Persistent Bladder Pain: Causes and Treatment Options

Q: Persistent Bladder Pain: Causes and Treatment Options

David： If it is temporarily inconvenient to perform a cystoscopy, you can start by keeping a voiding diary： 1. Record the time and volume of each urination. 2. Note the time and amount of water intake. 3. Keep this record for at least 3 days, preferably a week

Persistent pain in the bladder area?

Hello Doctor! I would like to ask for your advice.
At the beginning of September, I suspected I had a urinary tract infection.
All tests from Western medicine came back normal, with no pathogenic bacteria detected, but I still experienced symptoms of a urinary tract infection (burning and pain during urination, etc.).
Therefore, I sought treatment from a traditional Chinese medicine practitioner.
Based on my reported symptoms, the practitioner suspected a possible Chlamydia infection (however, my Chlamydia DNA enzyme test from Western medicine was negative).
Since the traditional medicine practitioner suggested this, I hesitantly took Chinese herbal medicine for two courses (a total of one month).
The alarming part is that during the medication period, I did experience gradual improvement, but after stopping the medication a month later, starting this past Monday, I began to experience severe pain in my lower abdomen near the bladder (lower abdominal area), accompanied by burning, stabbing, itching, and a feeling of fullness.
The pain is almost unbearable, and I find some relief only when lying down or leaning on a table.
Consequently, I sought help from Western medicine again.
I am still in pain and can only take the painkillers and smooth muscle relaxants prescribed by the doctor for relief.
I have undergone venography, renal ultrasound, colonoscopy, and transrectal prostate ultrasound, all of which showed no findings...
no signs of stones...
the only test I haven't done is a cystoscopy.
I also discussed with the urologist whether it could be "interstitial cystitis," but he does not believe so.
However, I have been in pain for seven days now, and it persists...
Taking painkillers and resting (lying down for a few minutes alleviates the pain somewhat) helps, but as soon as I stand up, the pain returns.
My initial urinalysis showed hematuria, with the first RBC count at 50-100, which then decreased to 4-6, and later to 0-5, eventually normalizing to 0-2.
Recent urinalysis results have all been normal (only slightly low specific gravity).
The doctor explained that since the urinalysis results are normal, he sees no reason to perform a cystoscopy.
He also mentioned that the health insurance bureau is very strict regarding this matter, and if there is nothing significant, directly performing a cystoscopy would cause complications.
The course of my condition has been long and recurrent, and I feel tormented...
I really don’t know what to do...
Thank you for your response, helpless David.

david, 20~29 year old female. Ask Date: 2012/12/18

Dr. Xu Weikai reply Urology

David: If it is temporarily inconvenient to perform a cystoscopy, you can start by keeping a voiding diary: 1.
Record the time and volume of each urination.
2.
Note the time and amount of water intake.
3.
Keep this record for at least 3 days, preferably a week, to get a better understanding of your urination patterns.
If there are significant issues, this information can serve as a basis for further examination.
Additionally, it may be due to autonomic nervous system dysfunction, which is often caused by lack of exercise, irregular sleep patterns, or excessive stress.
It is recommended to undergo urodynamic testing and cystoscopy.
Certain infections (such as viral infections) or chronic inflammation may not always show abnormalities in urinalysis.
Furthermore, applying heat to the lower abdomen and performing massage, as well as keeping the calves warm to maintain good circulation, may help improve the situation.
Regular exercise is advisable, ideally more than three times a week, with each session lasting at least 30 minutes at a level that induces sweating; or maintaining a heart rate above 130 beats per minute for more than 3-5 minutes (depending on individual fitness).
This can help improve autonomic nervous system function.
If you have any further questions, feel free to ask, and we can discuss and research together.
Online responses should only be used as a reference; if necessary, you should seek medical attention at a healthcare facility.
This message is from Dr.
Hsu Wei-Kai, Director of Urology, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2012/12/18

More Info

Hello David,
I'm sorry to hear about the persistent pain you're experiencing. It sounds incredibly frustrating, especially after undergoing numerous tests and treatments without a clear resolution. Let's break down your situation and explore potential causes and treatment options for your bladder pain.

Understanding Your Symptoms
From your description, it seems you have been dealing with symptoms consistent with a urinary tract infection (UTI), including burning during urination and lower abdominal pain. However, the absence of detectable pathogens in your tests complicates the diagnosis. The fact that you experienced some relief with traditional Chinese medicine (TCM) suggests that there might be underlying factors that are not being addressed by conventional Western medicine.

Possible Causes
1. Interstitial Cystitis (IC): Although your doctor does not believe this is the case, IC is characterized by chronic bladder pain and can occur without visible inflammation or infection. Symptoms often include urgency, frequency, and pain that can be exacerbated by certain foods or stress.

2. Chronic Pelvic Pain Syndrome (CPPS): This condition can cause significant discomfort in the pelvic region, and it may not always be linked to an identifiable infection. CPPS can be influenced by psychological factors, muscle tension, or nerve irritation.

3. Nerve Irritation or Damage: Given that your pain seems to improve when lying down, it could be related to nerve issues in the pelvic area. Conditions like pudendal neuralgia can cause similar symptoms.

4. Muscle Tension: Pelvic floor dysfunction or muscle spasms can lead to significant pain and discomfort. This is often overlooked but can be a significant contributor to chronic pelvic pain.

5. Other Conditions: Conditions such as endometriosis, fibroids, or even gastrointestinal issues can sometimes present with similar symptoms, so it's essential to consider a comprehensive approach.

Treatment Options
1. Further Evaluation: If you haven't had a cystoscopy (bladder scope), it might be worth discussing again with your urologist. This procedure can help visualize the bladder's interior and rule out conditions like IC or bladder lesions.

2. Pain Management: Since you are currently taking pain medications, it may be beneficial to explore other options, such as physical therapy focused on the pelvic floor, which can help alleviate muscle tension and improve function.

3. Dietary Modifications: Some patients with IC or bladder pain find relief by avoiding certain foods and beverages that irritate the bladder, such as caffeine, alcohol, spicy foods, and artificial sweeteners.

4. Bladder Training: This involves gradually increasing the time between urinations to help retrain the bladder and reduce urgency.

5. Alternative Therapies: Since you found some relief with TCM, you might consider continuing with those treatments alongside conventional medicine. Acupuncture and herbal remedies may provide additional support.

6. Psychological Support: Chronic pain can take a toll on mental health. Cognitive-behavioral therapy (CBT) or mindfulness practices can help manage the emotional aspects of chronic pain.

Communicating with Your Doctor
When discussing your concerns with your healthcare provider, it’s essential to be clear about your symptoms, their impact on your daily life, and your desire for further investigation. You might say something like:
"I understand that my tests have come back normal, but I am still experiencing significant pain. I would like to discuss the possibility of interstitial cystitis or other conditions that might not show up in standard tests. Could we consider a cystoscopy or referral to a specialist in chronic pelvic pain?"

Conclusion
Your situation is undoubtedly complex, and it may require a multidisciplinary approach to find relief. Don't hesitate to advocate for yourself and seek a second opinion if you feel your concerns are not being addressed adequately. Chronic pain can be challenging, but with the right support and treatment plan, improvement is possible.
I wish you the best in your journey toward relief and recovery. Please feel free to reach out if you have more questions or need further assistance.

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