Questions posted in the The Urology Forum have been answered by urologists from Henry Ford Health System and by Dr. Kevin Pho.

Question Title: Painful/Non-burning Urination

Forum: The Urology Forum
Topic: Bladder Cancer

The last few days or so I've been have this pain right when I start urinating. It doesn't burn. It's more like cramping kind of. The pain is usually on the right side just above the pelvic bone and when I finish it goes all the way across. The pain lasts anywhere from 1/2 hr. to 3 hours and then goes away until I void again. My urine is normal color and I have noticed a more than normal amount of discharge (yellow) lately. I wouldn't really say I have the urge to go, but when I do and I get there - the trip was hardly worth it (very small amount considering I'm drinking something all throughout the day). I've been w/ the same partner for 7 years and we have a 16mo old son. I'm currently taking birth control pills and 20 mg. Paxil daily (Paxil for only 2 wks.). I've never had this problem before.

Questions:

What could it be?
Is this something I should worry about?

Any help would be greatly appreciated.
Thank You --- Lisa

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Dear Lisa,

The condition you describe is called dysuria which means pain with urination. Most often, patients with condition have an infectious or inflammatory cause for the apin. The most common cause is urinary tract infection. Other possibilities include interstitial cystitis which is a painful bladder condition, and infections of the glands surrounding the urethra. The first step you must take is to have your urine tested for bacteria and infection. If no evidence of infection is found, you may need to be evaluated by a urologist for interstitial cystitis.
Interstitial cystitis is a disorder that affects approximately 43,500 women in the United States. It is characterized by pain, frequent voiding , burning and urgency in the absence of any evidence of infection.. Treatment is largely directed at alleviation of symptoms. Many drugs have been evaluated in the treatment of IC. Recent attention has been given to Sodium pentosanpolysulfate ( Elmiron), tricyclic antidepressants such as amitriptyline, and bladder instillation with various agents such as DMSO and BCG. DMSO has been utilized since it was first popularized in the 1960’s. It has a success rate of about 60 to 80 % . In your case, since you are taking an anti-depressant currently, it may be worthwhile to switch to a tricyclic medication to treat both conditions concurrently. However , the relapse rate is high. Many patients get better for a short duration of time and then require further treatment. In your case, it would be advisable to explore all of your options with a physician that specializes in this condition.
Evaluation by a urologist that specializes in interstitial cystitis is worthwhile as they have access to various experimental protocols not available to the average urologist. It is very common for patients with IC t o average 4 physicians before the diagnosis is correctly made. To contact a physician in your area call the Interstitial Cystitis Association ( ICA) (212) 979-6057. This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568)

HFHS MD-KR
*keyword: interstitial cystitis
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