Standard Investigations

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Standard investigations and treatments

What happens when you are referred for more tests?

Urinary tract infection (UTI) sufferers for whom short courses of antibiotics haven’t worked and whose dipstick tests and urine cultures fail to show infection are usually referred for further tests. At this point, GPs and urologists have usually discounted bacterial infection as a cause of their patient’s urinary symptoms.

Common investigations for chronic lower urinary tract symptoms

  • Ultrasound
    A scan of the kidneys and bladder to detect anatomical abnormalities of the urinary tract
  • Cystoscopy
    A camera is inserted into the bladder to check the bladder wall and rule out bladder cancer
  • Biopsy
    Tissue is taken from bladder wall to look for ulcers
  • Urodynamics
    The bladder is filled with fluid while the patient is catheterized to measure how the bladder and urethra store and release urine.

Tests often find no cause for symptoms having already dismissed bacterial infection

These tests typically find no cause for the symptoms patients suffer from.  This leads many people to be diagnosed with interstitial cystitis (IC), bladder pain syndrome (BPS), urethral syndrome (US) or overactive bladder (OAB). These conditions are ‘diagnoses by exclusion’ meaning that no physical cause can be found.

IC, PBS, US and OAB instead describe groups of symptoms – including pain, urgency, frequency, difficulty passing urine and incontinence – often with inflammation or ulcerations in the bladder wall.  Inflammation can also be caused by an infection.

Standard treatment options are bleak

The medical consensus on IC, PBS, US and OAB is that they are poorly understood and incurable. As no treatment does very well in trials, there is no universally agreed care pathway.

There is no evidence to show that any of these treatments are suitable for treating chronic or recurrent urinary infections. Instead, they:

  • Offer no cure1
  • Give just limited, or no relief to symptoms1
  • Have significant side effects and potential for severe harm2,3
  • Are untested on children, yet children as young as six have undergone them4
  • Can lead to loss of quality of life and productivity, low self-esteem, and psychological harm when patients fail to benefit from repeated treatments despite reassurances from doctors5.

 

Standard treatments for chronic lower urinary tract symptoms

Surgical interventions could include:

  • Urethral dilation
  • Bladder stretch
  • Bladder instillations (mixtures of medicines, painkillers or botulinum toxin (Botox) put directly into the bladder)
  • Bladder enlargement (augmentation cystoplasty)
  • Bladder removal
  • Sacral nerve stimulators (device implanted at the base of the spine)

Risks with surgical interventions can include

  • Pain and bleeding
  • Further infections
  • Urinary retention
  • Urethral swelling
  • Bladder damage
  • Risks associated with general anaesthetic (if given)
  • Needing to self-catheterise to empty the bladder

Drug based treatments including side effects:

Cimetidine – an antihistamine
Side effects include feeling dizzy, depressed, or agitated; breast swelling or tenderness (in men); joint or muscle pain; mild skin rash; headache; diarrhoea; nausea or constipation

Oxybutynin – an anticholinergic drug that relaxes the bladder muscles
Side effects include being unable to urinate; constipation; dry mouth; blurry vision; dizziness; drowsiness; sweating less than usual; insomnia; headache

Vesicare – an anticholinergic drug that relaxes the bladder muscles
Side effects include: dry mouth, blurred vision and light sensitivity; increased pressure in the eye; hot and flushed skin; dry skin; abnormal heart rate, palpitations and arrhythmias; urinary retention; constipation

Betmiga – a bladder muscle relaxant
Side effects include: headache; joint pain; dizziness, blurred vision; tiredness; dry mouth; stomach pain; nausea; diarrhoea; constipation; bloating; sinus pain; sore throat

Elmiron – (pentosan polysulphate) thought to coat and protect the bladder wall
Side effects: hair loss, diarrhea, nausea, blood in the stool, headache, rash, upset stomach, abnormal liver function tests, dizziness and bruising

Cystistat – a liquid put directly into the bladder to coat the bladder wall

Amitriptyline – a tricyclic antidepressant also used to treat chronic pain
Side effects include: constipation, diarrhoea; nausea, vomiting, upset stomach; mouth pain, unusual taste, black tongue; appetite or weight changes; itching or rash; breast swelling; decreased sex drive, impotence, or difficulty having an orgasm

Gabapentin – an epilepsy medication also used to treat chronic pain
Side effects include: dizziness, drowsiness, weakness, tired feeling; nausea, diarrhoea, constipation; blurred vision; headache; breast swelling; dry mouth; loss of balance or coordination

Opioid painkillers
Side effects can include constipation; drowsiness; nausea; vomiting; addiction/risk of tolerance/worsening pain

So, what tests and treatment are there for chronic UTI?

Early detection is key to preventing chronic UTI. Find out about tests here and treatment options for chronic UTI, the links below open in a different website.

https://www.chronicutiinfo.com/treatment/conventional-medicine/antibiotics/

https://www.chronicutiinfo.com/treatment/conventional-medicine/hiprex/

https://www.chronicutiinfo.com/treatment/conventional-medicine/vaccines/

https://www.chronicutiinfo.com/treatment/conventional-medicine/uk-treatment/

CUTIC does not endorse any specialists or treatments and recommends that you carry out your own due diligence.

References

  1. Kavvadias T, Baessler K, Schuessler B. Pelvic pain in urogynecology. Part II: treatment options in patients with lower urinary tract symptoms. Int Urogynecol J 2012; 23(5): 553- 61.
  2. Santucci RA, Payne CK, Anger JT, Saigal CS; Urologic Diseases in America Project. Office dilation of the female urethra: a quality-of-care problem in the field of urology [published correction appears in J Urol 2009; 181(5):2390. Anger JT]. J Urol 2008; 180(5): 2068-75.
  3. Nalamachu S. An overview of pain management: the clinical efficacy and value of treatment. Am J Manag Care 2013; 19(14 Suppl): s261-s6.
  4. ICA (interstitial cystitis America). Available at: IC/BPS in Children | Interstitial Cystitis Association (ichelp.org)
  5. https://www.ncbi.nlm.nih.gov/m/pubmed/9676411/