I'm trying to get advice on whether or not I have a UTI, and…

I'm only 28, though overactive bladder can probably strike at any age. Below is some more information and further details about what I'm feeling. Please bear with me and with the length of this post. I'm a little desperate and hope that you can offer some advice.

I have a long history with UTIs. I got my first probably about nine years ago, and it was bad. Like, pee turning, over the course of an hour, from light yellow to rust-colored deep orange because of the blood in it bad. Lots of pain, lots of sensitivity and frequency and urgency. It was a horrible experience and I think it in some ways scarred me and made me ultra-paranoid about having another.

After that first infection, I did have others, probably about six total. They were always related to sex, and it was getting to the point that I was having NO sex with my boyfriend at the time, which didn't make either of us very happy. So I saw a urologist, who prescribed me a low-dose antibiotic (50 mg of Nitrofurantoin) to take prophylactically after sex (he also gave me a full inspection, including a cystoscopy, which ruled out interstitial cystitis). That seemed to solve the problem. Even though I wasn't super thrilled with the idea of taking an antibiotic a few times a week, taking one after sex seemed like a better solution than taking a full course after getting an infection. In the seven or so years I've been doing this (mind you, I haven't had one boyfriend for those entire seven years, so I haven't been taking these antibiotics for seven years straight), I've only had one breakthrough infection. That's a pretty good record.

Except for last night. As usual, after having sex with my boyfriend, I took the antibiotic. I also did the post-coital routine: peed, rinsed off, etc. About three hours later, though, I suddenly felt some of the familiar sensations of a UTI. I definitely had the frequency, and I think the stream may have been a little weaker than usual, but other than that, I didn't have the burning twinge at the end of my pee (if you know what I'm talking about) like I've had in the past with all my UTIs. I also seemed to be actually peeing a moderate amount when I did go: not just a dribble, but actually a decent pee, albeit not long enough to warrant the real feeling of frequency that I was having.

This shocked me. And I got so scared that I actually went to the ER, where they tested my pee and found nothing, but sent me home with a prescription for Cipro, which, they told me, I didn't have to take, but could take if my symptoms got worse.

So here I sit, not sure what's going on, or what I should do. The one thing that's bothering me most is that feeling of heaviness in my bladder and urethra that never goes away. Like, after you get up from going pee, it's still there: peeing doesn't provide any relief. I HATE THAT.

Because of my history with UTIs and my paranoia, I also have at home hospital-grade urinalysis dipsticks that test for leukocytes, nitrite, and blood in the urine (the three hallmarks of a UTI). I've been checking my urine ever since last night (about 18 hours have gone by since all this started). Every time, the test is negative. I understand that having taken antibiotics can throw off the results of one of these dipstick tests, but wouldn't they be out of my system 18+ hours after taking the 50 mg of Nitrofurantoin?

I got the prescription for Cipro filled, but haven't started taking it yet because 1) the doctor told me to take it only if I got worse, which I haven't, and 2) they sent my urine out for a culture and I'd rather see if there really is any bacteria there before taking the meds, since they really throw my system out of whack and I'd prefer NOT to have to deal with a yeast infection on top of everything else.

Anyway (and I'm almost done typing: bless you if you've made it this far), there are a number of factors that have given me urinary urgency/frequency in the past that made me feel like I was having a UTI, but which I ruled out as being a true UTI because I wasn't sexually active at the time. I'm experiencing many of those factors all at once now:

1) Little sleep: I'm a professor at a university and we just started the school year last week. I got very little sleep Wednesday night (today's Sunday) and this past Friday night as well. Often when I get overly fatigued, I find that I pee a lot more. In fact, when I was writing my dissertation a few years ago, I was almost certain that I had a UTI because I had all the signs: frequency, urgency, burning. But it was nothing, or at least nothing that showed up on any urinalysis. I was barely sleeping and exhausted and not taking very good care of myself at the time.

2) Anxiety: I just bought a condo and think I may have a bug problem. This has made me incredibly anxious. I've noticed that when my anxiety is at a high level, I pee a lot. I was so anxious last night that I was literally trembling -- my whole body was shaking uncontrollably.

3) Period: My period should be here either today or tomorrow. Usually right before my period I experience an increase in urination, and even some urethral sensitivity/irritation (a urologist told me that this is normal, as the tissues of the bladder and urethra are susceptible to changes that correspond to a woman's menstrual cycle, and are more sensitive right before the period begins), although what I'm experiencing now seems more extreme than what I feel normally every month.

4) Water retention: for some reason, I retained TONS of water this month when I was ovulating and also in the past ten days or so. Like, to the point that I was starting to get a little poofy belly, which I never have. I don't know if it's coincidence or not, but this morning when I woke up, I noticed that the "belly" was gone...is it possible to pee out all the water you've retained over the course of the month, right before you start to menstruate?

5) Bike riding, sex, and irritants: Yesterday I rode my bike to my boyfriend's house, I drank a soda and a vodka drink, and then we had sex. Those all seem to be urethral irritants: bike riding (for obvious reasons), soda and liquor (which are supposedly bladder irritants, and sex (duh).

So. Does it seem like I just have kind of a recipe for misery here, when all of these factors are combined? Has you heard of anyone ever having a lingering, sort of urethral discomfort, absent of having an actual UTI? I can't figure out what's going on and am scared that I'm going to feel like this forever. It's very hard for me to sleep when I'm so uncomfortable and I'm freaked out that I'm just going to become an exhausted mess.

I wrote in my post above that interstitial cystitis has already been ruled out with a cystoscopy. And I did go to the ER last night and had my urine checked; I mentioned that in the post above as well.

I didn't accept your answer because the advice you gave me (i.e. to rule out interstitial cystitis and have my urine checked) was already outlined in the long post I sent you; as I wrote, I've previously been checked by cystoscopy for interstitial cystitis (all clear) and had also been to an ER to have my urine checked. So you essentially suggested that I do two things I had already one.