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Q. I have bladder pain with poor bladder control. Please give me an effective solution.

Answered by
Dr. Samer S J Altawil
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 04, 2020

Dear doctor Sorry post so long but have other complex healthy issues I felt you need to know before answering my query. I would very much appreciate your patience in reading such a long post but today feeling desperate.

Two years ago I started getting pain in my bladder, groin and urethra. I have never had any stinging when I wee. I also started to experience hesitancy before starting to wee and a start stop flow. For nine months I was repeatedly placed on antibiotics by numerous GPS at my practice even though tests coming back negative for an UTI. The antibiotics were doing nothing to help and sometimes after a cause I felt worse as if bladder irritated or inflamed. At the age of ten, I had recurrent kidney infections in both the ureters.

Eventually a GP referred me for a bladder scan. After the scan I was told it clearly showed I had a retention problem and eventually I saw a urologist. It was a quick appointment where no tests were done and told it’s a common problem and last year had my urethra dilated. I was then told I would be seen again by the urologist in out patients but am still waiting and due to Covid I have no idea how long that may now be.

Prior to the procedure a GP placed me on a drug I cannot recall the name of believing it may be bladder spasms but this intensified the pain, once it caused me to black out and would vary from day to day, sometimes intense. Just before the procedure I had an episode of acute urinary retention just after the bladder scan and after being treated in A&E was told to stop taking the tablet for suspected muscle spasms of bladder which helped. The urologist told me if I am not getting stinging when I am wee then it is definitely not an UTI. Since the procedure nothing has improved but have good days and bad days. But as of recently am struggling to wee most days despite drinking 7 cups of drink a day including Cranberry juice, tea, water and fruit smoothie. Then a fortnight ago I had gone 22 hours with out a wee so phoned my GP practice. We are not allocated a specific GP so have a phone consultation same day you phone receptionist then get given an appointment if felt need to see you in person. I was told he would arrange for a nurse to come and see me the following morning but eventually managed to wee but them it’s like a flood and sprays all directions, hence nurse cancelled.

However the GP stated an UTI can cause bladder retention so put on antibiotics for an UTI with no urine requested for a sample. I explained pass history and that I had no stinging but told I must take them so I did. They never helped and I finished the cause four days ago but since then have opposite problem. I am weeing far more but still hard to start and each time it’s like a dam has burst. Ever since the antibiotics I have had and still have constant pain in my bladder, groin, lower abdomen and my flank area both sides yet last three days have produced more wee then in last ages not only am I getting the aching and odd stabbing pains like when I have urinary retention but my. bladder feels irritated also as if on fire constantly and at times same sensation down both legs. I have been taking paracetamol maximum dose daily for over two weeks but has not eased pain or discomfort.

Other important information you should know is I have complex neurological problems for which I have been told by the neurology doctor in nothing more can be done. I was diagnosed it before 14 years with the rare movement disorder late onset generalised dystonia. No meds tried helped and before 6 years, as a last resort had Deep Brain Stimulation surgery with the aim of improving my quality of life but the op failed. By now I had been medically retired from an office job. Two weeks after the op I developed myoclonus muscle jerks and a very over exaggerated startle response so placed on o.5mg clonazepram twice daily which helped.

Then I went on to develop seizures and diagnosed eventually with frontal lobe epilepsy with tonic clonic seizures but discovered I was severely allergic to every epilepsy drug accept one for which I am on maximum dose, before the epilepsy diagnosis my clonazepram was upped to 1mg twice daily to try and stop the heavy falls backwards I was by now having daily. Since then I have gone onto acquire numerous other neurological symptoms such as stroke symptoms which self resolve within 24 hours, and episodes of tunnel vision and an episode of temporary loss of all sight in one eye. I have also suffered personality changes such as talkativeness, and become very impulsive. I have also been told I have damage to the thought processing part of my brain causing me memory and recall issues and mild cognitive issues and episodes of confusion.

I have been housebound now seven years and as of six months ago bed bound after four heavy falls in two months from just standing when pulling clothes up after using the toilet and before being able to strap myself safely in my wheelchair. The last fall before three months caused me to be admitted to hospital for a week. After being accessed by a hospital and community physio I have been told I must only transfer to my wheelchair now when a carer here and never go to the bathroom alone. My muscles are all becoming weaker and weaker despite exercise routines and physio. My legs, arms, torso, neck, hands and swallowing have become badly affected by my dystonia.

I now have carers four times daily and need help with washing, dressing. meals prepared for me and can now only eat puréed food due to worsening dysphagia. I now wear incontinent pants 24/7 and the NHS ones leak so buy tenna pull up pants with elasticity around the legs and maximum protection yet they still leak occasionally. As of yesterday and today despite adding another NHS pad inside when I wee it goes on so long it soaks through both pads and my clothes and I can feel the wee going all directions even if sitting upright on my adjustable bed.

It goes downwards and leaks and runs down my legs, goes backwards up to bottom half of my back and pours out sideways too despite the elastication for extra protection and soaks my trousers over a large area. It is stating to ware me down and I feel confused from going from constant retention problems to the opposite and weeing a lot and it spraying all directions and the constant pain and discomfort.

Now as writing this I feel the need to wee again but now back to stage of finding it hard to start anything at all. I just would like some advice please as on top of all my other health issues, muscle spasm pain constantly and constant fatigue and now the bladder problems worse than before urethra dilation but have no idea when I will get to see am urologist again and GPS want to start going back down the antibiotics for UTI route but have no stinging when I wee, but bladder constantly feels as if inflamed inside and burning.

I want and need help but told it could be over a year or more now before I get to see an urologist and feel desperate. I am single and as medically retired 18 years early cannot afford to go to hospital. Is it possible it could maybe interstitial cystitis. Sorry post so long and thank you for your patience but would appreciate any advice or thoughts you can give me.

#

Hi and thank you very much for consulting cliniq

Your post is interesting. 58 years female complains of tingling sensation while peeing and pain due bladder spasms. Multiple trials of antibiotics failed. Urethral dilatation was done. Pain is getting worse. Peeing spray in all directions. Difficult to initiate and maintain stream. History of vur repaired before age of 10. History of neurological and myotonic disorder. Generalized muscle weakness.

Dear patient, You have mixed issue currently ranging between urethral stricture and neurogenic bladder dysfunction. As you ur neurological issue affect ur muscles make them weak. It also making your bladder weak as bladder is a muscle and will be affected by nerves. Bladder neurological issues have been identified as over active bladder and under active bladder. Obstruction caused even after dilatation shows under active bladder or over active bladder with sphincter over activity which we call it as dyssenergia.

Diagnosis require urodynamic study in order to get proper diagnosis. Treatment in most of times will be according the status of ur bladder. In ur history u mentioned that at ultrasound ur bladder was full. Therefore I can estimate that u got under active bladder. Urethral stricture and under active bladder should be treated by clean intermittent catheterization. It’s to place a catheter called low fric catheter in bladder every 2-3 hours to empty ur urine.

This I think will improve u and will prevent u from developing renal failure due to neurogenic bladder. U can go to pharmacy and by it by name if low fric catheter. To use it u should in front of mirror. Then spread ur legs and with ur left hand spread ur labia then with right hand put the catheter inside urethra. Empty ur bladder then wash the catheter and dry it for next use after 2-3 hour. Don’t wait for desire to pee just do it regularly every 3 hours. One catheter will last with u for 1 month. Then u need to change it. Please follow up and update me about your condition and if u need further assistance. Kind regards


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