Women's Health Community

Dear An: You may have what one uro-gynecologist friend calls "The UTI That Isn't". Here are some possible explanations:

1. Urethral Syndrome
While the symptoms of frequency/urgency/pain are present in almost all true UTIs, 30-50% of patients with these symptoms do not have significant bacteria in their urine (Najar, 2009). However, many of those without bacteria may have white blood cells (sign of infection or inflammation) in their urine. This likely reflects the presence of other infections which may not be bacterial. The presence of white blood cells, no bacteria, and UTI symptoms is the one common description of "urethral syndrome."

Many of the organisms thought to be causes of urethal syndrome are also causes of vaginal infections. Included in this category are Chlamydia, Ureaplasma urealyticum, gonorrhea and trichomonias. In a study of 63 women with urethral syndrome (Mutlu, 2001), evidence for Chlamydia was found in 38% of the group. The organism Ureaplasma urealyticum was identified in 192 women with urethral syndrome (Skerk, 2001).Less commonly, a genital herpes lesion within the urethra can prompt urinary symptoms. Even a vaginal yeast infection, while it does not infect the urethra, can be associated with pain as the urine stream touches irritated skin on the vulva--but you have been treated for this.

2. Overactive Bladder Syndrome
Overactive Bladder (OAB) can be distinguished from a UTI, or urethral syndrome, by the absence of any type of infection. Moreover, OAB does not cause pain with voiding. The hallmark of OAB is pronounced urgency and frequency. Many women have episodes of incontinence where large amounts of urine are suddenly released---often as they run for the toilet. Most GYNs are adept at diagnosing OAB; it can be confirmed by urodynamic studies. OAB is thought to be caused by the inappropriate firing of nerves in the bladder wall. These impulses tell the brain that the bladder is full and needs to be emptied, even if there are only small amounts present. Treatments include Kegel exercises, bladder training, lifestyle changes, and medications to decrease the inappropriate urge to void.

3. Anatomic Abnormalities
Less commonly, pain coupled with urgency and frequency may indicate an anatomic problem. Fletcher and Zimmern (2009) list urethral diverticulum, a cyst of the Skene's gland, and strictures/narrowing of the urethra as conditions to be ruled out. A urethral diverticulum is a small "pouch" in the urethral canal where urine can collect. Skene's glands are located on either side of the urethra. These glands can develop a cyst, or an abscess, which would narrow the diameter of the urethra. A stricture of the urethra would also narrow the outlet through which urine needs to pass.

4. Interstitial Cystitis/ Painful Bladder Syndrome (IC/PBS)
IC/PBS is a characterized by urinary frequency, urgency, and lower abdominal pain where no identifiable pathology can be found (Butrick, 2003). It can be misdiagnosed as chronic UTI, OAB, or even chronic pelvic pain. Unlike a UTI, pain tends to improve with urination; unlike OAB there is an element of pain. Unlike chronic pelvic pain, one study (Warren 2008), found that pain above the pubic bone and pain in the urethra were more common than genital pain among 226 women with IC/PBS.

Anon_240957, as you can note, not everyone with urethral syndrome has evidence of infection (ie white blood cells or positive bacterial screens). It's OK to let your urologist know that the symptoms are still present. In some cases medications may be used (even pyridium or imipramine) to treat the symptoms just until the pain receptors stop firing without an apparent cause. I remember one patient who had a series of multiple, confirmed UTIs which left a residual of UTI-like symptoms despite sterile urine cultures.

Yours,
Jane

I'm a 56 year old female and had the same problem and had to go to a hospital and get a cat-scan (CT scan) from severe pain. They found no infection in the urine and only diverticulosis (age bulging intestine) on x-ray except 5 golfball size fibroids (which I knew I already had-makes me look 3 mo pregnant) and one they said had calcified (died) which happened with my third child with lots of pain. They said there was nothing in that area and that my IBS might have been acting up. I do have OAB. They gave me pain meds and said that sometimes the abdomen just has pain and it isn't explained, and it eventually went away. It was just another weird bad pain incident in this crazy life, I'm healthy and still here.
Good Luck!

Oh before all this I did have to go to my local MD and she gave me some antibiotics for diverticulitis (swolen infected colon) and still had pain.

I had problems with UTIs for many years. Sometimes there was infection but many times there was none. I had seen four urologists. Last summer I passed some small kidney stones that were checked and found to be uric acid type stones. Usually this is a symptom of gout but I don't have it. My family doctor put me on a half dose of allopurinol and I have had no problems since then. This is " an of label" use for the drug but my doctor and her partner have had good success with this approach. It is an old drug. It is inexpensive and has few side effects. I hope this is helpful.

Thanx stitcher9 I forgot to say that I've only had 3 UTI's in my whole life and didn't have many problems with them. I think I was miss diagnosed not problem because Dr.'s are only practicing medicine and we are all lab rats HA! I'm thankful for them and their knowledge.

I'm a 56 year old female and had the same problem . I also had diverticulosis .UTI test was negative, I took pain medication for several days pain but the pain got worst. I went to the emergency and tests(CT) was done and found I had an access on my bladder due to the diverticulosis. I had emergency surgery to correct and have been feeling great ever since.

The culprit could be something you're eating. I experience very similar pain after consuming anything made with Splenda (Sucralose). Try to eliminate this from your diet. It will require reading food labels because not everything is labeled as a Splenda product. The most common culprits are sugar-free products. Frankly it is a pain to avoid, especially with diabetic in-laws that use Splenda in everything. However, I've come to terms with the fact that the bladder pain and heaviness I experience afterward is just not worth it. Good luck!

Thank you all so much! I will talk over these things with my doctor and see what she thinks. It helps so much to know that other people have had the same problem and have been able to find ways to deal with it.