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UTI, lower abdominal bloating and dull pain - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Good Posted in: Urinary and Bladder Problems
Answered by

General & Family Physician
Practicing since : 2004
Answered : 40 Questions
User :   Hi, I am a 32 year old male who was doing fine until about 3 weeks ago. It started with frequent urination and then wen into lower abdominal bloating and dull pain mainly on the right side but the bloating was the entire lower stomach. I went to a local walk in medical center they tested/ultrasound of bladder /kidneys and my urine and said it was fine. They also took blood for (PSA) and said that was fine, the CBC that they did showed a elevated wbc. The instructed me to follow up with a urologist . So I had a few days until I saw the urologist and the bloating turned into bloating with dull pains in my lower back so I went to the ER. They took blood, urine, and did a CT scan with oral contrast. The ER doc thought I could have a problem with my appendix. The urine came back clean, the blood showed a slightly higher wbc when compared to the walk in clinic. They gave me ORAL contrast for the CT of my stomach which came back normal.So they discharged me. I saw the urologist and he did a DRE and asked me if it hurt when he pressed on my prostate , it kind of did hurt a bit. He said its probably my prostate that was inflamed and told me to take 3 weeks of CIPRO. So I thought ok I was just on that and I could stomach it no problem well as soon as I took the first dose it made all of my problems worse. So he changed it to doxycycline , which I have been on for 2 weeks and still have another 2 left. I still feel the same if not worse. I does not burn and there is no pain when I urinate , I just have to go all the time or the pressure builds up in my lower abdomen and bladder. I am at at total loss and I have an apt when the same urologist tomorrow. I have no clue what is going on maybe they missed something on the CT scan at the hospital ?
Doctor :   Hi,
Doctor :  
User :   Hi
User :   Hey
Doctor :   Please give me a couple of minutes to read your post
User :   ok thanks
Doctor :   ok, can i ask you few details of your problem ?
User :   sure
Doctor :   do you feel tenderness or pain in the testicles ?
User :   not really once in a while but nothing major
Doctor :   If it does ache is there any relation with bloating of the abdomen ?
User :   no if my testicles ache there is no relation to pain in my stomach
User :   oh I also have mild hypertension (on no medication)
Doctor :   ok,

Doctor :   Does the pain and bloating aggravate or subside on urinating ?
User :   a bit , it also feels better some times when I have a bowel movement but when I am urinating all the time the ache in my lower back gets worse
Doctor :   ok, based on your history i consider of two possibilities
User :   ok
Doctor :   one would be long standing chronic infection which is not being picked up by routine urine analysis
Doctor :   and can be confirmed by URINE CULTURE and SENSITIVITY test

User :   ok
User :   and the other?
Doctor :   and the other would be a TORSION testis, though no much pain in the testicles but the presentation matches
User :   ok what is that?
Doctor :   and can be ruled out by a DOPPLER study of the testis
Doctor :   Torsion in the testis is a condition where there will be mild to mod insufficiency in the blood supply to the testis
User :   and that may cause all these symptoms ?
Doctor :   leading to reffered pain in the lower abdomen along with bloating
Doctor :   This is a diagnosis always missed
User :   oh...
User :   so you dont think it is the prostate ?
Doctor :   since testicles do not show any symptoms until affected more

Doctor :   No, Prostate problems will come with positive PSA even with milder infection or inflammation

Doctor :   it can never be missed

User :   they did not tell me what they found when they took urine at the urologists
User :   I did have a prostate infection years ago that doxy cleared up
Doctor :   go through the report , and as i said in long standing infections the routine analysis of the urine may be normal

User :   gotcha because at first I thought it was my appendix but I guess the ct is a good tool to rule that out
Doctor :   Ok, though there are recurrences in prostate , PSA is a sensitive indicator

User :   oh
Doctor :   Yes, and both the differential diagnosis i mentioned are missed in a CT
User :   I see
User :   should I ask my urologist for those tests?
Doctor :   hence get Urine culture and sensitivity and a Doppler of testis
Doctor :   yes, he will help you to get these for sure
User :   I was very worried that is was something bad like my appendix
User :   but I guess that pain would be really sharp
User :   so this doxy that I am on is really doing nothing ?
Doctor :   appendix is one easily doubted by clinical examination itself and well confirmed by a USG and much more in detail by a CT which can never miss it

User :   what is a USG?
User :   ok
User :   gotcha
User :   what is the treatment for the conditions you have suggested ?
Doctor :   Whether the doxy helps or not can be determined only after culture and sensitivity test

User :   what does the sensitivity test do?
Doctor :   Urine is cultured for bacteria and subjected to a list of antibiotics, After urine C/s you get a list of antibiotics for which the bacteria is sensitive most and you are put on it
User :   and if I am allergic to it?
User :   I am allergic to penicillin and sulfa
Doctor :   there will be more than one sensitive and they may go for alternative in the same or related class of antibiotics
User :   oh ok
User :   thank you for giving me some insight
Doctor :   Is there anything i can help you with ?
User :   I will ask about those tests tomorrow
User :   that will be all
Doctor :   ok,
User :   have a good day
User :   bye
Doctor :   Thanks for consulting me, kindly provide your feedback
Doctor :   Bye for now
Doctor :   take care
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