Hematuria with pain

[lizgordon24]

Hello.  I am just desperate for someone to just give me an opinion in which I realize that you can't give a diagnosis.  I have been in and out of the doctor's for the past month.  I went in because I thought I was just getting a bladder infection.  I gave a urine sample, but there was not any signs of a uti, but blood was found in my urine under a microscope.  I was still given an antibiotic in which is still have pain.  The sent me in for a ct scan, and that came up negative for tumors on my kidneys and for stones.  I had an ivp done over a week ago, and will find out the results when i go to the urologist on the 29th of Feb.  I also went to the gyncologist and when she touched the bladder area it bothered me afterwards, but nothing else she touched did.  She really thinks it points to my bladder but did not want to give a diagnosis since she's only going by my symptoms and my bladder being sore when touched.  My pain is so hard to figure out where it's coming from.  It's a pain in which is on and off and gets worse as the day goes by at first, but now starts a lot earlier during the day.  Sometimes it feels as if it's off to the right on ab area, but then seems like it's just above pubic bone center of abdomen.  Sometimes I feel like I'm swelled up down there in certain areas while I am working. I have always had uti since I was at least 18.  If you put just enough pressure on my bladder it hurst and then throbs afterwards.  Sometimes I think I have ic since I do also have pain when my bladder fills up and I urinate 2 to 3 times in the middle of the night.  Hot baths do help with the symptoms, but not so much now, and the vicodin 500 mgs does not do me any good at all.  Thanks for taking your time to read my story.  Liz

[Vanessa Lacuesta]

Hi,

There is no definite diagnostic tool for interstitial cystitis. But it is a differential for  long term pelvic pain in the absence of a UTI. Given that a complete gynecologic examination was done, urine void cytology may be done as well as this may help ascertain the cause of the hematuria.

[lizgordon24]

Hi,
I know what you mean about being concerned, and I am so stressed and when I get upset my pain seems to worsen.  I am pretty sure that the protein came back normal.  I have not done a void cytology yet.  It's funny that you mentioned IC which I believe is Interstitial Cystitis, and when I visited my gynecologist she had asked if I had been tested for it.  I know other things must be ruled out before it can be diagnosed.  Thanks again!

[Vanessa Lacuesta]

Hi,

There are two sources of concern here: Pain and the hematuria.

Microscopic hematuria and its source may be hinted based on microscopy. The appearance, shape and size of the red blood cells may give the examiner an idea on where the RBCs come from. Since you present with pain , your hematuria needs to be further evaluated. Your scans came back fine. However other aspects of the urine also need to be assessed. Were there casts or crystals present? How about protein
( albumin) levels in the urine? Was urine void cytology done?

Let us wait for the cystoscopy. If this is normal, a potassium sensitivity test for IC may be an option and other factors need to be ruled out like chronic pelvic pain syndrome secondary to pelvic myalgia, pelvic congestion, musculoskeletal and neuropathic causes.

[lizgordon24]

Thanks for getting with me.  They did send my urine to a lab for a urinalysis and that came back negative along with my pap, The blood is microscopic,  I believe that they did also measure my renal function and that also came back fine, and don't remember what the reading was, but they said nothing showed up on the ct scan.  As for the 24 hour urine collection I'm not sure if I did or not.  I also had an ivp but do not know what the results were on that.  Everytime that I have given a urine sample blood has always been found microscopically.  I know a lot of times when blood is found in the urine it can be nothing, and just to continue with follow ups in the future, but my pain just continues and the vicodin in which I absolutely won't take unless the pain is not tolerable then I will take one but even then it just doesn't kill the pain.  If the cystoscope procedure doesn't show any signs of problems then what is next since this pain keeps continuing.  Thanks for your time.

[Vanessa Lacuesta]

Hi,

Is your hematuria ( blood in urine ) gross or microscopic?

Any other urinalysis findings such as casts, white blood cells and crystals?

Hematuria needs further evaluation and I think you are currently being assessed along this line. A lower urinary tract disorder involving the urethra, bladder and kidneys may be considered. The small units of the kidneys called glomerulus may also  present with hematuria.

Have you had  a 24 hour urine collection done?

How is your renal function? Was it measured?