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Urology (Expert Forum)
Painful Bladder
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Painful Bladder
by Brenda__0__0, Aug 22, 1998 12:00AM
I have been diagnosed with SLE, sjogrens, Fibroidmyalgia (all for 6yrs),
Thyroiditis (6months). Thru out my illnesses I have had reacurrent
UTI's; or more acurretly everytime they take a urine test they find
white blood cells in my urine and tell me that "I'm getting over an
infection" and then give me an antibiotic and phenazopyridine. This
usualy takes care of the pain for awhile. But this time I was put on
macrobid and phen. and its not working. I also have pain in my sides
tward my lower back its worse in the morning; actualy wakes me up in
the night. I have been having a flare (that is the worst
I have ever had)of my lupus and sjogrens for about 5 months now.
I am on 20mg of prednisoneas well as salagen, prilosec, arthrotec,
carafate, serazone, levoxyl,cyclobenzaprine (as needed) and
plaquenil. My primary doctor thinks I should be put on
Methodextrate treatments. The second opinionfrom a rhemy who only
saw me once was not unless further tests showed kidney involvement.
Its been weeks and no tests have been ordered. I am currently looking
for a new rhematoligist.The doctor said in two weeks they would order
them. Is this right? I know my doctor is concerned but I don't think
he takes the bladder this seriously. He said he could send me to a
uroligist. But should I see a kidney doctor? I am confused about what
treatment to take and what all these meds are doing to my kidneys
and bladder. I am rarely without at least some bladder discomfort. It usualy feels
swollen as if full of air or gas. I don't have a problem with
incontence but I do have some leakage if/when the pain is present.
Sorry this is so long I just want an acurate opinion and I know
my case is complicated, as I'm often told. I would so appreciate
answers or at least some treatment/possibilities. Thankyou very
much for your valuable time.
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Dear Brenda,
The diagnosis of urinary tract infections can only be made if a urine culture (the result of which takes 2-3 days) is positive. The finding of white blood cells in the urine on a dip-stick test in clinic is not necessarily indicative of a urinary tract infection. Therefore, I’m not sure whether you actually have had a history of recurrent urinary tract infections unless a urine culture was obtained each time you have had symptoms. Irritative voiding symptoms such as frequency, urgency, dysuria (pain with urinating), and suprapubic pain can all be symptoms of cystitis (irritation of the bladder) which may have many causes. The symptoms you describe are similar to that of interstitial cystitis (IC). This is a diagnosis of exclusion, meaning that you can only say one has interstitial cystitis if all other possible causes of cystitis are ruled out. However, there is an association between interstitial cystitis and Sjogren’s syndrome. Of course, I can not diagnose you over the internet without the benefit of a complete history and physical examination, and therefore recommend you see a urologist who takes care of patients with interstitial cystitis to first rule out any other possible problems that may be causing your symptoms, and then try to offer relief if you are finally diagnosed with IC. Unfortunately, no one really knows the cause for IC and there is no cure at this time (only palliative therapy). Therefore, it is important not to be labeled with this entity until other possible causes are ruled out.
I am not aware of any specific bladder problems that are directly due to SLE, although the kidneys may become affected as you correctly stated. However, that should not cause the bladder symptoms you describe. Wish you the best.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).
Sincerely,
HFHS M.D.-JJ
*Keyword: Interstitial cystitis, Sjogren’s syndrome
