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Urology (Expert Forum)
re-occuring bladder infections and gross hematuria
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
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.
re-occuring bladder infections and gross hematuria
by kidneycrazy, Apr 05, 2003 12:00AM
Dear Doc,
I am a 32 years old female, have had re-occuring bladder infections and gross hematuria for the past several years. Many or these UTI's I can pin-point because of a specific event. Because of my job, I am often not able to use the restroom when I need to and have to "hold it" for several hours. During the course of UTI's and having symptons of an UTI, my UA's have usually shown low WBC counts and my general practioner has prescribed Cipro or Imotrex. I have used the Cipro, which has helped, but not the Imotrex.
Recently, since January 2003, I have had mild to severe right side low abdominal pain. I was hospitalized in late January for five days as the pain was very severe and was initially diagnosed as kidney stones. However, no stone or other abnormalities were present in either the CAT or the IVP.
I have since been examined by an urologist and have had a cystoscope exam which was also negative for polyps or other problems.My urologist also viewed the CAT and IVP films and stated all was in order.
My urologist stated he was confident that I had a bactieral infection in my uriertors (sorry spelling ?) or uretha, and prescribed a 3 month treatement of Macrobid in hopes of breaking the cycle of infections.
My question.... If I am having low WBC counts on my UA, usually under 2, how can I have an infection? Also, ( not to be gross) he asked if I notice the blood in the urine or I after I wipe. When I am having a problem, I usually only notice it because I have red blood visible after Im done urinating and am using toilet paper. I do not understand what this would mean.
A second question, I have now been on Microbid for three days, (since I had the cystoscope) and continue to have moderate pain- both on my left and right side now- very low near the groin. Will this improve with the antibiotic? Also, the urologist stated that the bactiera were "probally my own". Does this mean I am not using good hygine? Again, not to be icky, but I do wipe front to back and go before and after sex ( same man-8 years).
And the last Q, since Im going to be on an antibotic (antibiotic) for three months, is okay to start taking an over the counter yeast inhibitor?
Thanks in advance for you help!
I am a 32 years old female, have had re-occuring bladder infections and gross hematuria for the past several years. Many or these UTI's I can pin-point because of a specific event. Because of my job, I am often not able to use the restroom when I need to and have to "hold it" for several hours. During the course of UTI's and having symptons of an UTI, my UA's have usually shown low WBC counts and my general practioner has prescribed Cipro or Imotrex. I have used the Cipro, which has helped, but not the Imotrex.
Recently, since January 2003, I have had mild to severe right side low abdominal pain. I was hospitalized in late January for five days as the pain was very severe and was initially diagnosed as kidney stones. However, no stone or other abnormalities were present in either the CAT or the IVP.
I have since been examined by an urologist and have had a cystoscope exam which was also negative for polyps or other problems.My urologist also viewed the CAT and IVP films and stated all was in order.
My urologist stated he was confident that I had a bactieral infection in my uriertors (sorry spelling ?) or uretha, and prescribed a 3 month treatement of Macrobid in hopes of breaking the cycle of infections.
My question.... If I am having low WBC counts on my UA, usually under 2, how can I have an infection? Also, ( not to be gross) he asked if I notice the blood in the urine or I after I wipe. When I am having a problem, I usually only notice it because I have red blood visible after Im done urinating and am using toilet paper. I do not understand what this would mean.
A second question, I have now been on Microbid for three days, (since I had the cystoscope) and continue to have moderate pain- both on my left and right side now- very low near the groin. Will this improve with the antibiotic? Also, the urologist stated that the bactiera were "probally my own". Does this mean I am not using good hygine? Again, not to be icky, but I do wipe front to back and go before and after sex ( same man-8 years).
And the last Q, since Im going to be on an antibotic (antibiotic) for three months, is okay to start taking an over the counter yeast inhibitor?
Thanks in advance for you help!
Doctor's Answer
by Kevin Pho, MD, Apr 05, 2003 12:00AM
, Apr 05, 2003 12:00AM
Hello - thanks for asking your question.
Typically more than 10 WBC in a urinalysis is considered abnormal.
You note a normal CT scan (I assume of the pelvis), cystoscopy and IVP.
Unfortunaly recurrent urinary tract infections are common. First check if the culture grew anything - and if it did, make sure it is sensitive to the antibiotics you are on.
Also, you may want to check whether an STD (chalymdia or gonorrhea) or vaginosis (bacterial, yeast, or trichomonas) is present. This can be tested at your physician's office and appropriately treated. All can cause recurrent UTI-like symptoms.
If all is negative, then you may have to deal with refractory UTIs. Refractory UTIs can be affected by the pelvic anatomy. There is also a genetic predisosition - women with recurrent UTI have been shown to have an increased susceptibility to vaginal colonization with uropathogens, even during asymptomatic periods, compared with women without a history of recurrences.
Prophylaxis has been advocated for women who experience two or more symptomatic UTIs within six months or three or more over 12 months. Macrobid is appropriate for this purpose - bactrim is another alternative.
There is no harm in taking a yeast inhibitor (such as lactobacillus) while on antibiotics.
Given the gross hematuria, I would also consider a kidney ultrasound and urine cytology to go along with your cystoscopy, IVP and CT scan. If these 5 tests are normal, then cancer is very unlikely. I would follow up closely with your urologist to periodically monitor this.
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.
Typically more than 10 WBC in a urinalysis is considered abnormal.
You note a normal CT scan (I assume of the pelvis), cystoscopy and IVP.
Unfortunaly recurrent urinary tract infections are common. First check if the culture grew anything - and if it did, make sure it is sensitive to the antibiotics you are on.
Also, you may want to check whether an STD (chalymdia or gonorrhea) or vaginosis (bacterial, yeast, or trichomonas) is present. This can be tested at your physician's office and appropriately treated. All can cause recurrent UTI-like symptoms.
If all is negative, then you may have to deal with refractory UTIs. Refractory UTIs can be affected by the pelvic anatomy. There is also a genetic predisosition - women with recurrent UTI have been shown to have an increased susceptibility to vaginal colonization with uropathogens, even during asymptomatic periods, compared with women without a history of recurrences.
Prophylaxis has been advocated for women who experience two or more symptomatic UTIs within six months or three or more over 12 months. Macrobid is appropriate for this purpose - bactrim is another alternative.
There is no harm in taking a yeast inhibitor (such as lactobacillus) while on antibiotics.
Given the gross hematuria, I would also consider a kidney ultrasound and urine cytology to go along with your cystoscopy, IVP and CT scan. If these 5 tests are normal, then cancer is very unlikely. I would follow up closely with your urologist to periodically monitor this.
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.
Member Comments
by kidneycrazy, Apr 10, 2003 12:00AM
To: Urology - General
0
by wiz, Apr 16, 2003 12:00AM
To: Urology - General
0
by kidneycrazy, May 31, 2003 12:00AM
To: Urology - General
0
