Distinguishing Between Urological and Gastrointestinal Issues: A Patient's Journey

Uncertain whether it is a urinary tract issue or a gastrointestinal disease?

Hello, Doctor.
In order to help you accurately assess my possible condition, I have detailed my medical history as much as possible.
Initially, I experienced a urinary tract infection due to unprotected sexual intercourse, which resulted in burning during urination and white discharge from the urethra.
I visited a urology clinic and took antibiotics for four days.
However, I occasionally still felt some itching.
Due to my busy schedule at the time, I waited a month until the symptoms worsened before returning for a follow-up.
After taking antibiotics for about two weeks, my symptoms nearly resolved.

About five days later, I began to experience mild swelling and pain around the base of the penis (without increased frequency of urination).
After three or four days, I returned to the same urology clinic, where the doctor suggested it might be muscle strain or inflammation.
However, the symptoms did not improve; the swelling and pain sometimes radiated to other areas of the lower body.
After some time, I developed mild urinary frequency, which was not typical urgency but rather a slight urge accompanied by a dull sensation.
After urination, I felt somewhat relieved, and this occurred approximately once an hour, with urine volume being about half of what it normally is (the two "@" represent about a month’s time).
Two days ago, I visited the urology clinic again, and a urine test showed normal results (the type of test where results are available immediately).
The doctor suspected prostatitis and prescribed TINTEN extra, SONGORA, WEIDOSON, TAMLOSIN D, and DITROPAN (the doctor mentioned to take DITROPAN for urinary frequency, but I did not take it since my symptoms were mild).
Additionally, over the past week or two, I have experienced increased flatulence (relief after passing gas) and discomfort in the anal area, which worsens after prolonged sitting.
Therefore, I consulted a gastroenterologist today.
The doctor performed a digital examination and noted mild hemorrhoids, providing me with medication and suppositories for the condition.

Currently, I am taking medications from both the gastroenterology and urology departments.
My remaining symptoms include increased flatulence and perineal and anal discomfort after sitting for long periods.
The swelling and pain have significantly improved after taking a hot shower for one to two hours.

Could you please advise whether my symptoms are more indicative of a urinary system disorder or a gastrointestinal disorder? Or would you recommend any further tests?

QQ, 10~19 year old female. Ask Date: 2020/03/29

Dr. Chen Shidian reply Gastroenterology and Hepatology

It is advisable to collaborate with two specialists for joint diagnosis and follow-up, as well as to prevent recurrent urinary tract infections.

Reply Date: 2020/03/29

More Info

Based on your detailed medical history and the symptoms you've described, it appears that you are experiencing a complex interplay of urological and gastrointestinal issues. This can often make diagnosis and treatment challenging, as symptoms from one system can mimic or exacerbate issues in another.
Initially, your symptoms began with a urinary tract infection (UTI) following unprotected sexual intercourse, which is a common cause of such infections. The treatment with antibiotics seemed to alleviate the symptoms temporarily, but the recurrence of discomfort and the development of new symptoms, such as pain in the base of the penis and mild frequency of urination, suggest that there may be an underlying issue that has not been fully addressed.

The fact that your urinalysis returned normal indicates that there may not be an active infection at this time. However, the suspicion of prostatitis (inflammation of the prostate) is plausible, especially given your symptoms of pelvic discomfort and urinary frequency. Prostatitis can be tricky to diagnose and may require further evaluation, such as a prostate-specific antigen (PSA) test or even a prostate exam, depending on your age and risk factors.

On the gastrointestinal side, the presence of flatulence and discomfort in the anal region, along with the diagnosis of mild hemorrhoids, suggests that there may be some gastrointestinal involvement as well. Hemorrhoids can cause discomfort, especially after prolonged sitting, and can be exacerbated by straining during bowel movements. The fact that you find relief after warm baths indicates that your symptoms may be related to muscle tension or inflammation in the pelvic region, which can be influenced by both gastrointestinal and urological conditions.

Given the overlap of symptoms, it would be prudent to consider the following steps:
1. Continued Monitoring: Keep track of your symptoms, noting any changes or patterns. This can help your healthcare provider in making a more accurate diagnosis.

2. Follow-Up with Urology: Since you have already been evaluated by a urologist, it may be beneficial to return for further assessment, especially if your symptoms persist or worsen. Discuss the possibility of prostatitis and whether additional tests, such as imaging or a prostate exam, are warranted.

3. Gastrointestinal Evaluation: Since you have also been experiencing gastrointestinal symptoms, a follow-up with a gastroenterologist may be beneficial. They may recommend tests such as a colonoscopy or imaging studies to rule out any underlying gastrointestinal issues that could be contributing to your symptoms.

4. Lifestyle Modifications: Consider dietary changes that may alleviate gastrointestinal symptoms, such as increasing fiber intake to help with bowel regularity and reducing foods that may cause gas. Additionally, managing stress and ensuring regular physical activity can also help with both gastrointestinal and urological health.

5. Pain Management: For the discomfort you experience, especially related to hemorrhoids, topical treatments and sitz baths can provide relief. If pain persists, discussing pain management options with your healthcare provider may be beneficial.

In conclusion, your symptoms appear to be a combination of urological and gastrointestinal issues, and a multidisciplinary approach may be necessary for effective management. It is essential to maintain open communication with your healthcare providers and advocate for further testing if your symptoms do not improve. Your health and comfort are paramount, and addressing these issues holistically will likely yield the best outcomes.

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