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I am a 35 year old female living in the Memphis, TN area.

Hello. I am a...
Hello. I am a 35 year old female living in the Memphis, TN area. Married, no children. Sexually active, not currently on birth control. Otherwise healthy as far as I know. I’m going to try to keep this short but try to give the most important info.My first urinary tract infection happened when I was 12, at the exact same time as my first period. Antibiotics cleared it up quickly and I did not get another one until I became sexually active at age 20. I have gotten a uti every time I’ve had sex since then unless I have had some kind of antibiotic on hand to take prophylacticly. During long periods of time between sexual intercourse I never get infections. I have never had one unless I have had sex within the last 24-48 hours. (Except my first one.) My doctors have given me antibiotics all these years but one after another they have become ineffective. In late June, the one I had been using for 2-3 years, Augmentin, failed to prevent an infection and after several days of taking it twice daily, the symptoms continued to get worse. So I went to my ob/gyn. (My symptoms are urgency, frequency, pelvic pain, passing small amounts of urine, slight burning feeling while urinating. I feel relief after urinating as long as I am drinking plenty of water. When I don’t drink enough water, my bladder hurts until I drink a bunch and get a good flush of water through it. Drinking a lot of liquids is my only way to manage the pain besides Uribel.) Uribel masks a lot of the symptoms but if I don’t drink enough fluids I start to feel the pain even with the Uribel. Ive been taking it 2-3 times a day for pain for the past four-five months.In the last six months I have been put on Macrobid, Cipro, Septra, Augmentin, Doxycycline, Keflex, and now Ceftin. Four of my last five urine cultures have come back clear, but one recent one showed enterococcus faecium. That’s when they said it was susceptible to the Ceftin. I’m on the last day of a 10 day course of the Ceftin but I still have to take Uribel to be comfortable.Tests that have been done include an ultrasound which showed I was emptying my bladder pretty well but not quite as much as the urologist would have liked for a woman who has never had kids. I’m sorry I don’t have a real number there- anyway he also said the bladder wall was a little thick. He put me on tamsulosin to help things flow better because I was having to push to empty my bladder all the way. (It has helped a little.). Then I had a cystoscopy and a CT scan with dye and they didn’t find any physical abnormalities. My bladder walls were chronically inflamed, he said. He gave me hydroxyzine to take with the tamsulosin and after a few weeks when I wasn’t feeling better, a new urine sample finally came back with the bacteria I mentioned before. So I’m about to start another round of Ceftin because honestly I guess they just don’t know what to do with me anymore. I’m at a loss, too. For 14 years sex always caused this but antibiotics always prevented it or if I forgot to take one right after sex, they still cleared this up in a few days. Now nothing is helping, nothing is growing in a Petri dish, nothing is showing on tests, and sex still results in some kind of flare up that does seem to be more controlled when antibiotics are being used, despite the fact that my new “normal” is already uncomfortable. Is it possible that the bacteria are hiding out in my bladder- getting killed on the surface but not deep down? Also, believe me I am doing all the hygiene stuff and then some- I’ve tried everything they tell you to do to prevent these things. We are very clean- we shower thoroughly first, I’ve even tried cleaning myself with antibacterial wipes before we get busy but literally nothing seems to make any difference at all. I’m at a loss. We can’t have sex and we have a cruise coming up for Christmas, and worse we want to start a family and can’t because of this. I need someone who specializes in this and is committed to figuring it out. I feel like my urologist has given up or is out of ideas. What should I do?
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Answered in 5 hours by:
12/16/2017
Ross
Ross, Doctor
Category: Medical
Satisfied Customers: 347
Experience: Urologist
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hello DR ROss IM a urologist. THese are difficult problems i will try to help with the simple. YOU have t ydrink more water to get your urine clear by 3 pm every day when not on the uribel. second how are you bowels you may need to take a stool softner. three it would not hurt to take cranberry pills daily

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im sure you get up and void after intercourse to flush out you must have a short urethra so bacterial migration easier

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Customer reply replied 6 months ago
My bowels are usually normal. Cranberry pills don’t do anything as far as I can tell. I’ve also tried Cystex, D-mannose, uva ursi, 8 oz of water every hour, high doses of Vitamin C, zinc, D3, B complex, probiotics, oregano oil, horsetail, baking soda water, pineapple juice, cutting dairy out of my diet, showering before and after sex with and without soaps or cleansers, husband and I showering plus me cleaning front to back with antibacterial wipes before sex, putting a little gob of triple antibiotic ointment over the opening to my urethra before sex, various sex positions to avoid pressure on my urethra (although I do not feel any irritation during sex) and probably other things I just can’t remember right now.
Customer reply replied 6 months ago
Probably wouldn’t hurt to drink more water- on days when I’m feeling good I sometimes forget to drink. I think maybe I have had some constipation over the last year or two, but that doesn’t explain the many years prior of having this issue. If anything my stools used to be on the softer side but very regular. Maybe I’m just older or not eating right, but I’m not as regular as I used to be and my stools are on the firmer side. I bought a stool softener and will use it as needed to help things go a little easier. I don’t know if that will make a difference with the uti thing, though.
Customer reply replied 6 months ago
When I test my urine, it always comes up with a pH of 4.5-5. Could the acidity be the problem? Or part of the problem? Isn’t healthy urine usually closer to neutral? I’m just out of ideas at this point. ��

look at osmolality urine like i said watch the color urine. Cranberry needs taken every day in the studies and it may take months to help your bacteria urine should be more neutral try lemonade your body buffers that raising the urine ph

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you need to do all you mentioned all the time you say as needed but that means after the problem. do the water , bowels CJ every day to correct the problem

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Customer reply replied 6 months ago
The only thing I take “as needed” is stool softeners because they give me diarrhea if I take them too frequently. Other things I have tried for several weeks to several months hoping they would eventually help.Most of the things I’ve read say that studies overall have come up with mixed results as far as Cranberry goes and whether it actually helps. The “active” ingredient is supposed to be a sugar called D-mannose, which supposedly has the anti-adhesion properties cranberry is known for. I have tried both Cranberry juice and pills as well as D-mannose pills and powder. They seem to work really well for some people but I haven’t had any luck with them. I suppose I haven’t taken any of it for several months on end, so I guess that might be something to try. Can’t hurt. But if I have sex I will get another infection (or have the same one flare up?) and none of this stuff prevents it even after weeks of taking it.Hopefully more studies will be done on this issue. It is ruining my life and apparently all doctors can tell me is to drink water and cranberry juice. Honestly, I don’t want to be rude, but I can’t think of a less helpful thing to hear at this point. I mean, after 15 years I’ve tried about everything, some things multiple times. It seems to me no one is listening, but maybe there just aren’t any good answers out there. I just had hoped that maybe a different doctor would have something new to tell me.Thanks anyway.
Dr. J
Dr. J, Board Certified MD
Category: Medical
Satisfied Customers: 742
Experience: Gynecologist
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Hi there. Board-certified obgyn here. Are you still looking for assistance?

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Customer reply replied 6 months ago
ma’am. Are you able to read what was already said?

I am. Let me take a moment to review and I will get back to you shortly.

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Customer reply replied 6 months ago
Ok thank you

To recap, after intercourse you have symptoms (pressure, painful urination, frequent urination, incomplete emptying). In the past antibiotics used to help but your symptoms have gotten more severe and antibiotics do not seem to help. Furthermore your urine often time does not grow any bacteria when it is tested. You had an evaluation with a urologist where the bladder wall looked thick on ultrasound, there was some "slow" emptying, and the inside of the bladder looked inflamed and thus hydroxyzine was added to your meds. Does this seem about right?

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Customer reply replied 6 months ago
For many years, the urine cultures did show e.coli. There was a noticeable odor to the urine and a cloudiness. The last several have shown nothing however, and I do not notice the smell and it is clear.

Do you typically take an antibiotic every time you have sex regardless of if the symptoms have started or not?

Have you ever seen a physical therapist?

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Customer reply replied 6 months ago
For the last couple of weeks I’ve been taking an NAC supplement and Zyrtec instead of the hydroxyzine (I kept waking up at four in the morning with my nose blocked with dry congestion and he suggested Zyrtec as a replacement) I have also been taking a Pepcid complete every day to buffer my urine (as well as cutting out coffee, soda, and dairy for the most part). I’m getting better results with this approach in two weeks than I did in two months on the hydroxyzine/Zyrtec alone. (Oh still taking flomax, too) I’m almost to where I don’t need the uribel at all now. In fact, when I feel a little discomfort, I have tried taking a Tums instead of uribel and it has worked about as well. Maybe for now I have found something that is helping me/allowing me to heal.I guess my big question now when it comes right down to it is... now that antibiotics don’t seem to work prophylacticly anymore, how can I have sex again and not start this whole stupid thing over again?
Customer reply replied 6 months ago
I was taking antibiotics prophylacticly after sex. Every couple years the one I was taking would stop working, but a change in antibiotic would always clear it up quickly, and prevent problems for a while, but this past June I thought nothing was clearing it up. I had sex a couple of times at points when I was on various antibiotics and was feeling ok. About 12-24 hours later my symptoms flared up again each time.No on the physical therapy. I’ve considered it, though. My pelvic floor muscles are always tight unless I consciously think about relaxing them. I’ve wondered if that was probably not helping things.

Thank you.

Yes, I agree that the antibiotics no longer seem to be working prophylactically. It could also be that bladder infections are not the problem any more, but some lasting inflammation or damage from all those prior infections has caught up with you.

I would start with the following:

- Stop using antibiotic gels and creams down there. We are meant to have good bacteria in the vagina. That good bacteria actually defends your body against the bad bacteria from ascending your urethra and into your bladder.

- Use lube everytime you have sex. If you have one you like that's fine otherwise olive oil or coconut oil is really good too.

- I think it's time for you to see a gynecologist who can refer you to a good pelvic floor physical therapist. You are having some irritation (not necessarily an infection) every time you have sex and it is possible that some muscular spasm or irritation is part of the problem. A PT can work with you to figure out which muscles are causing you pain and work with you to relax them.

- There is a disorder called IC (Interstitial Cystitis). It is a poorly understood condition basically of bladder irritation and pain, in the absence of infection. (Info about IC from Mayo Clinic here.) Your urologist may or may not have mentioned this to you, but I think it is worth calling your urologist back and asking if there's a chance you have IC and/or is there any evaluation or treatment you can consider for it.

Dr. J
Dr. J, Board Certified MD
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Satisfied Customers: 742
Experience: Gynecologist
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Customer reply replied 6 months ago
Yeah- I mean my urologist is treating me as if I have IC in absence of any other real data. He told me to look up the drug elmiron and see what I thought about it (poss. side effects vs. how much discomfort I was in). He said it could be many months on the elmiron before I felt better. Of course that’s if I don’t ruin the healing process by having sex. He gave me other options which were more invasive and seemed worse than the actual problem. I’ve looked up IC in several places, and I have to say that it doesn’t *quite* seem to fit what I’m experiencing, since flare ups for other people tend to happen randomly or in response to multiple things like food or stress, and other people seem to experience considerably more pain than I do. Unless my only trigger is sex. But everyone is different. Every doctor I talk to says “really?” a lot and looks at me funny. So perhaps I’m the oddball with interstitial cystitis only triggered by intercourse. Stranger things have probably happened.I can see if my ob/gyn would refer me to a physical therapist. He’s pretty cool- I bet I could just call up there and he’d get back to me with one.
Customer reply replied 6 months ago
That’s definitely something I haven’t tried. Thank you for the advice, I really appreciate it.
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