An ultrasound scan of a longitudinal view of a healthy right kidney
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
A scan of the kidneys and bladder to detect anatomical abnormalities of the urinary tract
A camera is inserted into the bladder to check the bladder wall and rule out bladder cancer
Tissue is taken from bladder wall to look for ulcers
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), painful bladder syndrome (PBS), urethral syndrome (US) or over-active bladder syndrome (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. But inflammation can also be caused by bacterial 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 cure 1
- Give just limited, or no, relief to symptoms 1
- Have significant side effects and potential for severe harm 2,3
- Are untested on children, yet children as young as six have undergone them 4
- 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 doctors. 5
Standard treatments for chronic lower urinary tract symptoms
Surgical treatments 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 treatments 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
Side effects 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 and treatment options for chronic UTI.
1 From ‘Pelvic pain in urogynecology. Part II: treatment options in patients with lower urinary tract symptoms.’
2 See for example http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2630407/
3 Kavvadias T1, Baessler K, Schuessler B. Int Urogynecol J. 2012 May;23(5):553-61.
For example see ’An Overview of Pain Management: The Clinical efficacy and Value of Treatment’ by S. Nalamachu. American Journal of Managed Care 2013;19(14 suppl):S261-S266
4 ICA (interstitial cystitis America)