Urinary Issues: Painful Urination and Menopause Effects

Q: Urinary Issues: Painful Urination and Menopause Effects

Hello： Because the symptoms resemble a urinary tract infection, it is possible for the urine test at a large hospital to come back normal, especially after taking antibiotics for a few days (from a clinic). <br>However, some infections require a longer course of treatment to full

Urinary problems

Hello Doctor, my mother has been experiencing pain, a burning sensation, and urgency during urination.
Initially, she visited a small clinic where her urine was tested and showed signs of inflammation.
The doctor prescribed antibiotics, but after three days there was no improvement.
She returned to the clinic, and the doctor noted some improvement in the inflammation and advised her to continue the medication.
However, after two more days, her symptoms persisted, so she went to a larger hospital for further evaluation.
The doctor conducted a urine test and an X-ray, stating that there were no bacteria present and suggested that it might be related to menopause, which my mother has been experiencing for over ten years without any prior issues like this.
The doctor concluded that since the urine test and X-ray were normal, there was no urological problem, and prescribed a hormonal cream for her to apply, claiming it would help.
Unfortunately, there was still no improvement.
Subsequently, my mother consulted a gynecologist, who found no bacteria during the internal examination and suggested we return to the urology department.
Doctor, my mother has been dealing with this situation for almost a month now.
What could be the underlying factors? What further tests should we consider?

Mai Mai, 30~39 year old female. Ask Date: 2019/09/14

Dr. Du Shixi reply Urology

Hello: Because the symptoms resemble a urinary tract infection, it is possible for the urine test at a large hospital to come back normal, especially after taking antibiotics for a few days (from a clinic).
However, some infections require a longer course of treatment to fully resolve due to their tendency to recur.
Currently, it is important to pay attention to lifestyle factors, such as ensuring adequate hydration, checking for constipation, assessing for diabetes, and determining if urination is painful or if symptoms improve after urination.
All of these factors can be considered.
If urinary tract infection symptoms persist, it is advisable to repeat the urine test.
Results can vary slightly depending on the timing of the tests.
As for what further examinations may be necessary, that should be determined by a physician's evaluation.
Generally, more invasive procedures such as cystoscopy or urodynamics may be recommended, and this should be assessed by a doctor.
It is also suggested to refer to the resources provided by the Urological Association.
http://www.tua.org.tw/tua/tw/publications#衛教出版品.
Wishing you good health.

Reply Date: 2019/09/14

More Info

It sounds like your mother is experiencing a complex set of urinary symptoms, including painful urination, frequent urination, and a burning sensation. Given her history of menopause for over ten years, it’s important to consider how hormonal changes can affect urinary health.
Firstly, the symptoms your mother is experiencing could be attributed to a condition known as atrophic vaginitis, which is common in postmenopausal women. This condition occurs due to decreased estrogen levels, leading to thinning and inflammation of the vaginal and urethral tissues. As a result, women may experience symptoms such as pain during urination, increased frequency of urination, and a burning sensation.
The initial treatment with antibiotics was appropriate given the initial suspicion of a urinary tract infection (UTI). However, since the urine tests and X-rays did not reveal any bacterial infection, it suggests that the symptoms may not be due to an infection but rather to the effects of menopause. Hormonal treatments, such as estrogen creams or vaginal rings, are often prescribed to alleviate these symptoms by restoring moisture and elasticity to the vaginal tissues.

If your mother has been using the hormone cream as prescribed and has not seen improvement, it may be beneficial to explore other potential causes of her symptoms. Here are some suggestions for further evaluation:
1. Urodynamic Testing: This test assesses how well the bladder and urethra are functioning. It can help determine if there are issues with bladder storage or emptying that could be contributing to her symptoms.

2. Cystoscopy: This procedure involves inserting a thin tube with a camera into the bladder to visually inspect for any abnormalities, such as inflammation or lesions that may not be detected through imaging.

3. Pelvic Floor Assessment: Sometimes, pelvic floor dysfunction can lead to urinary symptoms. A physical therapist specializing in pelvic health can evaluate and provide treatment options.

4. Dietary and Lifestyle Factors: Encourage your mother to consider her fluid intake, caffeine consumption, and any irritants in her diet that may exacerbate her symptoms.
5. Alternative Treatments: If hormonal treatments are not effective, some women find relief through alternative therapies such as vaginal moisturizers or lubricants, which can help alleviate dryness and discomfort.

6. Follow-Up with Specialists: Since your mother has already seen both urologists and gynecologists, it may be helpful to seek a second opinion or consult a specialist in female pelvic medicine and reconstructive surgery, who can provide a more comprehensive evaluation of her symptoms.

In conclusion, while menopause can significantly impact urinary health, it is essential to rule out other potential causes of your mother’s symptoms. Continued communication with healthcare providers and advocating for further testing will be crucial in finding an effective treatment plan. Encourage your mother to keep a symptom diary, noting when the pain occurs, its severity, and any other associated symptoms, as this information can be valuable for her healthcare team in diagnosing and managing her condition.

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