Urogynecology Expert Forum
BLADDER PAIN IN THE MORNING
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Questions in the Urogynecology forum are answered by Bruce Crawford, MD, J. Kyle Mathews, MD, and other medical professionals and experts. Topics covered include overactive bladders, bladder pain, fallen/drooping bladder, bowel urgency, bowel prolapse, cystitis, incontinence, pain with intercourse, rectal prolapse, surgery, urinary urgency, and uterine prolapse.

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BLADDER PAIN IN THE MORNING

I have endometriosis and after my first surgery 8/06 I began waking up with my bladder full and in pain.  As time has gone by the pain has worsened.  I went to a urologist and I don't have any kind of infection or UTI.  I have been checked several times.  My urologist referred me back to my gynocologist because he did a cystocopy and didn't find any IC.
  My gynocologist decided to do another sugery removing adhesions, endo and doing a hydrodistention and cystocopy.  First the urologist did the hydrodistention and cystocopy and didn't find anything. My gynocologist did remove some adhesion and endo including a little bit of endo on my bladder.
  I didn't have any of my usual pain until 2 weeks after my surgery.  My guess is that's because I didn't sleep more than 4 hours at a time.  It seems that my bladder gets filled up & since it doesn't get emptied for 7 hours while I sleep that it makes my bladder hurts.  I go to the restroom a lot and I have to squeeze my stomach to help relieve the fluid out of my bladder.
  I still had some fluid in my bladder during my surgery.  Since I hadn't drank anything since 10pm the night before it appears that my bladder isn't emptying completely.  My doctor has put me on Flomax and I've been taking it since Sunday. So far it isn't helping. My pain seems to be getting worse.
My doctor thinks there is a possibilty that I might have adenoyosis (endo of the bladder).  He really didn't see that many signs of it when they did surgery but there really do way to know unless the uterus is removed and biopysied.
  This pain is really bad.  Currently I am taking a Percocet or a loratab and a half for the the pain as soon as I get up. That's just to get me out of bed.
Any suggestions would be greatly helped!!!!  
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Please get an evaluation by a pelvic floor physical therapist. They may be able to diagnose pelvic muscle trigger points which may be causing SOME of your symptoms. If this is the case, they can cure the trigger points (and possibly your symptoms) with directed pelvic floor physical therapy. I am not sure why you have been prescribed the Flomax, this is usually given to those who are unable to empty their bladder. That is if there is more than 200+ cc left in the bladder after you void. If you do have this problem (also called urinary retention), you should have bladder testing to determine why you are in retention; is it because your bladder muscle is refusing to contract to squeeze out the urine? or is it because your bladder outlet muscle is not relaxing to let the urine out? Each one of these has a different potential solution, and it would be most helpful to know which of these problems you have before trying to solve it.

Dr. Hoyte.
6 Comments
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Just wanted to update that I've been taking Flomax for over 1 week now 1/20/08 and the pain has only gotten worse.
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136956_tn?1363091289
I hope that you find out what it is because i have to a "T" the exact same problem.  I was diagnosed with stage IV endo in june and I too am having the same issues and has gotten worse since after my surgery. This actually started when i had my daughter 5 yrs ago and they put a cathader in and when they took it out i couldnt pee and the pain i felt than is what i feel now. After i had the surgery in june a cathader was put in and I still couldnt pee afterwards.  I cant stop peeing and when i go to bed i have to get up and pee at least 4-5times within in 1/2 to 45min than wake up at like 5pm to pee.  It hurts so bad.  Please keep in touch if they find anything
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Avatar_f_tn
I am so sorry to hear that. I really didn't think it was caused from the surgerys but if you have had the same issue after your surgery and mine as well than maybe that has something to do with it.  I will keep you informed!
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Avatar_f_tn
Thank you for your reply....
When I had my last surgery they noticed that my bladder was not empty.  I hadn't had anything to drink since the night before around 10 am and the surgery was at 7 am.  I had gone to the restroom several times in between those times.  Right before the surgery I did feel like I needed to go to the restroom.  I tried for about 5 minutes to release the urine without any luck.  The urine still in my bladder lead my doctor to believe that my bladder is not empting properly.
I will look into the pelvic floor therapist.  
"is it because your bladder muscle is refusing to contract to squeeze out the urine? "very possible "or is it because your bladder outlet muscle is not relaxing to let the urine out?" very possible.  How do I find out which one is causing my problem?

Can the urine that's is not releasing cause any other problems?  Like with my kidneys?
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Avatar_f_tn
I saw a urologist this last week and he thinks I have IC. Even though I was told twice after 2 cystocopies and a hydrodenstion that I don't have IC.  He says that my symptoms sounds like IC and put me on Elomiron.  Its fustrating because I won't know if them medication is working for another 3-6 months.  My pain is only getting worse.  I am going to stop drinking wine and dark chocolate since they may aggrivate IC. I drink wine every night and I hope that this is what is causing it.  I love wine but I will give it up in order to regain my life. I also dance and yesterday in Ballet I was brought to tears from the pain of my bladder from the jumping.  I think that the pelivic floor therapist sounds like a great option for me. Can you refer me to one in Atlanta GA?  Thank you
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Plano Urogynecology Associates
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