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Suggest Treatment For Recurring UTI And Fibroids
Question: My wife is 37, mother of 2 girls. She gets recurring Urinary Tract Infection.
We recently got full suite of preventive checks done. Everything was normal except a couple of fibroids (which have grown a bit in the past 4-5 years). She has 2-3 hypoechoic lesion in the walls of the uterus, largest measuring 3 X 2.1cm(left lateral wall).
For past 3-4 months, around menstrual cycle she gets symptoms of UTI. She has pain in lower abdomen area and in the back above waist area. Once Urine routine detected presence of pus cells and culture with same sample reported no growth. Still she took augmentin 650 for 5 days and did not benefit. Then she was adviced to take Niftas for 5 days. She got some relief but the symptoms returned in a week; discomfort in passing urine and pain in lower abdomen and back area.
Please advice the best course of action.
Regards,
XXXX
We recently got full suite of preventive checks done. Everything was normal except a couple of fibroids (which have grown a bit in the past 4-5 years). She has 2-3 hypoechoic lesion in the walls of the uterus, largest measuring 3 X 2.1cm(left lateral wall).
For past 3-4 months, around menstrual cycle she gets symptoms of UTI. She has pain in lower abdomen area and in the back above waist area. Once Urine routine detected presence of pus cells and culture with same sample reported no growth. Still she took augmentin 650 for 5 days and did not benefit. Then she was adviced to take Niftas for 5 days. She got some relief but the symptoms returned in a week; discomfort in passing urine and pain in lower abdomen and back area.
Please advice the best course of action.
Regards,
XXXX
Brief Answer:
need more information
Detailed Answer:
Hello dear,welcome to healthcare magic.I understand your concern.
Iam Dr.Srilatha gynaecologist.I have gone through your query.
In my opinion it appears from your history that there is recurrent urinary tract infection.
I would like to know :-
1)The colony count of organism found in culture and its susceptible antibiotic.
2)Does she have any pain and heavy bleeding during menstruation?
3)Were there any renal calculi detected on ultrasound?
4)Any bladder inflammation changes noted on ultrasound?
Kindly provide me the information.
Looking forward to hear from you.
Best regards...Dr.Srilatha
need more information
Detailed Answer:
Hello dear,welcome to healthcare magic.I understand your concern.
Iam Dr.Srilatha gynaecologist.I have gone through your query.
In my opinion it appears from your history that there is recurrent urinary tract infection.
I would like to know :-
1)The colony count of organism found in culture and its susceptible antibiotic.
2)Does she have any pain and heavy bleeding during menstruation?
3)Were there any renal calculi detected on ultrasound?
4)Any bladder inflammation changes noted on ultrasound?
Kindly provide me the information.
Looking forward to hear from you.
Best regards...Dr.Srilatha
Above answer was peer-reviewed by :
Dr. Prasad
Hello Doctor,
Thank you for the response. Here are the answers:
1)The colony count of organism found in culture and its susceptible antibiotic.
We haven't done culture recently. Last time around it was E.Coli. When she took Miftas (even in the past), there was immediate relief. Augmentin didnt help.
We just got the Urine routine done today, but it does not show any infection. The report says 1-2 pus cells and 2-5 epithelial cells. She has pain in lower back, frequently feels burning sensation in urine passing area. She feels pain in lower abdomen whenver she feels need to pass urine. All these symptoms are similar to when she gets a UTI; today's urine routine of course points otherwise.
2)Does she have any pain and heavy bleeding during menstruation?
Bleeding has been bit more compared earlier during first 2-3 days of menstruation. She always has pain during menstruation.
3)Were there any renal calculi detected on ultrasound?
4)Any bladder inflammation changes noted on ultrasound?
Ultrasound report says no evidence of calculi, mass or mural lesion. Post void study shows 14ml of residual urine. Pre-void was 342 ml.
4. Ultrasound report says Urinary bladder is well distended. Wall thickness is normal.
Thanks so much.
XXXX
Thank you for the response. Here are the answers:
1)The colony count of organism found in culture and its susceptible antibiotic.
We haven't done culture recently. Last time around it was E.Coli. When she took Miftas (even in the past), there was immediate relief. Augmentin didnt help.
We just got the Urine routine done today, but it does not show any infection. The report says 1-2 pus cells and 2-5 epithelial cells. She has pain in lower back, frequently feels burning sensation in urine passing area. She feels pain in lower abdomen whenver she feels need to pass urine. All these symptoms are similar to when she gets a UTI; today's urine routine of course points otherwise.
2)Does she have any pain and heavy bleeding during menstruation?
Bleeding has been bit more compared earlier during first 2-3 days of menstruation. She always has pain during menstruation.
3)Were there any renal calculi detected on ultrasound?
4)Any bladder inflammation changes noted on ultrasound?
Ultrasound report says no evidence of calculi, mass or mural lesion. Post void study shows 14ml of residual urine. Pre-void was 342 ml.
4. Ultrasound report says Urinary bladder is well distended. Wall thickness is normal.
Thanks so much.
XXXX
Brief Answer:
Its an uncomplicated UTI
Detailed Answer:
Hi there,thanks for the information.
After seeing your history it appears to be a uncomplicated urinary tract infection(UTI).
For uncomplicated UTI nitrofurantion (Niftas) is the drug of choice.And E.coli is the most common organism for UTI.
Pus cells cannot be always taken as index of UTI.And review culture and sensitivity of urine needs to be done to ensure the clearance of infection after the antibiotic course.
As there are no renal calculi ,bladder wall thickness is normal and pre and post void volume is also normal nothing to worry and the chronic or long standing UTI is ruled out by these findings.
Once the urine culture and sensitivity is normal the pain can be attributed to fibroids.
Symptomatic fibroids usually present with painful and heavy bleeding.
Excess bleeding also might lead to weakness leading to backache or pain above the waist area.
And in a few people dehydration makes the urine concentrated leading to burning micturition without any infection.
So I suggest you to go for urine culture and sensitivity and Hb to rule out anaemia.
Take adequate fluids upto 3 litres per day and cranberry juice daily to prevent UTI.
Dont worry.She might need a further work up with gynaecologist regarding fibroids.
Hope this satisfies your query.
Feel free to discuss further.
Best regards...Dr.Srilatha
Its an uncomplicated UTI
Detailed Answer:
Hi there,thanks for the information.
After seeing your history it appears to be a uncomplicated urinary tract infection(UTI).
For uncomplicated UTI nitrofurantion (Niftas) is the drug of choice.And E.coli is the most common organism for UTI.
Pus cells cannot be always taken as index of UTI.And review culture and sensitivity of urine needs to be done to ensure the clearance of infection after the antibiotic course.
As there are no renal calculi ,bladder wall thickness is normal and pre and post void volume is also normal nothing to worry and the chronic or long standing UTI is ruled out by these findings.
Once the urine culture and sensitivity is normal the pain can be attributed to fibroids.
Symptomatic fibroids usually present with painful and heavy bleeding.
Excess bleeding also might lead to weakness leading to backache or pain above the waist area.
And in a few people dehydration makes the urine concentrated leading to burning micturition without any infection.
So I suggest you to go for urine culture and sensitivity and Hb to rule out anaemia.
Take adequate fluids upto 3 litres per day and cranberry juice daily to prevent UTI.
Dont worry.She might need a further work up with gynaecologist regarding fibroids.
Hope this satisfies your query.
Feel free to discuss further.
Best regards...Dr.Srilatha
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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