urology

  I'm an unmmaried female, 44 years old.  I've been diagnosed as having descended bladder.  My symptoms are urge and  frequency in urinating (sometimes within 10 minutes, somethimes within an hour and sometimes after 2-3 hours) but there is no incontinence as I'm able to control  urine.  But due to feeling of full bladder each time even within few minutes, I have to empty the bladder. There is no blood neither pain during urinating.  The baldder is completely drained each time I urinate. A urine sample examination but not culture has shown no infection. An ultra sound also showed clear kidney and bladder. But I have severe pain in the urogenital area and sometimes in the lower plevic floor which is not persistent. Pain is worse during menstrual period which I never experienced before.  I have nausea and have undergone an IVP which showed no stones in the system.
  I wish to know if I should perform further tests to rule out bladder cancer or other urological problems because sometimes I feel some kind of discomfort like sand in the uretra and the bladder.  Sometimes there is pain which travels from the naval to the urogenital area.  Is this kind of pain typical of descended bladders?
  I have been asked by my doctor to undergo physio-therapy (electrical stimulation) to excercise my bladder but I have objected b'cos I do not feel comfortable as they would have to do it through the vaginal wall.  Thus he has put me on drugs like xatral hoping to relax the nerves concerned.  This does not help much except for a sleepy feeling.  The fact that I'm working, I cannot sleep and thus I start developing headaches and numbness at one side of the head. I've stopped the medication for the time being. Please advise.  Thanking you in anticipation.
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Dear Devakie,
The symptoms of urgency, frequency and pain appears to be due to frequency-dysuria syndrome. The urethral syndrome is defined as lower urinary tract symptoms in women in the absence of bladder bacteriuria (bacteria in the urine). Patients have symptoms suggestive of a lower tract urinary infection but they don't have a conventional infection. The etiology and pathogenic factors involved in its development are still incompletely understood. Many factors have been suggested as causative of this syndrome, including non-specific infections, urethral obstruction and spasm, senile atrophy, psychosomatic and traumatic factors. Bladder descent does not cause this type of pain. If severe it may however cause urinary incontinence.
This syndrome remains a diagnosis of exclusion. More serious causes of urinary frequency, dysuria, and suprapubic discomfort must be excluded. A combination of a careful history, physical examination, urine culture, urine cytology, and cystourethroscopy with biopsy will help in making the diagnosis. Cervical and urethral swabs for microscopy and culture are necessary when infection with rare urethral pathogens is suspected.
Urethral calibration (dilatation), uroflowmetry and urodynamics (measurement of bladder pressures) may be needed in some patients. Selective usage of suppressive antibiotics along with reassurance and careful follow-up will prove effective in the treatment. In some patients a treatment with smooth muscle relaxants is helpful.  Local vaginal estrogen applications are effective in the treatment of urethral syndrome secondary to hypoestrogenaemia. If all the tests come back normal, you should relax and not worry too much.  You should however continue seeing your physician to make sure that nothing important is missed.  Treatment is mainly directed towards alleviating the symptoms.
This information is provided for general medical information purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
The Henry Ford Hospital Department of Urology has experience in the evaluation and treatment of problems such as you describes. They would be most interested in helping you. You can reach them through our toll-free number (1-800-653-6568). We can also arrange local accommodations through this number if this is your need.
Sincerely,
HFHS M.D.-A.T.
*keyword: Frequency-dysuria syndrome