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Suffering from nausea, headache, frequent urination, pain in thigh and stomach. How to get relief?

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Answered by

Practicing since : 1991
Answered : 1415 Questions
Dear Dr.,

Thank you kindly for your time...I truly hope you can help me as I'm exhausted trying to figure what's wrong :(

Here are my symptoms that have been ongoing for the last 7 unpleasant weeks...
(I will try to be as definitive as possible to help you :)

Profound constant malaise, slight nausea.
Intermittent headaches throughout the day.
Frequent urination - pain, burning, incontinence, or severe urge -day or night.
Intermittent testicular aching.
Intermittent aching in both left and right inner thighs
Intermittent stabbing and aching pains on BOTH sides of flank and lower back/kidney regions
Intermittent stabbing pains mid stomach area
Intermittent stabbing pains in bladder area.
Ejaculation not painful, but felt abnormal...very slight discomfort.
Libido 'ok', slight fatigue, still have good appetite

***most of these symptoms are intermittent, however there is always at least 2 or 3 symptoms occurring at the same time - they seem to rotate per se.

Test taken -

- Urinalysis - All negative. No urine culture as of yet.

- Blood tests - all negative at onset of illness.... including enzyme levels....
...BUT enzyme levels tripled after just 1 week when going for 2nd blood test. Did nothing between tests except tried to exercise.

No Hepatitis tests as of yet.

(I've not exposed myself to any of the causes of Hepatitis whatsoever, (sex-related, drug-related, tattoos, etc. contaminated food/water), nor do I really seem to have the typical symptoms of any of the Hepatitis' ?).

I really and truly feel I don't have hepatitis even with my strange sudden spike of enzyme levels that were completely normal at the onset of this illness.

- Ultrasound showed all normal except for a very slightly inflamed liver (I'm not a heavy drinker at all, only socially).

- Rectal exam showed no prostate enlargement.

My questions if I respectively may....

- Why are there no indications of an infection in any of my tests, although I'm almost certain I have an infection. It's frustrating to not see anything show up on the tests that would indicate an infection. Why would this occur?

- What is the next best recommended test to take so I don't lose any more money unnecessarily - IVP, CTscan, Cystoscopy? (I really don't want to do the latter if I can help it)

From my research, the closest things that 'may' have a correlation, is bacterial prostatitis, or something related to the prostate. Had a DRE 2 days ago, no enlargement of the prostate, ultrasound shows nothing.

- My gut instinct tells me that I don't have Hepatitis even with the strange and sudden elevated enzyme levels.........But perhaps something with the prostate, kidney or Urinary tract.

***All of these symptoms came immediately after drinking more than I usually do when I celebrated my birthday 7 weeks ago. Before that, I was in 100% great shape!
I fell asleep, did not go to the bathroom until the next morning and that's when all the symptoms came about.

I'm here in SE Asia and I really need to get to the bottom of this Dr.
I've lost so much work, hospital costs and stressed always leave empty handed...PLEASE HELP! :( :(

Thank you so kindly, XXXXXXX
Posted Fri, 2 Nov 2012 in General Health
Answered by Dr. G.Srinivasan 8 hours later
Welcome to XXXXXXX
I know to the surprise of both the physician and the patient, diagnosis sometimes is difficult to make.
Having said that, most of the illnesses need proper approach in the form of history and physical examination.
Thank you for the patient history.
To me, based on the history and the knowledge, I have, it looks more of a liver problem.
The positive thing got till now is the altered liver enzymes and we need to work on this basis.
Hepatitis A and E can be transmitted without the risk factors mentioned.
If I were your physician, I would do
1. Complete liver panel including Serum bilirubin and viral markers.
2. Of the tests you had mentioned, most probably CT SCAN with contrast comes closer to aid in the diagnosis as it can film the whole abdomen and look at other organs as well.
Having said that, abdomen is a magic box and sometimes surprises may spring, but systematic approach is a must to arrive at a diagnosis.
Hope this helps, Kindly get back for doubts if any---
Wishing you best health,
Above answer was peer-reviewed by
Follow-up: Suffering from nausea, headache, frequent urination, pain in thigh and stomach. How to get relief? 9 hours later
Dear Dr.

Thank you for your reply within 24 hours and the info you provided.

I have to respectfully say however (again, with the utmost respect to you), but I'm not very satisfied with this answer at all. Rather vague and containing info I already am aware of.

I realize you cannot possibly diagnose me without seeing me physically, and seeing first-hand all of my results in person.

However, I was so convinced that I don't have any type of Hepatitis (as you feel my problem is with the liver), that I just returned from the clinic to retest my strange, sudden surge of elevated enzymes that were normal at the onset of the illness), and when refraining from exercising (as I did just prior to the elevated enzyme discovery, as I've learned that even exercise can elevate enzymes, and refrained from drinking any wine at dinner), that now my enzymes today are back to normal in the mid 20's for both AST and ALT). I feel my liver is just fine.

I was more disappointed, that it seemed all of my other 'more prevalent' symptoms related to my prostate and urinary tract of which I'm experiencing, were virtually disregarded???

I've also learned from 3 other doctors, that liver ailments should not have any effect on aching testicles and inner thigh pain, as opposed to UI or prostate problems. This is not to mention the kidney pains (flank pains), bladder pains and frequent urination I'm experiencing. The aforementioned never seemingly was considered in your reply.

What I would like to know is, why would I receive negative blood, urine, DRE and ultrasound results which don't indicate any infection, yet I KNOW 100%, I DO have an infection??? It doesn't make sense?!

Pls, from ym extensive research also, it doesn't appear I have any of the symptoms related to any Hep virus...or at least, the symptoms are too conflicting and seem to be more related to another ailment instead.

Therefore, I would be most appreciative you could please 'this time'..., be much more definitive. I'm not expecting you to actually diagnose me per se, given this medium we're using. But at least provide me something more detailed regarding the possibilities and the 'whys'.

I really hope that in your follow up answer, it isn't in the dissatisfying context as your last answer.

Thank you nonetheless for your time and efforts.

Kind regards, XXXXXXX

Answered by Dr. G.Srinivasan 3 hours later
Welcome back.
Inspite of your illness, you have very been very courteous, i appreciate that.
Having said that, in today's availability of information via internet etc, i am not surprised that you know enough information, but that does not mean everything.
I am not supposed to give wrong information, just to satisfy you, even if it involves reimbursement. Also, i do not try to satisfy in a single answer as there are followups available, so that the problem is understood easier and in a gradual manner.

Coming to the actual problem, as the enzymes are negative and taking the symptom complex into consideration, chronic prostatitis/ chronic pelvic pain syndrome is a high possibility. In chronic prostatitis ( bacterial/ non-bacterial) urine culture, bloods, scan and DRE may not be positive.
Expressed prostatic secretions or semen need to be cultured to choose the right antibiotic.
In general, empirical antibiotics can be started usually of the quinolone group pending reports.
The varying pains can be attributed to that.
Of the tests you had mentioned, none is specific and the ones i had mentioned earlier( prostatic secretions/ semen culture) are more beneficial, unless there is something else to look for.
I will be happy if you get better and if it is a crisis , kindly apply for refund as i answer many free questions for service sake and i will consider this as one of them.
Hope this helps. Kindly get back for doubts if any.


Above answer was peer-reviewed by
Follow-up: Suffering from nausea, headache, frequent urination, pain in thigh and stomach. How to get relief? 1 hour later
Dear Dr.

Thank you kindly for your answer and also for your understanding.

Please know that my last reply was not at all whatsoever written with any ill, or disrespectful intent. Therefore, I'm grateful for your kind consideration.

Your recent answer above Dr., makes me feel better than the first answer, and yes you're right, I do have an opportunity to ask follow up questions to move gradually along if the first answer was not sufficient as you mentioned.

I have to go to see yet another 4th urologist tomorrow out of town in the capital city. I've found out, now you've mentioned 'expressed prostatic secretions' as an diagnostic option, that ejaculation should not be done at least 5 days prior to the appt. I've already made the appt. which I must keep, as I don't think I can handle another few days of feeling so horrible and miserable.

However 2 days ago, I wanted to ejaculate not for pleasure, but to carefully analyze the feeling more definitively so I can explain more accurately to the doctor. Therefore, my 5 day window for that test would be compromised unfortunately.

Last night, I thought I was going to die - pronounced symptoms I've never ever experienced in my life - not so much painful, but feeling like I'm on some horrible LSD trip (I've never done LSD myself, but this is from what people who have told me who've done acid before and their experiences). A wicked out-of-body experience..I guess from the infection peaking during the night, which is worse than in the day.

I've researched that alpha blockers aren't really that effective and also, that quinolones for treatment could possibly be substituted for amoxicillan-clavulanate, or, clindamycin-hydrochloride, which have slightly greater success rates (taken from the US National Health Institute). So we'll see what this upcoming Dr. says.

Also I read in the same resource, that a chronic bacterial prostatitis usually takes at least a few days to develop. I acquired these symptoms literally overnight after falling asleep after drinking/celebrating my birthday ,where I didn't empty my bladder during the night as I would normally a once or twice under normal conditions. Perhaps my urine stagnated in my bladder not being released, thus causing the infection? And, maybe it made its way to other areas?

Therefore, if I do in fact have bacterial prostatitis, then conversely, it could be acute, rather than chronic? Or, is even an overnight cause still too rapid even to acquire acute bacterial prostatitis?

My last questions doctor if I respectfully may please..., that is if I can receive an answer before I leave out of town tomorrow...

....that since I've spent so much money on many tests already with no results.....
- which test would you suggest that would have the best accuracy that I try first BEFORE I do a CT scan (as I'm presuming a scan is the most expensive).

Is a semen culture and an expressed prostatic secretion test usually done as a combination?

Not to worry about any refund Dr., as I'm feeling better about your last question and.., after I receive your answers from my above queries, I'm sure that your time and kind effort regardless of the outcome, will have certainly have satisfied the amount I've paid.

Thank you again for your time and kind understanding!

Kindest regards, XXXXXXX
Answered by Dr. G.Srinivasan 11 hours later
Welcome back.
Urine does not leak out due to overdistension, it is the kidneys that work slower to produce less urine - thats how the body is made.
I did not consider acute prostatitis as DRE was negative.
Expressed prostatic secretions (EPS)- done by collecting the fluid coming out of the urethra after a prostatic massage by DRE by a physician or a nurse - could give us a clue on the diagnosis and the antibiotic to choose.
Semen is collected by masturbation and so they are not the same.
It is usually the EPS which is analysed first and semen culture later if necessary - if the former is negative.
CT scan whether expensive or not - may not give a diagnosis in your case- as it identifies only structural abnormalities.
In prostatitis, a transrectal ultrasound scan can be a better imaging modality than a CT.
Get well soon and pls keep me posted on your progress, if it does not involve extra charges.
Pls forgive my ENGLISH as we are not native speakers of the language.
Thanks and regards
Above answer was peer-reviewed by
Follow-up: Suffering from nausea, headache, frequent urination, pain in thigh and stomach. How to get relief? 2 days later
Hello again Dr.

Thank you kindly for your comments..I'm very grateful.

Also, I've understood you completely regarding your english text, so that's quite alright....I've never misunderstood any of your statements at all.

I am sorry for the delayed reply, but I had to spend 2 nights out of town seeing another specialist to see if we can come to the bottom of this.

It seems as of now, that I have an enlarged bladder which is the cause of my interrupted urine stream flow and frequency of urination.

The doctor did a test by getting me to relieve myself in a container hooked up to a machine that records the urine flow, which results in a graph to show the strength and consistency of the flow.

Plus he did another ultrasound, and inserted an interesting 6-8 inch rod-like device into the anus, where he then was reading its findings on a machine. None of the other 3 doctors conducted these tests prior.

He concluded that I do NOT have an infection after all as I had thought, but my bladder size is larger than normal and explains the stop and start flow of my urine.

However, I would love to know why the constant malaise, headaches, rotating pain symptoms in the stomach and kidney areas, and aching testicles - all intermittent in their occurrence????

I asked him why also, and he said because right now, my body is all out of 'balance' due to the bladder enlargement. I see his perspective, but is that a valid reason?

Would the aforementioned symptoms be typical of an enlarged bladder, because I cannot find any on the internet that are relative? And why didn't the enlarged bladder show up in the first 2 previous ultrasounds when I was experiencing all of these symptoms?

If you would like to answer my last 2 questions doctor, I'd be so extremely grateful.

However, if this overextends my allowance on this medium, then I would also understand and will have to thank you kindly once again for helping me with your opinions in your previous messages. :)

I very much have appreciated both your time and kind effort indeed.

Best wishes, XXXXXXX
Answered by Dr. G.Srinivasan 57 minutes later

Welcome back.

1. Honestly speaking, i do NOT know the cause of malaise, aches and other symptoms as it is not explained by the enlarged bladder on TRUS ( if u can go back to my previous answer, you may realize that this is the scan i had suggested instead of a CT).
2. Enlarged bladder is a term used to explain patients, as it is not the correct or the medical term. The actual term is HYPO-CONTRACTILE DETRUSOR - used to mean the bladder does not contract to its full extent needed to empty completely.
This is diagnosed by high residual urine on ultrasound, findings on cystometry ( an extended form of the test done on you where 2 small tubes are sent into the bladder - one to instill saline into the bladder and the other to measure pressure changes during the filling- mimicking natural bladder filling with urine- but done at a more rapid manner. The test done to you is called UROFLOWMETRY, which is a basic test for anyone coming with symptoms that you have ( FYI- i have the facility in my private clinic as there is no urologic practice without that! and it is no surprise that no one has recommended the test to you.)
3. Enlarged bladder- as you can understand - cannot be made as a diagnosis on ULTRASOUND and thats why it was not mentioned - as the bladder can accommodate even upto 1.5 liters if needed, depending on the bladder training- if at all the diagnosis would be XXXXXXX over-distended bladder" or hypocontractile DETRUSOR.
Having said all these, i feel bad for not solving your problem, in spite of the medical advances.
Sorry about that.


Above answer was peer-reviewed by
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