Chronic minor urinary problem + doctor issues.
August 10, 2012 7:14 AM   Subscribe

I've had a chronic/recurrent urinary issue for a few years and doctors have been consistently unhelpful. Do I need to insist on a referral to a specialist, try something else or just chill out? Gross details inside.

The problem: frequent urge to pee, even immediately after peeing. It's not a "desperate have to go now" urge, but a slight discomfort, a feeling that I'm not quite done even though I am. The feeling seems to be lower in my bladder, maybe centred in my urethra instead of my bladder. No pain in the bladder or urethra, no incontinence, no blood in the urine, not a total life ruiner but it can get annoying.

It showed up one summer three years ago, stayed for a few months and then went away. Since then it has shown up for stretches of a couple months, and then gone away completely for longer periods of time. I haven't been able to establish a connection to diet, sex, or other behavior except that it seems to happen more in the summertime. It started before I was ever sexually active, so I don't think it is a sex thing. I have since had routine STI screenings and nothing came back.

I went to several doctors during the initial episode and got multiple UTI tests, all which came back negative, and after which I was told to calm down and/or go home. I talked to my regular doctor about possibly going to a urologist and the possibility of interstitial cystitis; she said she didn't feel it was necessary and that IC typically involves serious pain. She also said that the diagnostic for IC involves filling the bladder with fluid and seeing if you feel pain and pointed out that it was unlikely that it would happen for me. I do not have any pelvic or urethral pain, only discomfort/urge to urinate.

I also have history of being a bit of a hypochondriac and freaking out over various minor symptoms. I feel like this may have led my regular doctor to downplay the severity since she's used to just telling me cool it. On the other hand, she might be right since all the extra medical procedures may just leave me with additional bother and anxiety and lead to nothing. I live in Canada and do not have to pay to see a doctor but seeing a specialist requires a lot of waiting.

I had pretty much accepted that this is going to be annoying symptom that I will have to live with sometimes, but I'm a month into a bout of it right now and it's getting kind of annoying and I'm wondering if I've given up too soon. Should I put my foot down and get a urologist referral? Is it worth the bother to get tested to see if I have IC with my relatively minor, pain-free symptoms? Is there a chance I have something else like kidney stones, gynaecological issues, or irritation in my urethra? Are there any supplements or lifestyle changes I could try in the meantime?

Sorry for the long post - any and all advice is appreciated.
posted by anonymous to Health & Fitness (14 answers total) 3 users marked this as a favorite
It's your body and your symptoms. If they are discomforting enough to interrupt your life in any way and there isn't a cause that your doctor can find, then absolutely ask for a referral. It's always worthwhile to take the lead in your own health management.
posted by xingcat at 7:20 AM on August 10, 2012

Should I put my foot down and get a urologist referral?

YES. I have some medical issues and seeing a GP for anything but the most minor stuff is about as useful as taking an aspirin.
posted by griphus at 7:24 AM on August 10, 2012 [2 favorites]

Of course you need a referral. Insist on one.
posted by Ruthless Bunny at 7:25 AM on August 10, 2012 [4 favorites]

except that it seems to happen more in the summertime

Are you hydrated?
posted by sunshinesky at 7:25 AM on August 10, 2012

See a urologist - this is exactly what they're for.
posted by leslies at 7:26 AM on August 10, 2012 [2 favorites]

Nthing urologist! Uros are complicated. And there is nothing gross about your symptoms, like not even a little bit.
posted by samofidelis at 7:55 AM on August 10, 2012

You need to go to a urologist that specializes in IC. That totally sounds like IC. I have IC. Sometimes my only symptom is the constant urge to urinate. They can give you meds (like tofranil) that will make it go away (mostly).

The IC Network is a good resource.
posted by hotelechozulu at 8:05 AM on August 10, 2012 [1 favorite]

Interstitial cystitis isn't necessary as painful as all that, you could have a mild case. I have it, and while I do occasionally have pain and flareups, it tends to present how you have described.
posted by tau_ceti at 8:05 AM on August 10, 2012

Just a data point: Someone I know went to see a urologist and the urologist told him that urine dips can give false negatives. According to the urologist, a lot of primary care docs are bad at diagnosing infections for that reason. Your symptom is called shy bladder and it can be annoying. I would see the specialist.
posted by bananafish at 8:13 AM on August 10, 2012

I too have interstitial cystitis and that feeling of being unable to completely empty my bladder was one of my first symptoms.
posted by crankylex at 8:14 AM on August 10, 2012

I have something similar; you might have an irritable bladder. Which is sometimes its own condittion and sometimes a name for cystitis. Try cutting the caffeine out for a few days and monitoring your symptoms: I wouldn't be surprised if they decreased. (supposedly a small amount of caffeine is ok, but it depends on your sensitivity). Also, if you suffer any kind of anxiety, it can cause frequent urination.
posted by windykites at 8:50 AM on August 10, 2012

-I feel like this may have led my regular doctor to downplay the severity since she's used to just telling me cool it.-

But your description here is of minor symptoms as you mostly acknowledge : so there's no 'severity' being downplayed. And you advise you've tended towards hypochondria which the doctor knows about. I'm not being skeptical of your symptoms or how you feel, but I don't see any untoward response from the GP in the situation as you've laid it out.

But you probably won't find peace without a referral to a urologist or urogynaecologist*, so maybe you should again ask the GP for one. Then you will have symptoms PLUS the knowledge that a specialist appointment is on the horizon; otherwise, you'll still have the symptoms PLUS the anxiety of not being satisfied as to the cause and prognosis.
posted by peacay at 9:22 AM on August 10, 2012

Even a subjective feeling of pain is still painful. I'd say switch GYNs and get a referral to a urogynegologist.

FYI, I have a condition related to interstitial cystitis, and I was thus diagnosed after the procedure your doctor described showed none of the hallmark signs of IC. Just because it isn't that one thing doesn't mean there isn't something wrong.
posted by mchorn at 11:15 AM on August 10, 2012

If you are female I can almost guarantee it's irritable bladder. I have had that. One thing that will help is increasing your water intake and "training" your bladder. It is pretty annoying but the first time I had it my gen practitioner was able to give me a prescription that helped. But I don't think it's necessary. I'm dealing with it again now, and yep, more water.

If you are male, I have no idea what it is.
posted by St. Alia of the Bunnies at 2:07 PM on August 10, 2012

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