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Urology/bladder irritation/No UTI/possible kidney stones

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Question
Dear Doctor,
I am an 28 yrs old female, living in Europe.
I have been experiencing lots of irritation in my bladder for about 3 months now (started mid September). The urine analysis, cultute and the tests (ultrasound) the urologist perfored did not show any problem (like bladder infection due to bacteria etc).He thought that we should do a cystoscopy (but I was relactant).
 I also had all the gynecological tests and nothing showed up there. I have this urge to urinate and have a slight pain-irritation in my bladder and sometimes in my back. The irritation changes form. Sometimes it is like a burning sensation (not while urinating, but a general sense of burn throughout the day). The last urine analysis showed amorphous phosphate calcium crystals in urine and alkaline urine(even though I drink lots of water, I mean I do not think this showed up due to lack of liquids intake). My urologist suggested that those crystals might have been causing this irritation. (My father suffers from kidney stones).
 I have been drinking lots of water and herbal teas. One doctor I spoke with over the phone suggested Bactrim antibiotic.The thing is that noone has prescribed anything to me, neither something that could calm down the urge to visit the bathroom. Because mostly I feel I need something to soothe the area. When I drink lots of water, it feels somewhat better.
 According to you:1) should I take antibiotics, even though the urine analisis do not show up any bacteria? in order to rule out any potential UTI? (maybe there is a some bacteria that do not show up in urine analisis). 2) If I do not take antibiotics,what can I do to feel better? It has been going on for 3 months now and I am feeling very disappointed and sad, not being able to function as I used to. 3) I haven't ruled out IC, but I guess I would have different symptoms, because when I visit the bathroom, I do have urine and then the symptoms are not present all day long, all days (I guess with IC you do get the symptoms continuously. I mostly feel the strong urge to urinate, no burning during urination and a discomfort in the abdomenal area and in the muscles inside my bladder. The first days (mid September) it felt like a UTI, because I would go to the bathroom almost every 10 minutes and the urge to urinate was unbearable. Luckily then the symptoms changed, as I described above.
 Hope you can help, because what the doctors have been telling have confused me a lot. In this point I wish it as as easy as an UTI.
Thank you in advance for your time to read this. I could really, really use your advise as a guidance on what to do next.
Your sincerely

Answer
Teresa:

A trial of antibiotics such as doxycycline (which covers alot of unusual organisms that might not show up on a standard urien test) would be reasonable and so would a cystoscopy.  A voiding diary would help clarify the actual problem and a bladder pressure test might show if the bladder muscle is overactive or hyperactive.  I don't understand why no attempt at treatment has been done yet.

Interstitial cystitis is certainly a possibility.  It is not required to have the symptoms continuously in order to have this diagnosis.

My advice:

Try a course of antibiotics and see if you can find a urologist at a tertiary care university hospital or clinic that is willing to look into this for you.  

Avoid caffeine and hot spicy foods which tend to aggravate urinary problems.  Good luck.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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