignment and keep her from sitting too much. This article raises some dark memories for me, but I can see the truth of it. They said it was genetic, and she was never a “bucket baby” so I wonder… She came out of me and immediately unfolded herself. She never wanted to be “knees to chest” and was so happy to stand up and look around. She cried so hard whenever I put her in her carseat… Poor baby…

  14. GREAT post! The section that begins, ” Alignment has very little to do with fitness or sport…”, was awesome. When they dig up our civilization, your “cave drawings” will be hung in museums and lauded. I am struck by the quality of mirth-inducing info in your writing. And the replies and comments you receive! I will definitely use vesicoureteral/bilateral reflux, bladder/organ position and UTI in my classes to show how alignment affects, well, just about everything. Thanks.

  15. pretty cool stuff! also, i love the illustrations 🙂

    not forgetting, of course, the major role that sugar plays, and refined carbs, and lack of good quality probiotics. (not the stuff you buy at wholefoods: that’s the cubscouts. you need the marines. VSL#3, or pharmax are my favorites)

    so fix your pelvis! drink your cranberry juice (UNsweetened!). stop eating sugar and carbs! and get yourself some good probiotics! and live UTI free 🙂

  16. There’s another big cultural contributor to UTIs: toilet paper. The fact is that most UTIs are caused by e. Coli traveling from your bum to your urethra (hence the whole “wipe front to back” advice). I used to get UTIs every two or three months for years, ever since I was 16. I always wiped front and back separately, tried to drink lots of water, etc., but I still got them.

    Then I spent over two months in an Arab country, and got used to using water to clean myself after bowel movements instead of TP. (All the toilets there have a little sprayer on the side, like a diaper sprayer.) We have one on our home toilet as well, and now that I’m consistent about using it I haven’t had a UTI in almost two years.

    So it seems to me very simple: wiping with TP leaves behind a lot of bacteria, the bacteria travels up to your urethra while you’re moving around, and, boom, you’ve got a UTI.

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