Not sure if I have Interstitial Cystitis?

[Katsura]

I am 45 year old female.  In Aug08 I had bout with what I thought was food poisoning, or  virus, I noticed inflamation (inflammation) in my hands - lasted a couple of weeks.  Then I noticed that my sleep was being interupted by a lead weight feeling in my bladder - intermitent.  My fist thought was that this issue with my bladder had something to do with incontinence.  In Oct08 I went to see a Gyno-Urologist for a bladder test, with the possibility of getting a TVT sling.  They did a cystostomy.  Two weeks after bladder test I felt like I was coming down with UTI, with discomfort in my bladder - urgency and heavy feeling.  I had a couple of dip tests done, they were negative.  While waiting for a culture, I was prescribed 6 days of Cipro.  At first symtoms cleared.  I thought UTI was gone, however on the 5th day of Cipro the symptoms returned.  The culture came back contaminated with low levels of mixed gram positive bacteria.  My doctor said it was likely I had inflamation (inflammation) in my bladder, but no infection.  I started drinking lots of water.  Somedays my symptoms would lighten, but really no improvement.  I tried Detrol, under the theory that I had an overactive bladder.  This did not help.  By mid Dec08, my symptoms had worsened, now my Urethra was involved - it wasn't burning, but it felt like it was throbbing with sprayed urine stream.  I was prescribed 3 weeks of Macrobid and Phenzo.  At first this did not appear to be helping, but then by the end of the 2nd week I was starting to feel better, and by the end of the 3rd week, I felt cured.  For almost 2 months I was symptom free, then in March09 the symptoms creept back in.  I was prescribed 1 week of Macrobid, this did not help.  My symptoms are urgency with some bladder and Urethra discomfort and pain.  I can ignore it during the day, but my sleep is disrupted by bladder discomfort.  Another urine culture - again, contaminated with low levels gram positive bacteria.  My GP think I have IC - I hope it is UTI? What should I do?

[David A Burks, MD]

The question is-- what is the diagnosis?  Is this a UTI, with bacteria causing the symptoms or is this something other than an infection.  The symptoms seem to either improve or resolve after an antibiotic course, but then return off treatment.  The cultures grow a low yield of mixed gram positive flora, usually from a vaginal contaminant .  It seems that just a week or two of antibiotics does not effectively treat your symptoms.  If this is ultimately not a bacterial infection problem it may be Interstitial Cystitis (IC).  Your history is typical for early IC where the symptoms are often confused with a recurrent UTIs, and some patients even respond to antibiotics, when they don't have an infection.  Early IC symptoms can wax and wane spontaneously.  I recommend you try a 1 month trial of Cipro 500mg twice daily, then 1 at night to suppress any infection present. An infection deep in the bladder wall can be hard to erradicate with a short course of antibiotics. Bladder inflammation from a previous bacterial infection, can be a souce of continued symptoms but it usually resolves over time.   If, on antibiotics, you still have the symptoms then you need to be worked up for IC by a Urologist or Urogynecologist who specializes in pelvic pain disorders.  Any urine culture should be a straight cath urine to avoid the confusion with vaginal contaminants.  Good Luck