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Common Conditions

Interstitial cystitis (IC)

Interstitial cystitis (IC)

Definition

Interstitial cystitis is a long-term (chronic) inflammation of the bladder wall.

Alternative Names

Cystitis - interstitial; IC

Causes

Interstitial cystitis (IC) is a painful condition due to inflammation of the tissues of the bladder wall. The cause is unknown. The condition is usually diagnosed by ruling out other conditions (such as sexually transmitted disease, bladder cancer, and bladder infections).

IC is frequently misdiagnosed as a urinary tract infection. Patients often go years without a correct diagnosis. On average, there is about a 4-year delay between the time the first symptoms occur and the diagnosis is made.

The condition generally occurs around age 30 to 40, although it has been reported in younger people. Women are 10 times more likely to have IC than men.

Symptoms

  • Pain during intercourse
  • Pelvic pain
  • Urinary discomfort
  • Urinary frequency (up to 60 times a day in severe cases)
  • Urinary urgency

Exams and Tests

Diagnosis is made by ruling out other causes. Tests include:

  • Bladder biopsy
  • Cystoscopy (endoscopy of bladder)
  • Urine analysis
  • Urine culture
  • Urine cytology
  • Video urodynamics (shows how much urine must be in the bladder before you feel the need to urinate)

Treatment

There is no cure for IC, and there are no standard or consistently effective treatments. Results vary from person to person. As long as the cause is unknown, treatment is based on trial and error until you find relief.

Elmiron is the only medication taken by mouth that is specifically approved for treating IC. This medicine coats the bladder like Pepto-Bismol coats the stomach.

Other medicines may include:

  • Opioid painkillers for severe pain
  • Tricyclic antidepressants such as Elavil (amitriptyline) to relieve pain and urinary frequency
  • Vistaril (hydroxyzine pamoate), an antihistamine that causes sedation helps reduce urinary frequency

Other therapies include:

  • Bladder hydrodistention (filling bladder with fluid)
  • Bladder training (using relaxation techniques to train the bladder to go only at specific times)
  • Instilled medications - medicines are placed directly into the bladder. Medicines that are given this way include dimethyl sulfoxide (DMS), heparin, Clorpactin, lidocaine, doxorubicin, or bacillus Calmette-Guerin (BCG) vaccine.
  • Physical therapy and biofeedback (may help relieve pelvic floor muscle spasms)
  • Surgery, ranging from cystoscopic manipulation to bladder removal (cystectomy)

Diet modification

Some patients find that changes in their diet can help control symptoms. The idea is to avoid foods and beverages that can cause bladder irritation. Below are some of the foods that the Interstitial Cystitis Association says may cause bladder irritation.

  • Aged cheeses
  • Alcohol
  • Artificial sweeteners
  • Chocolate
  • Citrus juices
  • Coffee
  • Cranberry juice (Note: Although cranberry juice is often recommended for urinary tract infections, it can make IC symptoms worse)
  • Fava and lima beans
  • Meats that are cured, processed, smoked, canned, aged, or that contain nitrites
  • Most fruits except blueberries, honeydew melon, and pears
  • Nuts except almonds, cashews, and pine nuts
  • Onions
  • Rye bread
  • Seasonings that contain MSG
  • Sour Cream
  • Sourdough bread
  • Soy
  • Tea
  • Tofu
  • Tomatoes
  • Yogurt

Experts suggest that you do not stop eating all of these foods at one time. Instead, try eliminating one at a time to see if that helps relieve your symptoms.

Support Groups

For additional information and support, see interstitial cystitis support groups.

Outlook (Prognosis)

Treatment results vary. Some people respond well to simple treatments and dietary changes. Others may require extensive treatments or surgery.

Possible Complications

  • Chronic depression
  • Chronic pain that may cause a change in lifestyle
  • Emotional trauma
  • High costs associated with frequent medical visits
  • Side effects of treatments (depending on the treatment)

When to Contact a Medical Professional

Call your health care provider if you have symptoms of interstitial cystitis. Be sure to mention that you suspect this disorder. It is not well-recognized or easily diagnosed.

References

Hanno PM. Painful Bladder Syndrome/Interstitial Cystitis and Related Disorders. In: Wein AJ. Wein: Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 74.

Moldwin RM. Rational approaches to the treatment of patients with interstitial cystitis. Urology. 2007;69:73-81.


Review Date: 5/22/2008
Reviewed By: Scott M. Gilbert, MD, Department of Urology, Columbia-Presbyterian Medical Center, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Urinary Incontinence

Urinary incontinence

Definition

Incontinence is the inability to control the passage of urine. This can range from an occasional leakage of urine, to a complete inability to hold any urine.

The three main types of urinary incontinence are:

  • Stress incontinence -- occurs during certain activities like coughing, sneezing, laughing, or exercise.
  • Urge incontinence -- involves a strong, sudden need to urinate followed by instant bladder contraction and involuntary loss of urine. You don't have enough time between when you recognize the need to urinate and when you actually do urinate.
  • Mixed incontinence -- contains components of both stress and urge incontinence.

Bowel incontinence, a separate topic, is the inability to control the passage of stool.

Alternative Names

Loss of bladder control; Uncontrollable urination; Urination - uncontrollable; Incontinence - urinary

Considerations

Incontinence is most common among the elderly. Women are more likely than men to have urinary incontinence.

Infants and children are not considered incontinent, but merely untrained, up to the time of toilet training. Occasional accidents are not unusual in children up to age 6 years. Young (and sometimes teenage) girls may have slight leakage of urine when laughing.

Nighttime urination in children is normal until the age of 5 or 6.

NORMAL URINATION

The ability to hold urine is dependent on having normal anatomy and a normally functioning urinary tract and nervous system. You must also possess the physical and psychological ability to recognize and appropriately respond to the urge to urinate.

The process of urination involves two phases:

  1. The filling and storage phase
  2. The emptying phase

Normally, during the filling and storage phase, the bladder begins to fill with urine from the kidneys. The bladder stretches to accommodate the increasing amounts of urine.

The first sensation of the urge to urinate occurs when approximately 200 ml (just under 1 cup) of urine is stored. A healthy nervous system will respond to this stretching sensation by alerting you to the urge to urinate, while also allowing the bladder to continue to fill.

The average person can hold approximately 350 to 550 ml (over 2 cups) of urine. The ability to fill and store urine properly requires a functional sphincter (the circular muscles around the opening of the bladder) and a stable, expandable bladder wall muscle (detrusor).

The emptying phase requires the ability of the detrusor muscle to appropriately contract to force urine out of the bladder. At the same time, your body must be able to relax the sphincter to allow the urine to pass out of the body.

Causes

Incontinence may be sudden and temporary, or ongoing and long-term. Causes of sudden or temporary incontinence include:

  • Bedrest -- for example, when recovering from surgery
  • Certain medications (such as diuretics, antidepressants, tranquilizers, some cough and cold remedies, and antihistamines for allergies)
  • Increased urine amounts, like with poorly controlled diabetes
  • Mental confusion
  • Pregnancy
  • Prostate infection or inflammation
  • Stool impaction from severe constipation, causing pressure on the bladder
  • Urinary tract infection or inflammation
  • Weight gain

Causes that may be more long-term:

  • Alzheimer's disease
  • Bladder cancer
  • Bladder spasms
  • Depression
  • Large prostate in men
  • Neurological conditions such as multiple sclerosis or stroke
  • Nerve or muscle damage after pelvic radiation
  • Pelvic prolapse in women -- falling or sliding of the bladder, urethra, or rectum into the vaginal space, often related to having had multiple pregnancies and deliveries
  • Problems with the structure of the urinary tract
  • Spinal injuries
  • Weakness of the sphincter, the circular muscles of the bladder responsible for opening and closing it; this can happen following prostate surgery in men, or vaginal surgery in women

Home Care

See your doctor for an initial evaluation and to come up with a treatment plan. Treatment options vary, depending on the cause and type of incontinence you have. Fortunately, there are many things you can do to help manage incontinence.

The following methods are used to strengthen the muscles of your pelvic floor:

  • Bladder retraining -- this involves urinating on a schedule, whether you feel a need to go or not. In between those times, you try to wait to the next scheduled time. At first, you may need to schedule 1 hour intervals. Gradually, you can increase by 1/2 hour intervals until you are only urinating every 3 - 4 hours without leakage.
  • Kegel exercises -- contract the pelvic floor muscles for 10 seconds, then relax them for 10 seconds. Repeat 10 times. Do these exercises three times per day. You can do Kegel exercises any time, any place.

To find the pelvic muscles when you first start Kegel exercises, stop your urine flow midstream. The muscles needed to do this are your pelvic floor muscles. DO NOT contract your abdominal, thigh, or buttocks muscles. And DO NOT overdo the exercises. This may tire the muscles out and actually worsen incontinence.

Two methods called biofeedback and electrical stimulation can help you learn how to perform Kegel exercises. Biofeedback uses electrodes placed on the pelvic floor muscles, giving you feedback about when they are contracted and when they are not. Electrical stimulation uses low-voltage electric current to stimulate the pelvic floor muscles. It can be done at home or at a clinic for 20 minutes every 1 - 4 days.

Biofeedback and electrical stimulation will no longer be necessary once you have identified the pelvic floor muscles and mastered the exercises on your own.

Vaginal cones enhance the performance of Kegel exercises for women. Other devices for incontinence are also available.

For leakage, wear absorbent pads or undergarments. There are many well-designed products that go completely unnoticed by anyone but you.

Other measures include:

  • Regulate your bowels to avoid constipation. Try increasing fiber in your diet.
  • Quit smoking to reduce coughing and bladder irritation. Smoking also increases your risk of bladder cancer.
  • Avoid alcohol and caffeinated beverages, particularly coffee, which can overstimulate your bladder.
  • Lose weight if you need to.
  • Avoid foods and drinks that may irritate your bladder, like spicy foods, carbonated beverages, and citrus fruits and juices.
  • Keep blood sugar under good control if you have diabetes.
Your doctor may recommend medication or surgery, especially if home care measures are not helping or if your symptoms are getting worse.

Medications that may be prescribed include drugs that relax the bladder, increase bladder muscle tone, or strengthen the sphincter.

Surgery may be required to relieve an obstruction or deformity of the bladder neck and urethra. Uterine or pelvic suspension operations are sometimes needed in women. Men may require prostatectomy (removal of the prostate gland). Incontinence can sometimes be managed by artificial sphincters. These are synthetic cuffs that are surgically placed around the urethra to help retain urine.

If you have overflow incontinence or cannot empty your bladder completely, a catheter may be recommended. But using a catheter exposes you to potential infection.

PREVENTION

Performing Kegel exercises while you are pregnant and soon after delivery may help prevent incontinence related to childbirth.

When to Contact a Medical Professional

Discuss incontinence with your doctor. Gynecologists and urologists are the specialists most familiar with this condition. They can evaluate the causes and recommend treatment approaches.

Call your local emergency number (such as 911) or go to an emergency room if any of the following accompany a sudden loss of urine control:

  • Difficulty talking, walking, or speaking
  • Sudden weakness, numbness, or tingling in an arm or leg
  • Loss of vision
  • Loss of consciousness or confusion
  • Loss of bowel control

Call your doctor if:

  • You have been constipated for more than 1 week
  • You have difficulty starting your urine flow, dribbling, nighttime urination, pain or burning with urination, increased frequency or urgency, or cloudy or bloody urine
  • You are taking medications that may be causing incontinence -- DO NOT adjust or stop any medications without talking to your doctor
  • You are over 60 years old and your incontinence is new, especially if you are also having trouble with your memory or caring for yourself
  • You have the urge to go often, but are only passing small amounts of urine
  • Your bladder feels full even after you have just urinated
  • Incontinence persists for more than 2 weeks even with exercises to strengthen your pelvic muscles

What to Expect at Your Office Visit

Your doctor will take your medical history and perform a physical examination, with a focus on your abdomen, genitals, pelvis, rectum, and neurologic system.

Medical history questions may include:

  • How long has incontinence been a problem for you?
  • How many times does this happen each day?
  • Are you aware of the need to urinate before you leak?
  • Are you immediately aware that you have passed urine?
  • Are you wet most of the day?
  • Do you wear protective garments in case of accidents? How often?
  • Do you avoid social situations in case of accidents?
  • Have you had urinary tract infections in the past? Do you think that you may have one now?
  • Is it more difficult to control your urine when you cough, sneeze, strain, or laugh?
  • Is it more difficult to control your urine when running, jumping, or walking?
  • Is your incontinence worse when sitting up or standing?
  • Are you constipated? For how long?
  • Is there anything you do to reduce or prevent accidents?
  • Have you ever been treated for this condition before? Did it help?
  • Have you tried pelvic floor exercises (Kegel)? Do they help?
  • What procedures, surgeries, or injuries have you had?
  • What medications do you take?
  • Do you drink coffee? How much?
  • Do you drink alcohol? How much?
  • Do you smoke? How much each day?
  • Do you have diabetes or a family history of diabetes?
  • Do you have any other symptoms?

Diagnostic tests that may be performed include:

  • Urinalysis
  • Urine culture to check for infection if indicated
  • Cystoscopy (inspection of the inside of the bladder)
  • Urodynamic studies (tests to measure pressure and urine flow)
  • Uroflow (to measure pattern of urine flow)
  • Post void residual (PVR) to measure amount of urine left after urination
Other tests may be performed to rule out pelvic weakness as the cause of the incontinence. One such test is called the Q-tip test. This test involves measurement of the change in the angle of the urethra when it is at rest and when it is straining. An angle change of greater than 30 degrees often indicates significant weakness of the muscles and tendons that support the bladder.

References

American College of Obstetricians and Gynecologists. Urinary incontinence in women. Obstet Gynecol. 2005; 105(6): 1533-1545.

Madersbacher H, Madersbacher S. Men's bladder health: urinary incontinence in the elderly (Part I). J Mens Health Gend. 2005; 2(1): 31-37.

Kielb SJ. Stress incontinence: alternatives to surgery. Int J Fertil Womens Med. 2005; 50(1): 24-29.

Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE. What type of urinary incontinence does this woman have? JAMA. 2008;299:1446-1456.

Rogers RG. Clinical practice. Urinary stress incontinence in women. N Engl J Med. 2008;358:1029-1036.

Shamliyan TA, Kane RL, Wyman J, Wilt TJ. Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Ann Intern Med. 2008;148:459-473.


Review Date: 5/22/2008
Reviewed By: Scott M. Gilbert, MD, Department of Urology, Columbia-Presbyterian Medical Center, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Abdominal Pain

Abdominal pain

Definition

Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.

Alternative Names

Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps

Considerations

There are many organs in the abdomen. Pain in the abdomen can originate from any one of them, including:

  • Organs related to digestion -- the end of the esophagus, the stomach, the small and large intestines, the liver, the gallbladder, and the pancreas.
  • The aorta -- a large blood vessel that runs straight down the inside of the abdomen
  • The appendix -- an organ in the lower right abdomen that no longer serves much function
  • The kidneys -- two bean shaped organs that lie deep within the abdominal cavity
  • The spleen -- an organ involved in blood maintenance and infection control

However, the pain may start from somewhere else -- like your chest or pelvic area. You may also have a generalized infection, such as the flu or strep throat, that affects many parts of your body.

The intensity of the pain does not always reflect the seriousness of the condition causing the pain. Severe abdominal pain can be from mild conditions, such as gas or the cramping of viral gastroenteritis. On the other hand, relatively mild pain or no pain may be present with life-threatening conditions, such as cancer of the colon or early appendicitis.

Causes

Many different conditions can cause abdominal pain. The key is to know when you must seek medical care right away. In many cases you can simply wait, use home care remedies, and call your doctor at a later time only if the symptoms persist.

Possible causes include:

  • Appendicitis (inflammation of the appendix)
  • Bowel obstruction
  • Cholecystitis (inflammation of the gallbladder) with or without gallstones
  • Chronic constipation
  • Dissecting abdominal aortic aneurysm
  • Diverticular disease, including diverticulitis
  • Easly-stage shingles (a viral infection where pain begins before the appearance of a rash)
  • Excessive gas
  • Food allergy
  • Food poisoning (salmonella, shigella)
  • Gastroesophageal reflux
  • Heartburn or indigestion
  • Hernia
  • Infectious mononucleosis
  • Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
  • Intussusception -- while uncommon, this is a serious possible cause of pain in an infant who may be bringing the knees to the chest and crying
  • Irritable bowel syndrome
  • Kidney stones
  • Lactose intolerance
  • Pancreatitis (inflammation of the pancreas)
  • Parasitic infections (Giardia)
  • Sickle cell crisis
  • Spinal fracture
  • Ulcers
  • Urinary tract infections
  • Viral gastroenteritis (stomach flu)

When an inflamed organ (such as the appendix) in the abdomen ruptures or leaks fluid, you not only have excruciating pain, your abdomen will be very stiff and you likely will have a fever. This occurs as peritonitis (inflammation and infection of the lining of the abdominal cavity) develops and spreads from the site of the rupture. This is a medical emergency.

In infants, prolonged unexplained crying (often called "colic") may be caused by abdominal pain that may end with the passage of gas or stool. Colic is often worse in the evening. Cuddling and rocking the child may bring some relief.

Abdominal pain that occurs during menstruation may be from menstrual cramps or it may indicate a problem in a reproductive organ. This includes conditions such as endometriosis (when tissue from the uterus is displaced to somewhere else like the pelvic wall or ovaries), uterine fibroids (thick bands of muscular and fibrous tissue in the uterus), ovarian cysts, ovarian cancer (rare), or pelvic inflammatory disease (PID) -- infection of the reproductive organs, usually from a sexually transmitted disease.

Abdominal pain may actually be caused by an organ in the chest, like the lungs (for example, pneumonia) or the heart (like a heart attack). Or, it may stem from a muscle strain in the abdominal muscles.

Cancers of the colon and other gastrointestinal areas are serious but uncommon causes of abdominal pain.

Other more unusual causes of abdominal pain include a type of emotional upset called somatization disorder, reflected as physical discomfort (including recurrent abdominal pain). Strep throat in children can cause abdominal pain.

Home Care

For mild pains:

  • Sip water or other clear fluids.
  • Avoid solid food for the first few hours. If you have been vomiting, wait 6 hours. Then eat small amounts of mild foods such as rice, applesauce or crackers.
  • If the pain is high up in your abdomen and occurs after meals, antacids may provide some relief, especially if you feel heartburn or indigestion. Avoid citrus, high-fat foods, fried or greasy foods, tomato products, caffeine, alcohol, and carbonated beverages. You may also try H2 blockers (Tagamet, Pepcid, or Zantac) available over the counter. If any of these medicines worsen your pain, CALL your doctor right away.
  • AVOID aspirin, ibuprofen or other anti-inflammatory medications, and narcotic pain medications unless your health care provider prescribes them. If you know that your pain is not related to your liver, you can try acetaminophen (Tylenol).

When to Contact a Medical Professional

Seek immediate medical help or call your local emergency number (such as 911) if you:

  • Are unable to pass stool, especially if you are also vomiting
  • Are vomiting blood or have blood in your stool (especially if maroon or dark, tarry black)
  • Have chest, neck, or shoulder pain
  • Have sudden, sharp abdominal pain
  • Have pain in your shoulder blades with nausea
  • Your belly is rigid, hard, and tender to touch

Call your doctor if you have:

  • Abdominal discomfort that lasts 1 week or longer
  • Bloating that persists for more than 2 days
  • Burning sensation when you urinate or frequent urination
  • Diarrhea for more than 5 days, or if your infant or child has diarrhea for more than 2 days or vomiting for more than 12 hours -- call right away if a baby younger than 3 months has diarrhea or vomiting
  • Fever (over 100°F for adults or 100.4°F for children) with your pain
  • Pain that develops during pregnancy (or possible pregnancy)
  • Prolonged poor appetite
  • Unexplained weight loss

What to Expect at Your Office Visit

From your medical history and physical examination, your doctor will try to determine the cause of your abdominal pain. Knowing the location of pain and its time patten will help, as will the presence of other symptoms like fever, fatigue, general ill feeling, nausea, vomiting, or changes in stool.

During the physical examination, the doctor will test to see if the pain is localized to a single area (point tenderness) or whether it is diffuse. He or she will be checking to see if the pain is related to inflammation of the peritoneum (called peritonitis). If the health care provider finds evidence of peritonitis, the abdominal pain may be classified as an "acute abdomen", which may require surgery right away.

Your doctor may ask the following questions about your abdominal pain:

  • Is the pain all over (diffuse or generalized) or in a specific location?
  • What part of the abdomen is affected? Lower or upper? Right, left or middle? Around the navel?
  • Is the pain severe, sharp or cramping, persistent or constant, periodic and changing intensity over minutes?
  • Does the pain awaken you at night?
  • Have you had similar pain in past? How long has each episode lasted?
  • How often do you have the pain?
  • Does it occur within minutes following meals? Within 2 to 3 hours after meals?
  • Is it getting increasingly more severe?
  • Does it occur during menstruation (dysmenorrhea)?
  • Does the pain go into your back, middle of the back, below the right shoulder blade, or your groin, buttocks, or legs?
  • Does the pain get worse after lying on the back?
  • Does the pain get worse after eating or drinking? After greasy foods, milk products, or alcohol?
  • Does the pain get worse after stress? After straining efforts?
  • Does the pain get better after eating or a bowel movement?
  • Does the pain get better after milk or antacids?
  • What medications are you taking?
  • Have you had a recent injury?
  • Are you pregnant?
  • What other symptoms are occurring at the same time?

Diagnostic tests that may be performed include:

  • Barium enema
  • Upper GI and small bowel series
  • Blood, urine, and stool tests
  • Endoscopy of upper GI (gastrointestinal) tract (EGD)
  • Ultrasound of the abdomen
  • X-rays of the abdomen

Prevention

For prevention of many types of abdominal pain:

  • Eat small meals more frequently.
  • Make sure that your meals are well-balanced and high in fiber. Eat plenty of fruits and vegetables.
  • Limit foods that produce gas.
  • Drink plenty of water each day.
  • Exercise regularly.

For prevention of symptoms from heartburn or gastroesophageal reflux disease:

  • Quit smoking.
  • Lose weight if you need to.
  • Finish eating at least 2 hours before you go to bed.
  • After eating, stay upright for at least 30 minutes.
  • Elevate the head of your bed.

References

American Academy of Pediatrics Subcommittee on Chronic Abdominal Pain. Chronic Abdominal Pain in Children. Pediatrics. 2005; 115(3): 812-815.

Ohge H. Levitt MD. Intestinal Gas. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: WB Saunders; 2006: Chap. 10.

Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery, 17th ed. St. Louis, Mo: WB Saunders; 2004.

Abdominal Pain. In: Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo: Mosby; 2006: Chap. 22.


Review Date: 4/25/2008
Reviewed By: Jacob L. Heller, M.D., M.H.A., F.A.C.E.P., Section of Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Painful Urination

Urination - painful

Definition

Painful urination describes any pain, discomfort, or burning sensation during urination.

Alternative Names

Dysuria; Painful urination

Considerations

Pain on urination is a fairly common problem. It is most often caused by an infection somewhere in the urinary tract.

Causes

  • Candidal dermatitis or vaginitis
  • Contact dermatitis or vulvitis
  • Interstitial cystitis
  • Prostatitis
  • Radiation cystitis
  • Urinary retention
  • Urinary tract infection
  • Urethritis (in men) caused by gonorrhea or chlamydia

Home Care

Follow prescribed therapy.

When to Contact a Medical Professional

Call your health care provider if:

  • There is drainage or a discharge from your penis or vagina
  • You are pregnant and are having any painful urination
  • You have painful urination that lasts for more than 1 day
  • You notice blood in your urine

What to Expect at Your Office Visit

Your health care provider will perform a physical examination and ask questions about your symptoms and medication history, such as:

  • When did the painful urination begin?
  • Does the pain occur only during urination?
  • Does the pain stop after urination?
  • Is there back pain?
  • What other symptoms do you have?
  • Have you had a fever higher than 100 degrees F?
  • Is there drainage or discharge between urinations?
  • Is there an abnormal urine odor?
  • Are there any changes in the volume or frequency of urination?
  • Do you have the urge to urinate?
  • Did you notice blood in the urine?
  • Are there any rashes or itching in the genital area?
  • What medications are you taking?
  • Are you pregnant or could you be pregnant?
  • Has there been a previous bladder infection?
  • Do you have any allergies to any medications?
  • Have you had sexual intercourse with someone who has, or may have, gonorrhea or chlamydia?
  • Has there been a recent change in your brand of soap, detergent, or fabric softener?
  • Have you had surgery or radiation to your urinary or sexual organs?

A urinalysis will be done. A urine culture may be ordered. If you have had a previous bladder or kidney infections, a more detailed history and physical are needed, and extra laboratory studies may be necessary. A pelvic exam and examination of vaginal fluids are necessary if a female has a vaginal discharge. Men who have penile discharge will need to have a urethral swab done.

Treatment depends on what is causing the pain.

See:

  • Prostatitis
  • Urethral stricture
  • Urinary tract infection
  • Yeast infection - vagina

Review Date: 10/2/2008
Reviewed By: Louis S. Liou, MD, PhD, Assistant Professor of Urology, Department of Surgery, Boston University School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Painful Sexual Intercourse

Sexual intercourse - painful

Definition

For both men and women, pain can occur in the pelvic area during or soon after sexual intercourse. It can happen at any time during sex -- for example, at the time of penetration, erection, or ejaculation -- or after sexual activity.

Eventually, ongoing pain may cause a person to lose interest in any sexual activity.

The medical term for this is dyspareunia.

Alternative Names

Painful sexual intercourse; Dyspareunia

Causes

  • A diaphragm that does not fit properly
  • Endometriosis
  • Genital irritation from soaps, detergents, douches, or feminine hygiene products
  • Hemorrhoids
  • Herpes sores, genital warts, or other sexually transmitted diseases
  • Intercourse too soon after surgery or childbirth
  • Menopause
  • Ovarian cysts
  • Prostatitis -- inflammation of the prostate
  • Reaction to the latex of a diaphragm or condom
  • Sexual abuse or rape
  • Urinary tract infections
  • Use of certain medications
  • Vaginal dryness or too little lubrication (for example, from not enough foreplay)
  • Vaginal infection
  • Vaginismus

Home Care

For painful intercourse in women after pregnancy:

  • Wait at least 6 weeks after childbirth before resuming sexual relations.
  • Be gentle and patient.

For vaginal dryness/inadequate lubrication:

  • Try water-based lubricants.
  • If you are going through menopause and lubricants don't work, talk to your doctor about estrogen creams or other prescription medications.

For painful intercourse caused by prostatitis:

  • Soak in a warm bath.
  • Drink plenty of fluids, but avoid alcohol and caffeine.
  • Take acetaminophen or ibuprofen.
  • Take antibiotics as prescribed.

For hemorrhoids, try stool softeners. Antibiotics may be required for urinary tract infections, sexually transmitted diseases, or vaginal infections.

Other causes of painful intercourse may require prescription medications or, rarely, surgery.

Sex therapy may be helpful, especially if no underlying medical cause is identified. Guilt, inner conflict, or unresolved feelings about past abuse may be involved which need to be worked through in therapy. It may be best for your partner to see the therapist with you.

When to Contact a Medical Professional

Call your doctor if:

  • Home remedies are not working.
  • You have other symptoms with painful intercourse, like bleeding, genital lesions, irregular periods, discharge from penis or vagina, or involuntary vaginal muscle contraction.

If you have been sexually assaulted, report the crime to the police and go to the emergency room immediately. Get a trusted friend to accompany you. DO NOT change, bathe, shower or even wash your hands before the ER evaluation. The temptation to do so will be great, but it is important to not lose any evidence in order to help find, charge, and convict the suspect.

What to Expect at Your Office Visit

Your doctor will take your medical history and perform a physical examination.

Medical history questions may include:

  • When did the pain begin or has intercourse always been painful?
  • Is intercourse painful every time that it is attempted?
  • Is it painful for your partner as well?
  • At what point during (or after) intercourse does the pain begin? Upon entry/penetration? During ejaculation?
  • Where, specifically, is the pain?
  • Does anything make the pain better?
  • Do you have any other symptoms?
  • What are your attitudes towards sex in general?
  • Have you had a significant traumatic event in the past (rape, child abuse, or similar)?
  • What medications do you take?
  • What illnesses, diseases, and disorders are you being treated for?
  • Have you had a significant emotional event recently?
  • Have you ever had pain-free sex with this partner? With any partner?

It may be best to see the doctor together with your partner. Physical examination may include a pelvic examination (for women), a prostate examination (for men), and a rectal examination. If a physical problem is suspected, appropriate tests will be ordered.

Antibiotics, painkillers, or hormones are amongst the treatment options that may be considered.

Prevention

  • Good hygiene and routine medical care will help to some degree.
  • Adequate foreplay and stimulation will help to ensure proper lubrication of the vagina.
  • The use of a water-soluble lubricant like K-Y Jelly may also help. Vaseline should not be used as a sexual lubricant because it is not compatible with latex condoms (it causes them to break), it is not water soluble, and it may encourage vaginal infections.
  • Practicing safe sex can help prevent sexually transmitted diseases.

References

National Institutes of Health. National Institutes of Health State-of-the-Science Conference statement: management of menopause-related symptoms. Ann Intern Med. 2005;142(12 Pt 1):1003-1013.

Klein MC, Kaczorowski J, Firoz T, Hubinette M, Jorgensen S, Gauthier R. A comparison of urinary and sexual outcomes in women experiencing vaginal and Caesarean births. J Obstet Gynaecol Can. 2005; 27(4): 332-339.

Mahutte NG. Medical management of endometriosis-associated pain. Obstet Gynecol Clin North Am. 2003; 30(1): 133-150.

Eyler AE; Biggs WS. Medical human sexuality in family medicine practice. In: Rakel RE, ed. Textbook of Family Medicine. 7th ed. Philadelphia, Pa: WB Saunders; 2007:chap 55.

Lentz GM. Emotional aspects of gynecology: sexual dysfunction, eating disorders, substance abuse, depression, grief, loss. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 9.


Review Date: 8/1/2008
Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Maternal & Child Health Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; Susan Storck, MD, FACOG, Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine; Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Bladder Exstrophy Repair

Bladder exstrophy repair

Definition

Bladder exstrophy repair is surgery to repair a birth defect in which the bladder is inside out and sticks out of the abdominal wall. The pelvic bones are also separated.

Alternative Names

Bladder birth defect repair; Everted bladder repair; Exposed bladder repair; Repair of bladder exstrophy

Description

Bladder exstrophy repair involves two surgeries: One to repair the bladder and another to attach the pelvic bones to each other.

The first surgery separates the exposed bladder from the abdomen wall and closes the bladder. The bladder neck and urethra are repaired. A flexible, hollow tube called a catheter is placed to drain urine from the bladder through the abdominal wall. A second catheter is left in the urethra to promote healing.

The second surgery, pelvic bone surgery, may be done along with the bladder repair. Or, it may be delayed for weeks or months.

Why the Procedure is Performed

The surgery is recommended for children who are born with bladder exstrophy. Bladder exstrophy occurs more often in boys and is often associated with other birth defects.

Surgery to repair the defect is usually performed within the first 48 hours after birth.

Risks

Risks with this procedure may include:

  • Chronic urinary tract infections
  • Erectile/sexual dysfunction
  • Inadequate urinary control (incontinence)
  • Need for future surgeries

Risks for any anesthesia are:

  • Breathing problems
  • Reactions to medications
Risks for any surgery are:
  • Bleeding
  • Infection

Outlook (Prognosis)

Surgery is necessary to:

  • Allow the child to develop normal urinary control
  • Avoid future problems with sexual function
  • Improve the child's physical appearance
  • Prevent infection that could decrease kidney function

Some children are unable to develop enough urinary control and may need surgery again later.

Recovery

After pelvic bone surgery, the child will need to be in a lower body cast or sling. This helps the bones heal.

How long the child stays in the hospital depends on:

  • The severity of the bladder defect
  • The number of surgeries needed
  • Whether other medical problems exist

References

Gearhart JP, Mathews R. Exstrophy-Epispadias Complex. In: Wein AJ. Wein: Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 119.


Review Date: 5/22/2008
Reviewed By: Scott M. Gilbert, MD, Department of Urology, Columbia-Presbyterian Medical Center, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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