Unexplained Urethritis: Persistent Pain and Discomfort Solutions

Unexplained urethritis?

Hello Dr.
Wang, I have experienced a burning sensation during urination and pain at the urethral opening three times in the past two months.
However, each time I have undergone urinalysis, the results have been normal, and no infection has been identified, yet I continue to experience frequent urination and pain.
The physician who treated me previously did not prescribe antibiotics but instead provided pain relief and anti-inflammatory medication.
After taking the medication for a few days, I experienced temporary relief.
However, the urethritis keeps recurring, and I can no longer tolerate it.
I would like to ask Dr.
Wang what I should do.

Ms. Wu, 10~19 year old female. Ask Date: 2016/10/12

Dr. Wang Weijie reply Internal Medicine

Dear Ms.
Wu,
Thank you for your letter.
A urinary tract infection (UTI) occurs when bacteria invade the urinary system, leading to infection.
Common symptoms include: 1.
A burning sensation, pain, difficulty urinating, frequent urination, nocturia, cloudy urine, or hematuria during urination.
2.
Persistent fever and chills.
3.
Lower abdominal pain and discomfort in the lower back.

The causes can be attributed to personal factors such as holding in urine, low fluid intake, and incorrect wiping direction after using the restroom.
Disease factors include congenital bladder hypoplasia, diabetes, kidney disease, urinary stones, prolonged bed rest, long-term catheterization, and paralysis of the lower body.
Recommendations:
1.
Develop good personal hygiene habits:
- Wear cotton underwear.

- Wipe from front to back after using the restroom.

- Prefer showering over taking baths or using saunas.

- Change diapers frequently for infants to maintain cleanliness and dryness.

2.
Unless there are specific medical restrictions, daily fluid intake should be 2000-3000 cc; infants should consume an appropriate amount of fluids as guided by healthcare professionals.
3.
After returning home, the physician will prescribe oral antibiotics.
Although symptoms may improve within 1-2 days of medication, please ensure that all antibiotics are taken as directed to completely control the bacteria in the urinary tract.
4.
It is advisable to drink 250-300 cc of water before and after sexual intercourse, shower afterward, and completely empty the bladder.
5.
Consume foods rich in vitamin C, such as orange juice, to acidify the urine.
6.
Cranberry juice may be consumed to reduce bacterial adhesion (specifically E.
coli) to the bladder mucosa.
If symptoms do not improve, it is recommended to seek further treatment at a hospital.
Wishing you health, safety, and peace of mind.
Sincerely,
Dr.
Wang Wei-Jie
Deputy Director, Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2016/10/12

More Info

Unexplained urethritis, characterized by persistent pain and discomfort, can be a challenging condition to manage, especially when standard tests fail to identify an underlying infection. Your symptoms of burning during urination and urethral pain, coupled with normal urine test results, suggest that you may be dealing with a non-bacterial form of urethritis or chronic pelvic pain syndrome (CPPS). Here’s a comprehensive approach to managing your symptoms and improving your quality of life.

Understanding Your Condition
1. Non-Bacterial Urethritis: This condition can arise from various factors, including irritation from soaps, lotions, or even certain foods. It may also be linked to stress or anxiety, which can exacerbate symptoms. In some cases, the cause remains idiopathic, meaning it cannot be identified.

2. Chronic Pelvic Pain Syndrome (CPPS): This syndrome is often categorized into inflammatory and non-inflammatory types. The non-inflammatory type, which you may be experiencing, does not show signs of infection but can still cause significant discomfort.

Treatment Options
1. Pain Management: Since you have already been prescribed pain relief medications, it’s essential to continue using them as needed. Over-the-counter options like ibuprofen or acetaminophen can help manage pain and inflammation. However, be cautious with prolonged use, as it can lead to gastrointestinal or liver issues.

2. Lifestyle Modifications:
- Hydration: Increasing your water intake can help dilute urine and reduce irritation during urination.

- Dietary Changes: Avoid spicy foods, caffeine, alcohol, and acidic foods that may irritate the bladder and urethra.

- Regular Exercise: Engaging in regular physical activity can help alleviate stress and improve overall well-being.

3. Physical Therapy: Pelvic floor physical therapy can be beneficial for individuals with CPPS. A trained therapist can help you learn exercises to relax and strengthen pelvic muscles, which may alleviate pain.

4. Behavioral Therapy: Cognitive-behavioral therapy (CBT) can be effective in managing chronic pain conditions. It helps address the psychological aspects of pain and can provide coping strategies.

5. Alternative Therapies: Some patients find relief through acupuncture, biofeedback, or mindfulness meditation. These approaches can help manage pain and reduce stress.

6. Follow-Up Care: Regular follow-ups with a urologist or a specialist in chronic pelvic pain can help monitor your condition and adjust treatment plans as necessary. If symptoms persist, further evaluations such as cystoscopy or imaging studies may be warranted to rule out other conditions.

When to Seek Further Help
If your symptoms do not improve with conservative management or if you experience new symptoms such as fever, chills, or blood in urine, it is crucial to seek immediate medical attention. These could be signs of a more serious underlying condition.

Conclusion
While unexplained urethritis can be frustrating and painful, a multifaceted approach that includes pain management, lifestyle changes, and possibly physical therapy can significantly improve your symptoms. It’s essential to maintain open communication with your healthcare provider to tailor a treatment plan that works for you. Remember, you are not alone in this journey, and with the right support and strategies, relief is possible.

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