abdominal pain at night after voiding

My mother is an 80-year old with severe osteoarthritis and spinal stenosis.  Until recently she played golf twice weekly even with the back pain.  She suffered a fall approximately six weeks' ago and fractured two vertebrae.  She underwent a vertebroplasty on one of the vertebrae.  I mention this as background for consideration of a problem that remains undiagnosed.

She has always had to get up at night to urinate as often as 6 to 8 times.  About six months ago she began having severe abdominal pain after urinating at night extending from below the belly button to the vaginal area; this also includes burning--not in the vagina while urinating--but afterwards inside the abdomen area.  This happens every time after urinating at night only.  She has had occasional symptoms while seated during the day, followed by the "heat building up and going down to her feet and extending out to her arm and chest area on both sides."  She was treated by a urologist who prescribed imipramine and hyoscyamine, which has not alleviated the symptoms.  A cystoscopy was negative.

She had a colonoscopy and barium enema which showed nothing.  Because of a "torturous" colon, the doctor didn't complete the colonoscopy but sent her for the barium enema following the first procedure.  She has had benign polyps removed in the past.  She also has a hiatal hernia for several years.

She had recent MRI and cat scans of the pelvic and abdominal areas.  The doctor was looking for an abdominal aneurysm or retroparateneil fibrosis, but neither was found. (He said her white cell count was high).

She has suffered ongoing from Polymyralgia Rheumatica (PMR) and her recent SED rate was 38.  A steroid pack prescribed by her doctor did nothing to relieve the abdominal pain.  She has also a history of heart disease and has had two angioplastys.  

After considering all test results her physician said that the only thing to be done was "pain management" and prescribed morphine, 15 mg. every 12 hours. He mentioned something about it is "probably the nerve endings originating from her back." My mother does not want to accept this as pain medication affects her vision and makes her too lethargic.  She has a wonderful attitude and has always been active and contributing much to people and animals.  We are not convinced that something is not going on that has not been diagnosed. I might mention that she had a gynecological exam about two months ago and they said that her estrogen levels were high.

She is presently taking the following medications:  zocor, aciphex, atenolol, plavix.  Can you please help?  The only specialist we have not consulted is a neurologist? When her physician said he thought it was nerves, I asked if seeing a neurologist would help, and he said, "no." Surely there is some diagnosis and treatment for this other than taking morphine to deaden the pain, which she is vehemently opposed to.

Your thoughtful response is most appreciated.

[Kevin Pho, MD]

A neurology referral would certainly be the next step.

A confirmed diagnosis of spinal stenosis can cause the urinary symptoms.  The fact it is worsening suggests that there may be additional damage from the stenosis.  

If medications are not controlling the symptoms, you may want to consider lumbar epidural injections, skin injections or possible surgical decompression to treat the stenosis.  

A neurologist would be the specialist who can best answer the questions as to what the next step would be.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[surgeon]

As I was reading your question, I was thinking "neurologist" even before your last comment. It seems possible that her pains and bladder dysfuction could be due to a neurological condition, and there are ways to check that. I'd think a neurolgist might be able to help.