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

Answered by
Dr. Samer Samer Juma Ali Altawil
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Nov 30, 2021 and last reviewed on: Feb 02, 2022

Hello doctor,

I was admitted in a hospital for an emergency laparotomy 16 months ago to examine my abdominal fluids but no problems were found and I was discharged. This started after I was in the hospital last year. During the laparotomy, I had 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 urgency, nocturia, mild bladder pain, discomfort, and occasional severe bladder cramps. I have tried the following antibiotics like Nitrofurantoin and Ciprofloxacin which did not work out. My urination was normal while I was taking Doxycycline. Tests for sexually transmitted infections were negative.

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#

Hi,

Welcome to icliniq.com.

These problems are common after catheterization, especially if the catheter was placed for more than a week. Those symptoms can be due to inflammation caused by the catheter to the bladder and the prostate. Usually, we check urine for culture and do a flexible cystoscopy to check the lower tract, and take a bladder biopsy if required. If it is cystitis on biopsy, we advise adequate clear fluids intake, avoiding fizzy drinks, maintaining a low potassium diet, avoiding spicy foods, coffee, and tea. If the symptoms are persistent after this, then 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 the appropriate antibiotic and start with an antibiotic course for four weeks.

Kind regards.

Hello doctor,

Thanks for the reply.

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

Kindly help.

#

Hello,

Welcome back to icliniq.com.

The catheter was not supposed to be removed in a standing position as all the muscles will be tight, and that 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. Still, my expected diagnosis are stricture, inflammation of the bladder, and inflammation of the prostate.

Kind regards.

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 extreme burning sensation in the bladder. Since then, I have had frequent urination urge as soon as water enters my bladder, several visits to the toilet to empty my bladder, waking up at night to urinate, very often the urination is only a dripping, but if I drink a liter of water, it will be a strong flow with most of the bladder being emptied. The antibiotics have reduced the frequency by at least 50% or more.

Is there an antibiotic solution to this?

Thanks.

#

Hello,

Welcome back to icliniq.com.

The possible diagnoses are stricture, inflammation of the prostate or bladder. In inflammation, there might be an infection that is why antibiotic was useful.

Prostatitis needs at least four weeks of antibiotics. We need to do a semen culture to choose the appropriate antibiotic to avoid resistance.

Thanks.

Hello doctor,

Thanks for the reply.

I have slight pain and strain in my testicles without swelling. Is this an indication of inflammation? How come the inflammation appears to be in more than one place?

When I was on Ciprofloxacin, I had completely normal urination. Why is it so?

Thanks.

#

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 reappear again.

Prostatitis or stricture can cause testicular pain as well. Those places are all connected hence the pain.

Kind regards.

Thank you doctor,

Thank you doctor, that is very helpful. My catheter yanked out 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 in the standing position, and would this be known as acute inflammation? If this was acute inflammation of the prostate, is it still possible to treat 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 semen and urine culture done. Thanking you.

#

Hi,

Welcome back to icliniq.com.

Thanks for the follow-up. I will answer all your questions. 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. Whether it is acute or chronic, we treat that with antibiotics, but in chronic, we need to add a few more medications. Antibiotics for prostatitis treatment are usually given for four to six weeks. That’s why we wait for semen culture results before we prescribe a long-term antibiotic to choose the proper antibiotic from the start. I will wait for your follow-up with the semen culture result, and I hope to hear from you soon. If you need any more clarifications, please let me know. Kind regards.

Thank you doctor,

I have had my prostate examined, and the doctor said that it feels normal. This doctor also said that the two weeks of Ciprofloxacin could have been helpful because it has anti-inflammation properties. If my condition is an inflamed bladder, would any more than two weeks of Ciprofloxacin be of any benefit? Is it possible that prostate inflammation could be possible even if it feels normal during a physical examination by a doctor? Can the prostate be inflamed but not felt swollen upon physical examination? I do have bladder spasms. Can an inflamed prostate cause bladder spasms? Are bladder spasms only linked to bladder inflammation?

#

Hi,

Welcome back to icliniq.com.

Hi, and thanks very much for consulting us. I will answer all your questions. Chronic prostatitis will sometimes feel tender, and sometimes no inflammation occurs in the long term, and the pain on the examination might not be there. But usually, in chronic prostatitis, the size will be enlarged. If the doctor tells you that the prostate is normal, then it means the possibility of chronic prostatitis is very low. Antibiotics of ciprofloxacin for two weeks will be sufficient for bladder infection. But inflammation of the bladder is not necessarily due to illness. That’s the reason if, in spite of completing two weeks of antibiotic, you still have symptoms, we will be looking forward to flexible cystoscopy to get 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. Let us take it step-wise. Complete the antibiotic. If there is the persistence of symptoms, then proceed for flexible scope and biopsy. Please keep me updated yeah. Kind regards.

Thank you doctor,

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.

#

Hi,

Welcome back to icliniq.com.

Hi, thanks for the follow-up. Not really will help for bladder infection antibiotic will be used for a week only unlike the prostate infection which requires four to six weeks. As I mentioned, bladder inflammation does not always mean infection. Sometimes it is cystitis that responds to other drugs than antibiotics, but we need a biopsy result to prove it. Usually, cystitis should be treated stepwise, like general precautions by modifying the lifestyle of avoiding fizzy drinks and reducing tea and coffee, reducing spicy food and high potassium-containing food. Drink two and a half liters of water to three liters of water daily. Then we can proceed further. Kind regards.

Thank you doctor,

I had urine and blood tests done with a urologist. Both results came back normal. The physical examination of my prostate is also normal by a urologist. The urologist advised that two weeks of ciprofloxacin may have worked because of the anti-inflammatory properties of Cipro. Last night I took antihistamine (loratadine) and Ibuprofen. I did not awaken at all to urinate and had a full 8-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?

#

Hi,

Welcome back to icliniq.com.

Hi, and thanks for consulting us. Yes, you are right. It is non-infectious bladder inflammation and treated with anticholinergics or sympathetic agonists drugs like Toltaridine 4 mg once daily or Merabegron one tablet once a day. 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 a day, and we will see how it goes. If it did not work, then I recommend you for flexible cystoscopy and biopsy. Kind regards.

Thank you doctor,

I will get 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 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?

#

Hi,

Welcome back to icliniq.com.

Hi, and thanks for the follow-up. If you improve on medication, you can take it for three months. Second, if we do not know the diagnosis, I cannot tell whether it will improve. But if symptoms improve with medications then, you can continue. This condition usually will not resolve and will need the medication for life long if the diagnosis is interstitial cystitis. But if it is simple or non-specific inflammation, then it will improve. That’s why we take a biopsy to know the diagnosis. Kind regards.

Thank you doctor,

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 simple? Are the side effects of Loratadine less significant than tolterodine?

#

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 Toltaridine. But if your symptoms got improved with Loratidine, please do continue it, and no need to start Toltaridine. I am happy to hear from you regarding your concerns, and I will be happy to assist you further. Kind regards.

Thank you doctor,

So this appears to be a post-catheterization bladder inflammation. I understand that a catheter was necessary and 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 generally?

#

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 medication that is effective with you. Some cystitis is complicated to treat. Let us see how it goes. Please let me know if you have any other concerns. Kind regards.

Thank you doctor,

I am getting the following tests done:

Flow study

Renal tract ultrasound

Flexible cystoscopy

I will let you know the results of these tests. I think that it is a urethral stricture. What are the possible treatment for catheter-induced urethral stricture and their success rate?

#

Hi,

Welcome back to icliniq.com.

I would be grateful to follow you after the tests are done. 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. Kind regards.

Thank you, doctor,

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 Fuzatal only for three months to see for any improvement.

#

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. Thanks for updating. Please keep in touch update me as well later. Kind regards.

Thank you doctor,

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

#

Hi,

Welcome back to icliniq.com.

What causes incomplete emptying? Mostly, it is the prostate, which remains enlarged and causes blockage partially. Another cause can be nerve supply to the bladder. To differentiate and diagnose, you need a urodynamic study. One hint if your emptying improved on alpha-blockers, then it is 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 bacteria to be given antibiotics. Kind regards.

Thank you doctor,

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

#

Hi,

Welcome back to icliniq.com.

Psa is related to detecting prostate cancer, and it 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 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. Kind regards.

Thank you doctor,

I have been taking 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 like I had been unblocked. But after some days, it went back to normal and felt like it closed over again. This makes me think that my urethra is restricted.

#

Hi,

Welcome back to icliniq.com.

Fuzatal is an alpha-blocker that relaxes the prostate's smooth muscles and enables you to pass urine easier. It is not the urethra causing a problem, and it is the prostate. You can change Fuzatal to Tamsulosin which is more selective for the prostate. Take tablet Tamsulosine 0.4 mg once at night. I hope you will do better.

Hello Dr,

After three months of alpha blocker fuzatal, I can say that my bladder is emptying when I go to the toilet. However, there is still a feeling of frequency. I am currently in need of the toilet once every two hours when awake and once every four hours when I'm sleeping. This is a big improvement because before the alpha blockers it took me six visits to to the toilet in an hour to empty my bladder and i was going to the toilet once every two hours when sleeping.

Note, immediately after I had the flexible cystoscopy I had extreme burning when urinating and cloudy urine. My doctor gave me broad spectrum antibiotics which cleared the burning but my urine us still cloudy. Since then my psa has changed to 4.78.

Thanks
Neil
# Hi and thanks for consulting us again
This is a good Progress on medication. Now frequency of 2 hours is Normal actually. At night every 4 hours is great u can reduce frequency at night by stop any fluids 2 hours before bed and pass urine immediately before sleep.
Turbid urine signifies infection and you need to do urine culture to see which organism is causing it.
Please note urinary tract infection can cause increased in frequency and urgency and increase in psa level.
Please follow up with urine culture result.
If you have any more queries please let me know
Kind regards
Thanks for the helpful reply.

I am assuming that the flexible cystoscopy probably caused the uti and this was not related to my original problem. I guess that this may be causing the feeling of frequency which I am currently feeling. My urine culture is currently in the lab for analysis.

My original problem now appears to me that the smooth muscle in my prostate was causing an obstruction and therefore the alphablockers 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 the alphablockers, but the pain/discomfort in my testicles is still there and has been since the start of my symptoms.
# Hi dear
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 of patients who have mild pain to live with it rather than taking life long treatment.
Kind regards

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