Tired of being sick; UTIs, bladder feels like a rock (diabetic II)

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I have an appointment with a Urologist in 3 weeks and my Family Doctor (who is very sharp) doesn't know what to think.

I have had 7 UTIs in the past year. Usually they sneak up on me being asymptomatic until I am extremely sick with much fatigue, malaise, slight fever.

I *never* have burning on urination, although I have frequency and hesitancy. (This fact makes the doctors doubtful, so sometimes I have to lie and say I have burning in order to get a urine test). My bladder gets very tender and painful. I am scrupulously hygienic in the bathroom.

Kidney ultrasound last week came out perfectly normal. Have had normal CTScans.

I am scrupulously hygienic in the bathroom, and am embarrassed because sometimes the nurses look at me as though I must be dirty. One nurse said the bacteria "always" comes from the outside.

The UTI I have today and am very sick with suddenly *only* showed up some leucocytes in the office, and no nitrates or blood this time. Culture will be in tomorrow.

Hx: Type 2 Diabetic for 5 years, well controlled. For the past few years it has felt like my bladder is hard as a rock and tender. I went to a urologist and was treated with Detrol because I thought I had bladder spasms (before all these UTIs). Orgasms make it worse (seems to send my bladder into spasms), although I've discontinued the Detrol because it doesn't seem to do much.

I had a total hysterectomy 10 years ago, so there's no uterus. I also had my gallbladder out 5 years ago. I don't have many organs in there left to hurt except my bladder.

I am so tired of being so sick. I hope you can give me some ideas that I can throw at my urologist this time. I am thinking a bladder scope? Thanks!

[Kevin Pho, MD]

Being a diabetic would increase your risk for recurrent infections.  There are a variety of other risk factors that that raise the possibility for recurrent UTIs.  Genetic factors (i.e. increased susceptibility to urinary pathogens), pelvic anatomy as well as menopause are the more common reasons.  

Options for evaluation would include a cystoscopy to evaluate if there is any anatomical abnormality.  Obtaining a sensitivity culture to the bacteria should also be obtained to ensure that the antibiotics are appropriately treating the infection.

If there is no clear cause, you may want to discuss whether the option of antibiotic prophylaxis is an appropriate option for you.

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.

Thanks,
Kevin, M.D.

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