What causes spasmodic pain in while urinating?
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17 days ago, I had a ureteroscopy done to remove a 9mm stone, but no stone was found, even though the xray clearly showed one. I know I did not pass it because I strained every time and nothing ever passed. The doctor said the juncture between my ureter and my bladder is exceptionally small, so not likely that a 9mm stone passed through it. The doctor never did an MRI, a CT Scan or anything else because the stone was showing up on a regular abdominal xray. Now he says he doesn't know what that shadow really was. But, here is my question. After 17 days, I am in excruciating pain. I have had to go to the ER twice to get an injection to relieve the pain. The CT scan that was done in the ER shows that my kidneys and ureters are swollen, but labs show no evidence of an infection. When I urinate, it feels lake razor blades in my ureter, and then my bladder goes into spasms and the pain lasts for an hour or more. I constantly feel like I have to empty my bladder. Sometimes, I have trouble starting my urine flow. If I bear down, I sometimes pass a small blood clot or a plug of blood tinged mucus, and then I can empty my bladder and I feel better. Today, a kernel of corn ended up in the strainer. I have no idea where that came from. I consistently have blood in my urine when I see the doctor, ranging from +3 to "many." Sometimes my urine is red. Still, no infection. My doctor wants to do an ultrasound in a month. No follow up appointments were made until after the ultrasound is done. I want to know if this pain is normal 2 1/2 weeks after that procedure, should I insist on another office visit, and how long am I going to be in pain.
Posted Tue, 25 Feb 2014 in Urinary and Bladder Problems
Answered by Dr. Deepak Kishore Kaltari 1 hour later
Brief Answer: Likely to be due to oedema of Ureteric opening Detailed Answer: Hi Welcome to Healthcare-Magic Greetings of the day Presence of spasmodic pain in relationship to bladder is likely to be due to clot colic . Presence of clot in bladder induces bladder spasm. I would definitely prescribe a bladder wash to be given in my patient. I would need further information about the following 1. Which side the stone was present 2. You mentioned CT Scan showed dilatation of kidney and ureter , is it on the same side as the stone or bilateral. Kindly provide me the detailed Ct report and ureter scope findings. In my opinion there seems to be oedema and swelling of Ureteric orifice in the bladder. Further management will depend on Serum Creatinine and Blood Urea level. Do get back to me for further guidance. Take care Best Regards Dr Deepak Kishore MBBS, MS, MCH Consultant Surgeon
Follow-up: What causes spasmodic pain in while urinating? 31 minutes later
The xray showed the stone to be present on the right side, 1/3 way down the ureter. The ureteroscope did not reveal any stones. The pain I have had since I first sought treatment was always on the right side. The CT scans both showed swelling on that side. All kidney function tests were normal. The CT scan did not view the bladder or urethra (where I feel most of my pain) because they did not use any contrast. Here is what the CT scan says: There is moderate elevation of the right hemidiaphragm. There is mild relative right renal fullness with moderate perinephric stranding indicating regional edema or inflammation. There is moderate right-sided hydronephrosis with moderate right-sided hydroureter without evidence of obstructing lesion or stone. There is also mild left-sided hydronephrosis without significant hydroureter. There is no evidence of nephrolithiasis. Recently passed stone cannot be excluded. There is diverticulosis most prominent in the sigmoid colon. I will give you the abnormal values for the UA and blood work I had done. UA Nitrite - positive UA Protein - positive UA Urobilinogen - 4 UA Bilirubin - 3 UA RBC - >100 Albumin - 3.3 (3.4 - 5.0) Globulin - 4.9 (2.5 -4.2) Albumin/Globulin Ratio 0.7 (1.0 - 2.5) Calcium - 8.2 (8.5 - 10.1) AST/SGPT - 12 (15 - 37) Platelet Count - 529 (150 - 400) Everything else was within the normal range. Does this help?
Answered by Dr. Deepak Kishore Kaltari 2 hours later
Brief Answer: To consider Bladder outlet obstruction Detailed Answer: Hi Greetings If the renal function test (Serum Creatinine and Blood Urea level) are normal, there is no flank pain ams fever then it's unlikely that there's significant obstruction of urinary tract. In your case the obstruction is likely to be at bladder outlet( the part from which urethra starts from bladder). The possible causes in your case could be bladder calculi ( do you have the clinical picture of corn like thing which you passed? ). Post cystoscope bladder oedema may obstruct both the Ureteric orifice and cause dilatation of Ureter and kidney on both side. I would suggest you bladder wash which will help in evacuation of any clots and ease the symptoms. Presence of nitrite in Urine denotes cystitis. Empirical treatment with antibiotics like Ciprifloxacin will be beneficial. Do get back to me if you need any further assistance, will be glad to assist you. Take care Best Regards Dr Deepak Kishore MBBS, MS, MCH Consultant Surgeon
Follow-up: What causes spasmodic pain in while urinating? 4 hours later
Your answer makes perfect sense to me and fits my symptoms. Would you explain to me what a bladder wash entails? My doctor has never mentioned it. Is it invasive and does it hurt? The kernel of corn is exactly that . . .one corn kernel, whole, tinged with brown. Thank you very much for your answer and I will follow up with the bladder wash suggestion.
Answered by Dr. Deepak Kishore Kaltari 36 minutes later
Brief Answer: bladder wash is by catheterization Detailed Answer: Hi Greetings Dear Ms Bladder wash is administered by catherizing and giving wash with warm betadaine saline. It will wash off the clots. Do get back to me if you need any further assistance, will be glad to assist you. Take care Best Regards Dr Deepak