HomeAnswersUrologyfrequent urinationWhy do I have frequent urination with pain and discomfort after catheterization during laparotomy?

Is it normal to have frequent urination with pain and discomfort after catheterization?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. K. Shobana

Published At November 30, 2021
Reviewed AtAugust 9, 2023

Patient's Query

Hello doctor,

I was admitted to a hospital for an emergency laparotomy 16 months ago to examine my abdominal fluids, but no problems were found, and I was discharged. During the laparotomy, they had placed a catheter to collect my urine which was fitted and removed. When it was removed, I experienced an extreme burning sensation in my bladder. After that catheterization, I have had symptoms like frequent urination, low volume urine, urge to urinate, nocturia, mild bladder pain, discomfort, and occasional but severe bladder cramps. These issues started when I was hospitalized last year. I have tried antibiotics, like Nitrofurantoin and Ciprofloxacin, which had no effect on me. My urination was normal while I was taking Doxycycline. And I also underwent a test for sexually transmitted infections, but the results were negative. What to do?

Please give me your suggestions.

Hi,

Welcome to icliniq.com.

These problems are common after catheterization, especially if the catheter was placed for more than a week. These symptoms can be due to inflammation of the bladder and the prostate caused by the catheter. Usually, we check urine for culture, do a flexible cystoscopy to check the lower tract, and take a bladder biopsy if required. If cystitis is ruled with biopsy, we advise adequate clear fluids intake, avoiding fizzy drinks, maintaining a low potassium diet, and avoiding spicy foods, coffee, and tea. If the symptoms persist after this, we suggest taking the tablet Detrol 1 mg (Tolterodine Tartrate). If there is no bladder inflammation, we diagnose it as an inflammation of the prostate and advise semen culture to decide on the appropriate antibiotic and start with an antibiotic course for four weeks.

I hope this has helped you.

Patient's Query

Hello doctor,

Thanks for the reply.

The nurse removed the catheter with a sudden jerk while I was standing. The catheter was placed for three days. After that, I had a severe burning sensation in my bladder. I could not urinate after that, and another catheter was inserted 24 hours later. Then the second catheter was removed after a day. I still could not urinate after the second catheter, and a third catheter was inserted to help me urinate. Since then, I have been experiencing these symptoms.

Kindly help.

Hello,

Welcome back to icliniq.com.

The catheter should not be removed in a standing position as all the muscles will be tight, which can cause injury leading to fibrosis. That is why it is advisable to get a flexible cystoscopy to assess the condition of your urinary tract. However, my differential diagnosis is stricture, inflammation of the bladder, and inflammation of the prostate gland.

I hope this has helped you.

Patient's Query

Hello doctor,

Thanks for the reply.

The nurse deflated the balloon, and the catheter immediately dropped out with force. Then I had intense pain and an extreme burning sensation in the bladder. Since then, I have had the urge to urinate frequently as soon as water enters my bladder. I have had problems like several visits to the toilet to empty my bladder and waking up at night to urinate, and very often, the urination is only drippings. But if I drink one liter of water, there will be an increased flow with most of the bladder being emptied. The antibiotics have reduced the frequency by at least 50 percent. Will antibiotic therapy resolve this?

Please help me.

Hello,

Welcome back to icliniq.com.

The possible diagnoses are stricture and inflammation of the prostate or bladder. Regarding inflammation, there might be an infection which is why the antibiotic was effective. Prostatitis needs at least four weeks of antibiotic treatment. So we need to do a semen culture to choose the appropriate antibiotic to avoid antibiotic resistance.

I hope this has helped you.

Patient's Query

Hello doctor,

Thank you for the reply.

I have mild pain in my testicles when I strain, but there is no swelling. I have a few queries regarding the same. Can this be an indication of inflammation? Why does the inflammation appear to be in more than one place? I had completely normal urination while I was taking Ciprofloxacin. Why is it so?

Please give me your suggestions.

Hi,

Welcome back to icliniq.com.

Ciprofloxacin is a good antibiotic for prostatitis, and it should be taken for at least four weeks. Or else the symptoms will recur. Prostatitis or stricture can cause testicular pain as well. The reason for the pain is that the structures in that location are interconnected.

I hope I have answered your question.

Thanks and regards.

Patient's Query

Hello doctor,

Thank you for the reply.

That was very helpful. My catheter was removed with a jerk suddenly while I was standing and caused extreme burning pain in my groin. Is it possible that the prostate gland became inflamed due to the abrupt removal of the catheter while I was standing? And would this be known as acute inflammation? If this was acute prostate inflammation, is it still possible to treat it with antibiotics? Or will the acute inflammation have progressed to chronic inflammation because I have had it for over 12 months? Is there a time limit on antibiotic treatment of acute prostate inflammation? I will now get the semen and urine culture done.

Please answer.

Thank you.

Hi,

Welcome back to icliniq.com.

Thank you for the follow-up.

The catheter was removed easily, as you said, after deflation of the balloon, so the injury to the urethra did not happen. The catheter itself can cause inflammation and infection to the prostate no matter in which position it was removed. Acute inflammation is inflammation occurring within three months. After that, it is called chronic inflammation. We treat that with antibiotics, whether it is acute or chronic, but in chronic inflammation, we need to add a few more medications. Antibiotics for prostatitis treatment are usually given for four to six weeks. That is why we wait for semen culture results before prescribing a long-term antibiotic to choose the proper one from the start. I will wait for your follow-up with the semen culture report.

I hope to hear from you soon.

Please let me know if you need further clarification.

Kind regards.

Patient's Query

Hi doctor,

Thank you for your reply.

I have had my prostate examined, and the doctor said that it feels normal. In addition, he also said that the two weeks of Ciprofloxacin could have been helpful because it has anti-inflammation properties. However, I have a few questions, if my condition is bladder inflammation, will taking Ciprofloxacin for two more weeks be of any benefit? Is prostate inflammation possible even if it feels normal during a physical examination? Can the prostate be inflamed but not swollen upon a physical examination? I have bladder spasms, and can an inflamed prostate cause bladder spasms? Are bladder spasms only linked to bladder inflammation?

Please answer.

Hi,

Welcome back to icliniq.com.

Chronic prostatitis will sometimes feel tender, and sometimes no inflammation occurs in the long term, and the pain while examining might not be there, and the size will be enlarged. If the doctor tells you that the prostate is normal, the possibility of chronic prostatitis is very low. Antibiotic therapy with Ciprofloxacin for two weeks will be sufficient for bladder infection. But inflammation of the bladder is not necessarily due to illness. That is why you still have symptoms despite completing two weeks of the antibiotic course. We will look forward to getting a flexible cystoscopy and a biopsy for diagnosis. And in addition, we might as well proceed further with MRI (magnetic resonance imaging) of your spine and urodynamic study if the biopsy is normal and you still have urgency. We shall take it step-wise. I suggest you to complete the antibiotic course. If symptoms persist, then I suggest you to proceed with flexible cystoscopy and biopsy.

I hope this has helped you.

Take care.

Patient's Query

Hi doctor,

Thank you for your reply.

Could four weeks of Ciprofloxacin help with a non-infectious bladder inflammation? The two weeks of Ciprofloxacin have helped with urgency. It is not as bad as it was.

Please share your opinion.

Hi,

Welcome back to icliniq.com.

Thank you for the follow-up.

An antibiotic will only be prescribed for a week, unlike prostate infection, which requires four to six weeks. As I mentioned, bladder inflammation does not always mean infection. Sometimes it can be cystitis that responds to drugs other than antibiotics, but we need the biopsy results to prove it. Usually, cystitis should be treated stepwise, with lifestyle modifications like avoiding fizzy drinks, reducing tea and coffee, reducing spicy food, and reducing high potassium-containing food. Also, I suggest you to drink two and a half to three liters of water daily. Then we can proceed further.

Thanks and regards.

Patient's Query

Hi doctor,

Thank you for your reply.

I underwent urine and blood tests with a urologist. Both results were normal. The physical examination of my prostate is also normal, which was done by a urologist. The urologist advised that two weeks of Ciprofloxacin may have worked because of its anti-inflammatory properties. Last night I took antihistamine tablet Loratadine and Ibuprofen. I did not wake up to urinate and had an eight-hour sleep. Does it seem that I have a non-infectious bladder inflammation? What steps would it be advisable for me to follow now? Is there a recommended medication for non-infectious bladder inflammation?

Please give me your suggestions.

Hi,

Welcome back to icliniq.com.

Thank you for consulting us on icliniq.com.

Yes, you are right. It is a non-infectious bladder inflammation and is treated with anticholinergics or sympathetic agonist drugs like tablet Tolterodine 4 mg once daily or tablet Mirabegron one tablet once daily. But still, before we use such medications, we usually do a flexible cystoscopy and bladder biopsy to confirm the diagnosis. You can start taking tablet Tolaridine 4 mg once daily, and we will see how it goes. If it does not work, then I recommend you to undergo a flexible cystoscopy and biopsy.

Thanks and regards.

Patient's Query

Hi doctor,

Thank you for your reply.

I will get a cystoscopy and all other tests and let you know. The urologist said scans and flow tests would help with the diagnosis. I will also try the lifestyle changes you mentioned. I will also try the medication you advised. How long would I need to take this medication in terms of months? Could this bladder condition improve over time? Is there a cure for non-infectious bladder inflammation?

Kindly answer.

Hi,

Welcome back to icliniq.com.

If your condition improves with medication, you can take it for three months. This condition usually will not resolve and requires lifelong medication if the diagnosis is interstitial cystitis. But if it is a simple or a non-specific inflammation, then it will improve. That is why we take a biopsy to know the diagnosis.

I hope this helps you out.

Patient's Query

Hi doctor,

Thank you for your reply.

I have been taking Loratadine for three days, and during this time, my urination has returned to normal. What does this indicate? Does this mean that the inflammation of my bladder is mild? Are the side effects of Loratadine less significant than Tolterodine?

Please answer.

Hi,

Welcome back to icliniq.com.

Loratidine is an antihistamine and will work well with bladder inflammation. We use it as a second line of treatment. The first line of treatment is anticholinergics like Tolterodine. But if your symptoms are improved with Loratidine, please continue it, and no need to start Tolterodine.

Thanks and regards.

Patient's Query

Hi doctor,

Thank you for your reply,

So this appears to be a post-catheterization bladder inflammation. I understand that a catheter was necessary, and it comes with this risk which is a common problem. It is not as bad as it was, so would I be right in thinking that this kind of inflammation can heal over time and gradually get better? Have you experienced this type of inflammation improving over time, and how long is the recovery time?

Please share your opinion.

Hi,

Welcome back to icliniq.com.

A catheter can trigger such inflammation. There are chances that it can heal on its own. You can stop the medication after three months and see how it goes. Luckily, you got the medication that is effective for you. Some cystitis is complicated to treat. Let us see how it goes.

Please let me know if you have any other concerns.

Thanks and regards.

Patient's Query

Hi doctor,

Thank you for your reply.

I am getting the some tests done which are, flow study, renal tract ultrasound, and flexible cystoscopy. I will let you know the results of these tests. I think that my condition is a urethral stricture. What are the possible treatment for catheter-induced urethral stricture and their success rate?

Please share your suggestions.

Hi,

Welcome back to icliniq.com.

It would be great to follow up after the tests are done. A catheter-induced stricture will be managed according to the position of the stricture in the urethra and the length of the stricture. If the stricture is confirmed by flexible cystoscopy, we need further urethrogram to assess the length of the stricture and give you the treatment options.

I hope this was helpful.

Take care.

Patient's Query

Hi doctor,

Thank you for your reply.

I had a cystoscopy which showed normal results with no stricture or abnormalities in either urethra, bladder, or prostate. Flow studies showed slow flow. Ultrasound showed only half of my bladder emptying after one attempt. The doctor has given me a tablet of Fuzatal for three months to improve my symptoms.

Thank you.

Hi,

Welcome back to icliniq.com.

Great to hear that everything was fine. This condition made your urologist start you on an alpha-blocker to empty your bladder better. Yes, I agree with the treatment, and you should have a uroflowmetry after three months to check for improvement. Alpha-blocker will relax prostate muscles and ease the urinary flow.

Kindly follow up and update me on your condition.

Thanks and regards.

Patient's Query

Hi doctor,

Thank you for your reply.

What kind of illness causes incomplete bladder emptying? Why would my flow be weak? Why would I get pain?

Please answer.

Hi,

Welcome back to icliniq.com.

Mostly, the prostate remains enlarged and partially causes a blockage, resulting in incomplete emptying. Another cause can be issues in the nerve supply to the bladder. To differentiate and diagnose, you need to undergo a urodynamic study. So, if your emptying is improved with alpha-blockers, then the problem is with the prostate, not the bladder. If not improved, then you need a urodynamic study to check the bladder. Pain can happen due to chronic prostatitis, which will not be seen on the flexible scope, and it should be diagnosed by examining the prostate. If it is painful, it is prostatitis, and semen culture is done to know whether there are bacterial infections, and antibiotic therapy is started.

I hope this helps you out.

Patient's Query

Hi doctor,

Thank you for your reply.

My PSA was 0.86 ng/ml, and the urologist examined my prostate and said it was normal. So how could my prostate be enlarged if my PSA is normal and the prostate feels normal? I am confused.

Please give your suggestions.

Hi,

Welcome back to icliniq.com.

PSA (prostate-specific antigen) is related to detecting prostate cancer and is usually not related to size. If the prostate felt normal and non-tender, then it is not prostatitis. The pain can also be idiopathic, and no apparent reason for it. The prostate has two histological components one is muscles, and the other is the gland if the prostate is normal size. Then the muscle could be causing the blockage, and the alpha-blocker relaxes the muscle action, which will start after 72 hours from the time you take it. Let us see how you respond to it.

I hope you find this helpful.

Patient's Query

Hi doctor,

Thank you for your reply.

I have been taking the tablet Fuzatal for seven days now, and there has been no improvement. However, for a few days after I had a cystoscopy, I noticed that my urine stream was much stronger, and it felt like I was urinating much easier. It felt that it had been unblocked. But after some days, it went back to normal, and I felt it closed or blocked again. This makes me think that my urethra is restricted.

Please give me a solution for this.

Hi,

Welcome back to icliniq.com.

Fuzatal is an alpha-blocker that relaxes the prostate's smooth muscles and allows you to pass urine more easily. So it is not the urethra causing a problem, but it is the prostate. You can change Fuzatal to Tamsulosin (alpha-blocker) which is more selective for the prostate. I suggest you to take a tablet of Tamsulosin 0.4 mg once at night. Kindly consult a specialist, talk with them and take the medications with their consent.

I hope this was helpful.

Patient's Query

Hello doctor,

After three months of alpha-blocker Fuzatal, I can say that I am able to empty my bladder whenever I go to the toilet. However, there is still a problem with frequency. Lately, I have had the urge to empty the bladder once every two hours when I am awake and once every four hours when I am sleeping. This has been a big improvement. Before I started taking alpha-blockers, it took me six visits to the toilet in an hour to empty my bladder, and I went to the toilet once every two hours while sleeping. Immediately after that, I had a flexible cystoscopy. I had an extreme burning sensation while urinating and also had cloudy urine. My doctor gave me broad-spectrum antibiotics, which cleared the burning sensation, but my urine is still cloudy. Since then, my prostate-specific-antigen test has changed to 4.78 ng/dl. What could be the reason?

Kindly give your suggestions.

Hello,

Welcome back to icliniq.com.

The progress is good. The frequency of two hours is normal. At night every four hours is great; you can reduce the frequency by stopping fluid intake two hours before bed and passing urine immediately before sleep. Turbid urine signifies infection; you need to do a urine culture to see which organism is causing it. Please note that a urinary tract infection can cause an increase in frequency, urgency, and increase in PSA (prostate-specific antigen) level.

Please follow up with the urine culture results.

Thanks and regards.

Patient's Query

Hello doctor,

Thank you for the reply.

I am assuming that the flexible cystoscopy is probably the cause of the urinary tract infection, and this was not related to my original problem. This may be causing an increase in urinary frequency. My urine culture is currently in the laboratory for analysis. My original problem now appears to me that the smooth muscle in my prostate was causing an obstruction, and therefore the alpha-blockers have relieved this by relaxing these smooth muscles. So assuming that my prostate appears to have a smooth muscle obstruction, could this be called prostatitis? My bladder cramps have resolved since I started taking alpha-blockers, but the pain and discomfort in my testicles are still there and have been there since the beginning of my symptoms. What to do?

Please give me your suggestions.

Hello,

Welcome back to icliniq.com.

Smooth muscle obstruction is related to benign prostate enlargement, not prostatitis. Testicular pain is another issue and will be mostly idiopathic, and we advise most patients with mild pain to live with it rather than taking a lifelong treatment.

I hope this was helpful.

Take care.

Patient's Query

Hello doctor,

I stopped taking Fuzatal, and after two weeks, all my symptoms returned. In addition, I have severe abdominal cramps, and I urinate 30 times in 24 hours. I visited another urologist who put me on a 28-day course combination of tablets Ofloxacin 200 mg twice daily and Tamsulosin 400mg once daily. It has been three months since then, and I have not taken any medication in the last three months. As a result, my symptoms are much improved. I urinate once every two hours when awake, and when sleeping, I wake up after four hours to urinate. My abdominal cramps are not completely gone but are much better. Could a stronger dose of antibiotics cure my problem, and which antibiotics would be best?

Please share your opinion.

Hi,

Welcome back to icliniq.com.

It does not work this way, as your condition, prostatitis is a chronic inflammatory condition, and it can be with or without bacteria. Antibiotics can have a partial effect on prostatitis without bacteria. And further treatment with antibiotics will not make a difference. Medications like anti-inflammatories, alpha-blockers, and anticholinergics are the drugs of choice. You can take anti-inflammatory medication like Celecoxib (Non-steroidal anti-inflammatory drugs) 200 mg twice daily for a month and take Tolterodine (alpha-blocker) 4 mg once daily for a month and lastly take Tamsulosin (alpha-blocker) 0.4 mg once at night also for a month. And there is no need for antibiotics. You can start taking a supplement Prosta-free that is great for the prostate once a day for three months. That should take care of your problem.

Kindly consult a specialist, talk with them and take the medications with their consent.

Kindly follow up if you have any more queries.

Thank you.

Patient's Query

Hello doctor,

Thank you for your reply.

I had an MRI scan of my prostate. There is a very mild peripheral zone signal change within the prostate which could represent either a variant of normal or resolving inflammation. The urologist suspects that I had prostatitis consequent to the episode of catheterization. However, my symptoms have improved with the combination of Tamsulosin and Ofloxacin that were taken for 28 days. In addition, I took two Ibuprofen which has caused an increase in urinary frequency. Does this sound like nonbacterial prostatitis, and what could have caused nonbacterial prostatitis?

Please give me your suggestions.

Hi,

Welcome back to icliniq.com.

Good that the MRI (magnetic resonance imaging) result is prostatitis. Please note that most prostatitis is chronic nonbacterial prostatitis. Even though it is nonbacterial, it responds well to antibiotics; therefore, you got better with Ofloxacin and Tamsulosin. There are multiple triggering factors for prostatitis. One is infection others are nonspecific and have no specific causes as there is other inflammation in other places of the body.

I hope this was helpful.

Take care.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Samer Sameer Juma Ali Altawil
Dr. Samer Sameer Juma Ali Altawil

Urology

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