what's wrong with me?! please help!

I am a 22 year old female with a problem I can't seem to get answered.  About a year ago, i awoke out of bed feeling like i had the beginning of a uti.  I went to the bathroom and i urinated and there was a little blood. Within the next hour, i was urinating straight blood and passing blood clots.  I was in horrible pain and couldn't get off the toilet. Three hours later, I felt fine. I tested neg. for a uti, so i thought maybe i passed a stone, w/o normal symptoms(back pain, vomiting, fever), but ultrasounds came out fine, my kidneys looked great. After that, is when my problem started.  Sometimes(more often than not), when i urinate, and for a little while afterwards, i experience a horrible burning sensation, and when i am done, i feel like i still need to push.  Not like a bladder infection though, my bladder does feel empty. The feeling of not finishing actually comes from my urethra. I started going to a urologist, and he said that blood keeps showing up in my urine, but not appearent to the naked eye.We never figuered out where it was coming from.  He performed a cysto., and he said that everything looked fine, but  there was a little portion of my urethra that looked inflammed.  So i went in for 2 seperate dialations.  I would feel relief, but within 1-2months the pain was back.  Now I read your info on strictures, but my urine stream is pretty good and strong. It always has been.  Also, the pain is not constant.  Sometimes, it hurts and sometimes it doesn't. I could have pain for a straight week, or sometimes, my first morning urination will hurt and the next time i go, i feel nothing. It's strange. For instance, on Thanksgiving, I was in horrible pain. I was crying on the toilet. It burned so bad, and I felt like I had to keep pushing. I was like that for the entire day, but the next day, I felt fine. No pain at all. Sometimes, I can even tell if I'm going to have a painful urination before I even start to urinate. Occassionally, if I have an intense feeling that I need to go, the burning will start then. Before I even actually start to urinate. It seems that when I drink anything but water, it brings on the pain as well. It's also giving me problems during intercourse. Sometimes the friction against my urethra will give me the same pain, to the point that I have to make my husband stop. Does this sound like a stricture to you,or something else? I don't know if this information is needed, but I have sexually related uti problems. I take an atibiotic after each time I have intercourse and I have tested neg. for all possible std's.  PLEASE HELP ME.

[Kevin Pho, MD]

You have been through a pretty good evaluation, looking at the kidneys and undergoing a cystoscopy as well as several dilations.  Sometimes UTIs may be present despite a negative urinalysis - if this is suspected, chronic prophylactic antibiotics can be considered to prevent future occurances.  

It is also possible that a stricture can recur despite prior procedures.  If the dilations are not helpful, you may want to consider stenting.  This can be discussed with your urologist - or consider another urological opinion if the symptoms are not improvement.  Preferably the second opinion should be done at a major academic medical center.  

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.
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