Thankfully I've only had one UTI, and that was during a bout of TM...probably due to the cath.

The urologist explained it this way.
He said that when the bladder doesn't empty completely, sometimes portions of the bladder wall get over stretched and that can cause the "cement" that holds the cells together to break down in those areas.
If there are bacteria, viruses or fungus present, the created space between the cells allows those pathogens to get in there and hide out. Then when the bladder does empty, those spaces close over, trapping the pathogens; where they escape the natural disinfecting nature of the urine, as well as antibiotics/antifungals.

When the bladder then gets over stretched again, the pathogens are released and are able to cause infection and/or re-infect other areas of the bladder wall that are over stretched.

My UTI did not respond to oral meds, so the urologist did an infusion of the bladder to stretch it and expose the bacteria/fungus to the medication. I think that he used a mixture of an anti-fungal, steroids and ABs. He then left the installed cath in place, which remained for 2 weeks, to ensure that the bladder emptied and the bladder wall didn't get over stretched during the healing process. That allowed the cells of the wall to heal over.

The procedure did come with a warning that if the bladder wall cells didn't heal over, that it could predispose it to more infection, because the procedure itself caused an overstretch of the bladder wall. Luckily, that didn't happen.

For after care, he said that it was important to empty the bladder completely and suggested what Sally does...to press down on the area above the pubic bone while leaning forward to ensure complete emptying.
He also said that if urinary retention remained a problem, that using a cath might be a good idea to ensure emptying and prevent infection, but he said that the cath itself increased the risk of introducing bacteria.

In the end, he felt that if I could strengthen the abdominal wall and pelvic floor, that in itself would support the bladder from the tissues outside of it to prevent over distension.
He added that, because I hadn't stretched those structures through pregnancy, that it was likely to be more successful...so I don't know if it is as successful for those who have had children.

The urologist then gave me some exercises to increase the strength of the lower abdominal wall and the pelvic floor. These are just sustained contractions that are done while sitting and leaning forward, to the side and back; with the hips flexed up wards (sort of like a reverse sit-up), first with one hip at a time, then with both together.

He said that it was equally important to drink plenty of fluids to keep the bladder flushed; despite possible incontinence or difficulty with voiding due to the neurological issues.
I do drink a lot of fluid and do the exercises regularly while at the computer or while sitting pre-meditation and haven't had any problems with infections since.

For those who get chronic UTIs, you might inquire about getting an infusion treatment to clear the bladder wall of possibly trapped bacteria/fungus. My treatment took around an hour and wasn't uncomfortable to have done. Sort of like a prolonged PAP for the ladies...don't know how it goes for the men though, because it does involve a cath.

With love, Erika