UTI or IC or OB?

[Bella31]

Hi

I wish to enquire whether my symptoms are related to bacterial or non-bacterial infection or whether it is overactive bladder.

I have constant urget to pee and little amount of water come out. Its foamy maybe because am on antibiotics. I have mild pain that radiates from left and right side of abdomen to the side from ribs to abs. Pain is not acute. I never had blood in urine.

I was diagnosed in june 08 with cystitis on the basis of a urine culture and sensitivity test which showed the presence of 2+ bacteria in the microscopic test but in sensitivity test they mentioned few bacteria but no organism isolated.

I was prescribed Doxy-1 and laxative which worked just fine with me but I made a mistake of discontinuing the medicine midway before completing the full course and the infection came back with yeast infection vulvitis.I also had the severe itching problem which persist in and outside vagina and on anus.

I went to see a more senior and experienced urologist in Ahmedabad, India and he did a sonography of KUB which showed my kidneys and rest to be normal. Even my bladder capacity is normal 300cc. He diagnosed Dysuria. He then put me on vaginal tablets Cantestan for candida yeast infection and oral antibiotics called Niftran, Dio-1 and Fole 150 which again worked for me and I completed the course. But now after the course is over the infection has come back with the urge of peeping all the time and wet/leaky around and in vagina. I also dribble after peeing.

Do you think my urethral pipe and/or spincture has been damaged or become weak and so I keep dribbling small amount of urine?

Kindly help!

Bella

[David A Burks, MD]

You have a combination of symptoms that need to be sorted out.  It is common for a female to void for a specimin, show bacteria in the urine but the culture shows minimal or no organisms.  That is usually due to bacteria from the vagina that got picked up by  the urine as it passed thru into the cup.  You got treated anyhow and got a vaginal yeast infection, not uncommon when women get treated with lots of antibiotics.  The good bacteria in the vagina are eliminated and the yeast have an opportunity to grow.  You eventually got that cleared up but you still have frequency, urgency and small volume voiding, plus what sounds like urge incontinence.  You state the pain is "not acute" and mild. Its unclear from your history if the pain is related to the bladder, either during filling or pain while voiding, or is this pain from another cause.
This is either overactive bladder with incontinence or interstitial cystitis.  Overactive bladder patients  have frequency and urgency to void, plus they may have incontinence and dribbling.  They usually do not have pain in the bladder or vagina with a full bladder or while voiding.  Treatment is with medications that reduce urgency to void.  Ditropan is the most widely used medication. Your Urologist would know what to prescribe.  Interstitial Cystitis patients also have frequency and urgency, but also have pain, pressure or discomfort  most often in the lower abdomen or vagina.  Treatment for this problem is more difficult and you would need to see an expert who specializes in IC. Your urethral sphincter muscle could be weak causing the incontinence as you noted.  
Your history is complex and an experienced Urologist needs to work you up for either overactive bladder, urethral incontinence or interstitial cystitis or some combination. The correct diagnosis needs to be made.  The most experienced Urologist in Ahmedabad, India for this problem is Dr. Nagendra Mishra at the Jivraj Mehta Hospital.  Good Luck      

[leeroy40]

A related discussion, post BNI was started.