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Post UTI inflammation or IC?
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Post UTI inflammation or IC?

Earlier this year I had two UTIs within a month (e coli infections).  Urine tests have been clear of bacteria since 10th March, although microscopic blood has been found.  For the first month after the infection I had increased frequency, burning in the bladder and electrical nerve sensations (like a cattle prod) up my urethra and around my bladder.  Burning increased after sex, and walking was difficult as the bladder was very tender.  Most of these symptoms have gone but for the last month I have had an 'itching' sensation and feeling of coldness in the bladder.  I have no pain at any time.  I have slightly increased frequency but this is simply because the itching is less when my bladder is empty - I can go for 3 hours without urinating if my mind is sufficiently distracted.  My urine samples remain clear other than the slight red cell count.  Ultrasound and urodynamics are normal.  I am reluctant to have a cystoscopy as I am worried it might cause another infection.  One of my doctors says this is just post UTI inflammation and will 'probably' go away on its own, but this may take several months.  Another says it is probably IC (or painful bladder syndrome as they seem to call it in the UK).  None of the sites on IC seem to mention itching or feeling chilled in the bladder.  I have no other problems, diet seems to have no impact.  Symptoms are less in the morning, gradually worsening through the day.  I have taken several courses of Diflucan in case it is thrush, to no effect.

Are these symptoms indicative of post UTI inflammation or IC?  Is there really a difference (IC seems to be a term covering a wide range of things).  Is the problem likely to clear up on its own or should I have the cystoscopy?  How long should I wait to see if I recover on my own before undergoing this?  How likely is it that a cystoscopy will exacerbate the symptoms?  
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If the tests are so far normal, you may want to investigate the possibility of IC.  Symptoms of IC consist of urgency, frequency, and/or pelvic pain in any combination. At least 16 percent of IC patients have only pain and at least 30 percent have only frequency/urgency, but most affected individuals have both.

You may want to consider the intravesical Potassium Sensitivity Test (PST) tests for abnormal urothelial permeability, which is present in many individuals who have IC. The test can be administered by a nurse in the clinician's office.  

Cystoscopy was considered the gold standard for diagnosis of IC. Positive findings consist of destructive changes of the mucosa (glomerulations, submucosal hemorrhages, ulcers); however, ulcers are only seen in advanced disease and glomerulations can be observed in many normal individuals.  If the tests remain negative, you may want to consider this test.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

Bibliography:
Parsons.  Interstitial cystitis.  UptoDate, 2004.
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