Very frustrated/concerned that it's IC; 4 mos. postpartum

[california transplant]

Hello, I am 4 months postpartum with my first child. Normal vaginal delivery except the placenta wouldn't detach and the OB manually removed it with his hand. I felt completely normal for the first 4 weeks postpartum (seemed to be healing just fine, no urinary problems, etc.)  However, I was still bleeding.  At 5 weeks pp, I developed some minor irritation of the urethra.  Dipstick test showed infection although looking back I guess it could have just been elevated red or white blood cells.  4 weeks of 4 different antibiotics later, I still felt like I had a UTI.  I had a D&C at 8 weeks pp and symptoms continued.  Symptoms include suprapubic pressure and feeling of having to urinate frequently.  Sometimes, there is a numbing/tingling or aching pain in the pelvis as well.  I have no history of frequent UTIs or abdominal surgery, also, no history of allergies.  Urine is clear.  I have vascular congestion (shown by CT scan) of the left side of my uterus with no known cause.  I am seriously concerned that this is Interstitial Cystitis, although I was wondering if it could be nerve damage to the bladder somehow relating to having the baby?  Urologists keep telling me that it will ultimately resolve but the pressure/frequency symptoms are very frustrating and haven't gone away.  No burning upon urination, simply the pressure like something is always sitting on my bladder.  OB did a cysto at time of D&C and showed normal bladder; Urologist wants to do another cysto with hydrodistension in a week to see for himself.  Do you think I could have developed IC or do you think this is something else that will resolve?  What should I do because I desperately need relief.  I never had irritative voiding symptoms ever in my life.  Also noteworthy is that my uterus is anteverted since delivering the baby and the baby sat very low in my pelvis the entire pregnancy.  Thank you for your time and expertise.

[David A Burks, MD]

Hi,
You have a complex history.  The cause/trigger of IC is unknown. Clinically we see patients who have IC symptoms immediately after a hysterectomy or pelvic trama.  In your case the symptoms started a full 4 weeks post partum and there was no history of bladder trama. The question is-- are your symptoms related to the recent birth or a separate new problem that happened to occur 4 weeks post partum?  There seems to be no association of the symptoms to the post partum bleeding or the D&C.  The whole pelvic floor is under pressure during the final weeks of pregnancy and during birth, and muscles and nerves are often tramatized in the process.  You could have the beginnings of IC but it's hard to tell in this post partum setting.  This is obviously not a UTI after 4 courses of antibiotics and your anteverted uterus is a normal variant.  IC has the triad of pain/pressure/, frequency and urgency.  I agree that a cystscopy with hydrodistention is the next step, Unfortunately a negative cystoscopy and hydrodistention does not rule out IC.  A drug like Ditropan or Vesicare could be tried to see if it reduces the symptoms. The differential diagnosis is IC vrs overactive bladder plus pelvic pain from nerve/muscle trama from childbirth.  Hopefully it will resolve spontaneously.
Good Luck

[Brookie1220]

A related discussion, freg. burning was started.

[IC7years]

I had IC even before I was sexuly active. When I was pregnent with my soon to be 4 year old son the IC was un-noticeable. After I had me c-section do to his head size I had the same Bleadding issue. Was noticing the IC more and more in the first 3 months pp, then they got verry hard to handle and I was having full on wetting eppasodes,like a potty training 2 year old, after I quit breast feeding him do to milk drying up in left breast. I have been doing the IC dance with over twenty meds, IC diets, and tests & treatments for the past 4 years. IC is unpredictable. I hope you don't have IC like I do! Keep a jurnal of the symptoms & Infections so you can talk to your doc. better. Good Luck Mint TEA helps me with the stinging of the urine.

[David A Burks, MD]

I'm happy your symptoms are getting better. It doesn't look like you had the classic findings of IC.   Its unclear whether your symptoms are getting better spontaneously, or a result of either the Oxytrol patch, your changing hormonal status, or some other unknown  variable.  There is no known hormonal modifying effect on bladder symptoms.  You are a mystery, but your symptoms are resolving.  I would not label you as having IC, and I hope you don't get it.  Good Luck  

[california transplant]

Dr. Burks,
I had my cysto and hydro on Monday.  The doctor said that the bladder filled to normal capacity and that small pinpoint hemorrhages were found in only 5% of the bladder, which he said could have been caused from the hydrodistension.  He said that in a true IC patient, the bladder would not have expanded to that capacity.  I have been on Oxytrol for a few weeks and this has improved my frequency.  I forgot to mention that I was breastfeeding up until 2 weeks ago.  During breastfeeding, my hormone levels (estro and progest) were extremely low.  Now that I've stopped bfdg, my hormones have increased and my symptoms are improving.  Is there a relation between hormone levels and urinary frequency symptoms?  I was just curious.  Thanks again for your response.  I hope that through your diligent research, other patients will continue to be helped with their urinary symptoms.  Thank you.