What in god's name could be wrong with my kidney, bladder and urethra?! And what can I ask my GP to do to investigate it further?

April 27, 2009 12:10 AM

I woke up in the middle of the night, five days ago, with a searing pain in my bladder. Over the next day this developed into stabbing pains in urethra, at the entrance and in the line leading toward my bladder. Stabbing pains in my kidney area followed and are now a dull constant ache. I also feel like I'm being stabbed in my urethra, constantly, and my bladder area and kidney are very tender to touch and ache constantly. UTI, right? Apparently not. More inside.

I went to see my GP on Friday morning, was diagnosed with a UTI, given Triprim 300mg. Took this on Friday morning, Friday night and Saturday morning. But instead of alleviating symptoms, things were getting worse and I began to experience stabbing pains in my right kidney. Went back to doctor, was prescribed 2 x 500mg of Keflex twice a day. Cut to Monday (today) and I'm experiencing stabbing pains in my urethra, a sore painful aching bladder and aching kidneys - left and right. Returned to doctor. Doctor advised my urine samples showed no sign of any bacteria or blood and said he was stumped. He examined me externally, poked the sore bits, confirmed that yes, that is where my bladder and kidneys are, said to keep taking the Keflex and sent me for a CT scan tomorrow.

Extra info: Since Friday, I have been drinking 3L of water and 1.5L of cranberry juice every day with absolutely no effect. (This isn't that much more fluid that I would usually drink, but it would usually be all water, no cranberry juice.) The only thing I can say for sure is the only time it *doesn't* hurt as much when I get up in the morning, when my bladder is empty. (I have usually gone to the bathroom in the very early hours of the morning.) I don't have any pain when I actually pee, altho my urine flows in fits and starts, which is unusual for me. I have no history of this sort of thing at all. Once, 12+ years ago, I had cystitis which sucked but was resolved within a week with antibiotics. That's it.

I am, to put it mildly, completely freaked out.

I know you are not my doctor, but my doctor seems to have no idea what this could be, so I'm looking for reasonable suggestions as to what course of action I might ask him to take after the CT scan.

1. Is a CT scan the best scan possible for diagnosing whatever might be going on in my kidneys?
2. Are there other blood or urine tests I should be asking for?
3. A referral to a urologist?
4. Are there other causes of this kind of pain apart from a UTI that I should be asking to explore?
5. Is there anything else I should be doing in the meantime? The scan is for 12.30pm tomorrow and I guess the results will be available the day after that, although I'll see if I can get them on the same day. It seems like quite a while to be letting something that seems, to me, pretty damn serious, go untreated and unmonitored.
6. Bonus question: am I freaking out about this completely unnecessarily?

I feel this is pretty damn urgent - it hurts like hell. And pain in kidneys? Seriously. That can't be good.

posted by t0astie to Health & Fitness (18 answers total)

Best answer: Though it's rare, I happen to know two different people with Interstitial Cystitis. Both of them had a hell of a time getting diagnosed. One of them had a fibroid embolisation procedure, an ovary removed, and was damn near talked into a hysterectomy before stumbling on the ICA. A strategic switch of doctors to someone who had heard of IC before was the only way she ever got relief. The other went through ten doctors in three years, with nobody being able to figure anything out until finally someone did.

Like I said, it's rare, so you probably don't have it. Good to keep in mind, though.
posted by ctmf at 12:36 AM on April 27, 2009 [1 favorite]

Kidney stone? Not entirely uncommon. Not pleasant, either, from all accounts. But a GP should know this, and a CT scan will likely pick it up.
posted by kisch mokusch at 12:58 AM on April 27, 2009

Sounds like a kidney stone, or perhaps, gravel, which is harder to diagnose - but no less painful. Keep up with the mega liquids, but don't overdo the cranberry juice, which is highly astringent and can make a sore situation worse in the case of kidney stones/gravel.
posted by The Light Fantastic at 1:22 AM on April 27, 2009

I think in the meantime you should drink a lot less fluids. 4.5 litres per day is way more than you should actually need (I'm assuming you're not partaking in a lot of vigorous exercise if you're in this much pain) and if having a full bladder is causing you pain that would be an obvious place to start.
posted by missmagenta at 2:20 AM on April 27, 2009

The CT scan will almost certainly pick up what's going on. Could be a kidney / uretal stone. Good luck.
posted by zippy at 2:39 AM on April 27, 2009

No idea, but I agree with The Light Fantastic that the cranberry juice might be irritating your bladder (and if ctmf is right about interstitial cystitis, cranberry juice is the last thing you should be drinking.). Maybe ease off for a bit on that.
posted by granted at 3:29 AM on April 27, 2009

This sounds like the pain I had from a kidney stone. I read that the pain is caused by spasms in the plumbing as it tries to move the stone along. In addition to doing what the doc prescribed (pain meds and water) I drank cornsilk tea, which I knew from experience relaxes me and which supposedly relieves urinary spasms. It seemed to help me but your mileage may vary. I would not drink anything strong like cranberry juice.
posted by PatoPata at 4:08 AM on April 27, 2009

Best answer: Despite the consensus that you might have a kidney stone, those would be most likely unilateral (you mention pain on both sides) and generally cause hematuria (you mentioned that your urinalysis was negative for blood. If you do have a kidney stone you do not have an entirely typical presentation. You seem to be pretty specific about what structures are involved but one of the hallmarks of visceral pain is that it is often poorly localized or even referred to other body parts (think of a heart attack being felt as arm pain) and so the organs you think are hurting may not be the ones involved in whatever is going on. The CT scan is a reasonable test, but there are many others that may be helpful as well. It sounds like a referral to a urologist is a good option, but be aware that this may be a GYN or GI problem masquerading as a urology problem. Probably not, but the best person to figure out what is going on is one who can talk with and examine you.
posted by TedW at 5:34 AM on April 27, 2009

Response by poster: I'm aware that if it's a kidney stone scan should pick it up, but to be honest, the lack of blood, or any other sign of kidney stones, in my urine, coupled with the fact that I *always* drink at least 3L of water daily - and with no previous problems - just makes me think it's unlikely. Not impossible though, I'm sure. Honestly, I'd almost be glad if it was. It's such a definite concrete problem with definite concrete solutions.

What really concerns me is my GP's attitude seems to be a shrug of the shoulders and a ''Huh! Beats me!''. I appreciate his honesty in telling me he doesn't know what the problem might be, but after the scan I think I'm at the end of the road as far as him helping me find out what's wrong.

So I'm really keen to have some options to discuss with him as to what test, or specialist to try next. Thanks TedW, I'll bring up the issue of referred pain, possible gyno or digestive problems, and also ask for a referral to a urologist if the scan shows nothing concrete. And thank you ctmf, I've never heard of interstitial cystitis, I'll bear it in mind depending on what the scan shows.
posted by t0astie at 6:01 AM on April 27, 2009

Best answer: I can't answer your medical questions, but I'll try with your question about it hurting.

On the whole spectrum of pain, is it painful-but-tolerable or is it more painful than that. Using a scale of 1-10: How bad does it hurt? If it hurts seriously bad, then I'd decide that in serious pain, it's a long time between now and Wednesday when the CT scan report is given to your doctor.

Do you have a temperature? If I had a very high temperature, along with these pains, I'd go back to the doctor now.

I guess I wouldn't freak out unless the pain or temperature was very high. Then, I wouldn't freak out but I'd be back in a doctor's office right away. If I did not feel confident in my GP, and I was having severe pain and/or temperature, I'd stop off at an emergency room.

I say this not as a doctor, but as a person who had a kidney infection. I did finally get myself to an emergency room, but before I got the forms filled out my temperature was high enough to make me hallucinate a bit, and the pain was bad enough that I couldn't walk. After they got be back on my feet, the doctors chided me for waiting so long to get help. I don't say this to freak you out -- I say this to tell you what they told me: If pain and temperature is very high, you need help right away.
posted by Houstonian at 6:19 AM on April 27, 2009

Response by poster: Thanks Houstonian, I would say it hurts ''like f**k'' - enough to keep me from sleeping and to distract me substantially from whatever I'm doing. I'm constantly aware of it. But I can still walk and I'm nowhere near hallucinating or needing opiates. There is also no sign of infection (in two separate urine samples). Nor do I have a temperature. For which small mercies I am thankful, but I will definitely hie myself to an ER if something changes. Thank you for suggesting these points. It sort of reassures me that I *don't* have these signs of something drastic, even though it's very painful.
posted by t0astie at 6:34 AM on April 27, 2009

Go see another doctor?
posted by kestrel251 at 6:55 AM on April 27, 2009

Get the urologist referral right away. It sounds like you really need the attention of a specialist. Interstitial Cystitis is definitely something you should look into, but I don't think kidney pain is usually associated with it. It's usually very localized to the bladder and pelvic area.
posted by hellboundforcheddar at 6:58 AM on April 27, 2009

You are right to be concerned about your GP's attitude.

Get the urologist referral, and try to get in to see your Ob/Gyn. I'd assume that if you had missed any periods, you would have mentioned it, but an ectopic pregnancy could be a possible, though unlikely, cause for all this pain.

And I know someone with interstitial cystitis, and it's very painful and difficult to diagnose and treat as ctmf said, so I would look into that thoroughly if I were you, as well.
posted by misha at 8:26 AM on April 27, 2009

Best answer: You sound pretty stoic considering what seems to be pretty bad pain. Hallucinating and an inability to walk are not prerequisites for taking pain meds, you know. :) If it "hurts like f**k" and keeps you from sleeping, that's a pretty severe episode of pain, in my book. (And I recently broke my leg in 20 places, so I know pain.)

Forget the GP who's either downplaying your pain or whom you maybe aren't informing vividly enough about the pain. Get the urologist referral asap. Take the CT scan results with you.

If your pain gets any worse, there is nothing whatsoever wrong with driving yourself to the ER. Good luck.
posted by ImproviseOrDie at 10:25 AM on April 27, 2009

Best answer: I would say it hurts ''like f**k'' - enough to keep me from sleeping and to distract me substantially from whatever I'm doing. I'm constantly aware of it.

Many MDs sort of suck at pain management.

Its your right as a patient not to be in any pain at all. If it doesn't respond to Tylenol/Advil then I'd call back your GP and request something stronger for the pain - at least enough so that you can sleep and otherwise function normally.
posted by anastasiav at 10:37 AM on April 27, 2009

Best answer: Interstitial cystitis doesn't typically start suddenly in the middle of one night, so you can scrub that off the list of differential diagnoses.

Common things are common, and I would still suspect that a UTI is the most likely diagnosis. The conventional midstream urine sample that your doctor has sent is an insensitive way of detecting some unusual bacteria. If I were in your situation I would go back to your doctor and ask for a third antibiotic, possibly norfloxacin, and while you are waiting for the CT you can pick up some sodium citrate from a pharmacy just to see if it helps.
posted by roofus at 11:57 AM on April 27, 2009

Response by poster: Thank you ImproviseOrDie and anastasiav, he did give me pain meds - Codalgin Forte, with 30mg of coedine - but they made me throw up so I've been taking over the counter tablets with 10mg of coedine. Those aren't great - it still hurts - but they're stopping me from screaming in agony. But you've made me realise I really need to push for better pain management if this isn't going to be sorted out right away. And thanks roofus, I'll ask for testing for less comon bacteria, another antibiotic and hit the pharmacy for some Ural sachets.
posted by t0astie at 6:59 PM on April 27, 2009