Chronic undiagnosed bladder discomfort...help please

I am a 34 yr old caucasian male.  5 years ago, I was diagnosed with a relatively mild ulcerative proctitis of unknown origin after some time of altered bowels and occasional blood in the stool.  But, recently I was given another sigmoidoscopy and apparently this has since resolved without treatment, and indeed my bowels are mostly normal now.

Starting just over 1 year ago from today, I started to have a constant bladder discomfort and irritating feeling, it is in a very specific spot where my bladder is located, generally just above the bone above my penis where the soft area of the lower abdomen begins.

These symptoms began shortly after I was dehydrated due to fever and was given i.v. saline in a brief emergency room stay.  I only mention this because of the suspicious timing, but I am not implying with certainty this is a connection.

Basically, my symptoms are nearly continuous, however there are times where I go for days or even weeks where the symptoms are improved so much that I barely notice it or not at all, but only to have it return spontaneously with no warning.

The discomfort is not agonizing, but it is a 3 out of 10 and it aggravates the symptoms when you press around on my bladder area,  and it makes sex undesirable.  I do feel the need to urinate much more often than usual when my symptoms are bothering me, and urinating often makes the symptoms better, but not completely and not always.

I have seen a Urologist.  My urinalysis is normal.  My bladder will empty properly, and my rectal exam is normal.  I am quite frustrated, because the specialist does not want to run any additional tests to find out what is causing the symptoms, he only wants to prescribe me a drug for the symptoms.  He said he does not think it can be cystitis because sometimes I do not have symptoms for periods of time. (??)

Does it sound like I should have additional testing, should I seek another opinion, and what do you think is wrong with me?  Do the symptoms of IC really not come and go? My STD risk is relatively small, but not impossible.

[S. Kaul, MD]

Hi there!

It is not necessary for symptoms of IC to be present continuously though regular symptoms, with waxing and waning in severity is common. In the current situation, further testing for infections (serial urineanalysis after an interval of 4-6 weeks), inflammations (cystoscopy), growths/ masses, ulcers erosions, referred pain from other regions etc may need to be considered. I would suggest considering an evaluation by an internist or seeking a review with your urologist for an accurate diagnosis and appropriate management.
Hope this is helpful.

Take care!