Abdominal pain - recurring UTI?

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So, I've been dealing with left abdominal pain for 3 - 4 weeks now. First time I went to a doctor, 5 days after I noticed the pain. She had me go for urinalysys showing WBC 1 - 2, then gave me ciprofloxacin (whatever is the spelling lol) and told me if I don't get better in 5 days best to go to an obgyne as it may be twisted ovaries. After taking my meds, pain goes away but comes back but it hurts more. I don't wanna believe its twisted ovaries, so I went to another internal medicine doctor, I told him bout my left abdominal pain, and I also feel pain before bowel movement and after. He said he's concerned if its ovarian or colon, so he asked me to go for CT scan. CT scan is normal, but the time I'm suppose to go to him he wasn't around. After a couple of days, my mom brought me to ER because can't wait any longer for the doctor. They had me for another urinalysis, CBC, and abdominal ultrasound. Ultrasound is normal though. Urinalysys showed that WBC went up to 6 - 10. CBC is said to be normal. I was given third generation antibiotics by the ER doctor because I have recurring UTI, and pain killers. She also suggested for me to go to an obgyne. Within 6 days of taking antibiotics, I can feel more symptoms of UTI - hesitance in urinating, frequent urination, lower back pain. I was also told to culture bacteria my urine. I actually dunno how to read the culture bacteria results, but it says staphylococcus haemolyticus as organism. Then, I went to an obgyne, she wants me to go through transrectal ultrasound tomorrow to see more and refer me to a surgeon. I'm getting tired of all the procedures honestly. If someone perhaps can say something bout my case?

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  • Posted

    Hello,

    persistent what you have and yes, frustrating procedure.

    First of all, if you gave spontaneous urine samples (like going to toilet), it easily gets contaminated by our tissue around urethra (where urine comes out, this area is NOT STERILE and has a lot of white blood cells around and bacteria).

    It is absolutely crucial for a correct urine sample (especially in women) to follow the instructions of a good midstream urine,

    'cleaning, wiping' beforehand is not enough,

    (so that not the first urine and last urine during stream is in container, even if your hand gets wet during producing this sample if holding and letting go is too hard, better a wet hand, that can be washed than a contaminated urine sample, that cannot distinguish, if stuff found in there is from inside or outside of body.)

    So if WBC went 'up' in your urine sample, is not quite proven as it could be just contamination, or really going up due to infection. ?

    (only catheter urine can free this contamination risk, but that's last resort. So be very careful with producing the midstream urine sample please.)

    But lab could culture a bacteria, staphylococcus haemolyticus.

    This one sits on the skin outside too fully normally, but can cause an infection of urethra as well.

    (usually lab counts the colonies of those bacteria in urine that grow on medium and if high count of colonies (they present as dots on medium) are found, it is rather a real infection than contamination from producing urine sample. "CFU/ml" you might see printed next to a number after bacteria name, = colony forming units)

    I have to say,

    a transrectal ultrasound does not sound that much of fun and not 'less embarrassing' or intrusive than a transvaginal one......

    Honestly.

    There has to be a very good reason to do that.

    Which organ do they want to see and cannot do otherwise?

    They want to see ovaries or kidneys in a doppler/blood supply ultrasound?

    With a full bladder a pelvic/abdominal ultrasound is usually as good for ovaries. Kidneys are easy through skin anyway.

    Please ask what exacly they want to achieve with this technique and if there was no other option.

    Was your abdominal ultrasound done with full bladder to see ovaries?

    This is possible (hard to time with full bladder, but possible).

    As to the bacteria,

    there is the possibility to do a sensitivity test and please ask for it, since you got another blind administered antibiotic that seems not to work.

    It is absolutely ok to prescribe antibiotics for UTI 'blind' the first few times, but if they are not working, so called 'treatment failure',

    these antibiotics need to be tested for sensitivity on culture, that can be grown from your urine.

    Antibiogram or antimicrobial susceptibility test it is called.

    I honestly think first an antibiogram (and retesting of midstream urine) should be done,  plus a normal transabdominal pelvic ultrasound with full bladder for ovaries check. (in case that was not done yet)

    All the best! Ask questions!

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    • Posted

      also for appendix: it can be seen and measured in normal abdominal ultrasound and in CT or MRI. No need to go transrectal for that one either.
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    • Posted

      Thank you for your detailed response. I appreciate it very much. Though, there are jargons which i'm not sure if I understand fully.

      There's something written in my culture bacteria, 90,000 colonies of Staphylococcus haemolyticus per ml of urine.

      I actually feel afraid doing transrectal, as I had triple constrast during my CT scan where one I needed a tube in my rectum, The doctor said it would be best for transrectal is because I'm a virgin. I'm actually not sure which organ is her target, as I complain with my lower left abdomen. But earlier with her, she tried touching my lower midsection and i felt pain and also my right. But the stinging pain is in the left, like pain coming from inside.

      I also can feel some stinging pain at my lower back,

      I was told before at the ER that I'm resistant with Ciprofloxacin. I was given Nirofurantoin macrocrystals, and today is my 7th and last day taking them and I can feel more pain in my back and I urinate more frequently than before.

      There are a series of antibiotics indicated in my culture bacteria, which I'm not sure how to comprehend.

      I did have a full bladder and empty bladder when I had my abdominal ultrasound.

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    • Posted

      Sorry, I am also not native English speaking.

      That makes it harder to understand me as well.

      So sorry.

      Don't want to confuse you.

      Sounds as if an antibiogram (a sensitivity testing, if the antibiotic you take, work against your bacteria) has been done.

      The colony (bacteria) count (90000/ml) is positive, but it is not a huge number at all.

      Goodness,

      oral (mouth), intravenous (blood) and rectal contrast in one go for CT is not uncommon, but uncomfortable and good it is over.

      You are very brave and patient.

      They should have been able to diagnose or rule out and see a lot though thanks to that triple contrast CT.

      ...

      or maybe got an idea where to have a better look at.

      Yes, please ask what your transrectal (any internal, if vaginal or rectal....) ultrasound is good for after CT and abdominal ultrasounds.

      There has to be a good reason or concern = medically indicated.

      Docs have to get consent from you/mum for a reason.

       You cannot be forced to get it done by impatient argument or even threats (like 'we cannot help you further if you don't'....), but you need to feel that it was the only way and necessary, not just done with most likely no clear outcome/diagnose or no different outcome to CT.

      It needs a clear 'indication', a clear reason as to why.

      If it was suggested to be done due to something seen in CT, which can be better seen in ultrasound (e.g. a fistula in rectal wall), ok, good indication. But you need to know.

      Also ask if (thin slice) MRI could do the same as transrectal ultrasound. Express your concerns, fears and that you are not comfortable with the idea of rectal ultrasound.

      Money is no reason for a virgin to have to accept transrectal if MRI was just as good, but just more 'work' and 'cost'. (CT was expensive, so MRI should be available, too.) If you had metals in your body, MRI cannot be done, there are contraindications, but this all can be discussed.

      My daughter (14) had colonoscopy, but was asleep during procedure. She also had other scopes and surgery, but 

      I would not allow an internal ultrasound (via rectum or vagina) just like that, there would be a discussion as to why and had to be very clear and understandable for me and her too to see the importance, the benefit and be clear there was no other option like MRI.

      Then of course, we would agree.

      Wishing you all the best and that it is less than it sounds.

      It also depends on doc and technician for one and the same procedure, if you feel comfortable and in good hands, their kindness and listening skills make a difference even everything else is the same.  We have our fair share of good and bad experiences, too.

      So all all the best!

      And get well soon!!!

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    • Posted

      Oh thank you for the support.

      The culture bacteria wasn't really explained to me. So I didn't really understand it.

      I actually cried during the process of CT scan. I never thought I was that difficult and needed a lot patience to go through triple contrast.

      My CT scan was normal. So my doctor said she wants to see more details. Another obgyne will do the transrectal ultrasound procedure. I'm really not comfortable with this. MRI wasn't mentioned in our discussion actually. I'm not really sure how the procedure works for that one too. Thankfully, I live through health insurance. I just hope it does cover all procedures. But, I'm not sure why I wasn't admitted yet. I've readied myself in case I'll be confined already.

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    • Posted

      Ah you poor girl.

      You can mention that experience and discomfort you had for your rectal contrast, hence are very concerned about rectal ultrasound and hence need to know exactly what benefit this ultrasound would gain since you have existing CT pics or if an MRI could not deliver same as ultrasound?

      You can asked if you can get 'to sleep' therefore since you fear the discomfort, pain and intrution of your personal space.

      CT is usually better quality than MRI so I am really confused as to why ultrasound.

      Usually it is the other way round, organs like ovaries hide in ultrasound, so an MRI or CT is ordered.

      But then, I am not a doctor.

      So there might be a very good reason, but please ask for that reason.

      Which more details of what does she want to see?

      Is there something in CT that showed up? 

      I dislike procedures that are done, are either painful or embarrassing and could be avoided.

      If nothing was seen in CT and ultrasounds, what exactly does she want to check on? Could it be checked with MRI? 

      Yes ask.

      Be prepared for some docs hate questions, but that is their problem. Really.

      Hope everything will be fine and your pain under control. 

      You need a correct diagnose for correct treatment.

      Hang in there!

      Wishing you all, all the best!

      xxoxox

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    • Posted

      Really thank you for your concern.

      I happen to survive the transrectal ultrasound. And they found nothing abnormal. Transrectal ultrasound feels like you're pooping, but i think i prefer that experience than my triple contrast during CT scan.

      I'm now dealing with a gastroentorologist with regards my abdominal pain. They'll have me undergo colonoscopy and esophagogastroduodenoscopy. I'm not sure of what my reaction would be for this. I do just hope it will end soon.

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    • Posted

      Really thank you for your concern.

      I happen to survive the transrectal ultrasound. And they found nothing abnormal. Transrectal ultrasound feels like you're pooping, but i think i prefer that experience than my triple contrast during CT scan.

      I'm now dealing with a gastroentorologist with regards my abdominal pain. They'll have me undergo colonoscopy and esophagogastroduodenoscopy. I'm not sure of what my reaction would be for this. I do just hope it will end soon.

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    • Posted

      Well done, felt like pooping, good, so no pain?

      But unfortunately -as expected honestly- no other diagnose.

      How frustrating.

      In regards to gastro(duodeno)scopy and colonscopy

      my daughter with 14 got a deep sedetion/anaesthesia (with propofol mix) for these procedures in one,

      which is an anaesthesia which needs no intubation, done by a anaesthetist.

      Not just a shallow sedation (people can be talked to, but forget about it).

      We personally due to our experience very much liked that kind of sedetain/anaesthesia since she was so nervous prior scopes and a double procedure.

      Others might fear or react to sedations and anaesthesia, we don't.

      The colon preparation was done with a non-cramping kit (Picolax).

      She (and I) were very surprised how easy it was since we expected her to not be able to get off the toilet or feel pain. But it was really not bad at all and still 'squeaky clean' as gastroenterologist called her clean out success.

      Make sure they give you a pediatric non-cramping colon prep clean out kit.

      (I had clean outs and massive cramps or even given enemas, uagh, nope)

      She was very nervous beforehand and no 'tablet' could help that.

      She also unfortunately has bad veins, all 4 veins were punctured. But then again, other docs have no problems for contrast or surgery, get it in in first go, I guess, this anaesthesist was just not very good with small veins. ;-)

      The procedure took 1 hour. 11 biopsies.

      After waking up from scopes, she was in much better condition than waking up after a full blown laparoscopy anasthesia. Not as green in her face and not feeling sick or vomiting.

      So anaesthesia is not anaesthesia, very different from 'deepness' to duration.

      The one needed for scopes is not the same as the one needed for surgery, hence the wake up was at least for us experienced very different and pleasant.

      She was a bit confused after scopes, but came back very quickly

      and said

      to remember absolutely nothing

      and that the whole fear was for nothing.

      She would do it any other day again.

      This I wanted to let you know. I wish -and am pretty sure- the same experience.

      Are your scopes done at hospital? Will an anaesthetist be present?

      Which colon prep will you get?

      Yes, ask those questions, you want to feel relaxed about it.

      Mind you, you will still be nervous, which is normal.

      (My daughter's teeth could be heard, that's how afraid she was....)

      Our experience though makes us relaxed for the check up scopes.

      (but again: no reason was found in my daughter's case, just gastritis in biopsies and bile lying in stomach. This is the frustrating part.)

      Thanks for keeping updated!!!

      And all the best!

       

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    • Posted

      many typos! Sorry! and yes, in theory I know 'an' infront of a noun starting with a vocal. redface

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    • Posted

      No problem with the typos, I didn't even notice. 😊

      Really appreciate the details you gave. Yes, this will be done at the hospital. I transferred to another hospital because my previous one always have doctors missing in action. It will be done today, this afternoon. They already gave me laxatives last night, and this morning some jell-o. Then, another type of laxative mixed with Sprite.

      I'm a bit anxious, but i try not to show. Though, I'm starting to half joke the nurses, because I'm too paranoid. I just do hope, this will be the last procedure for me to do.

      Again, thank you very much! 😊

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    • Posted

      All the best 

      and have a good sleep during the procedures!

      And that you get rid of your pain!

      Thinking of you!

      I know it is all just too much, isn't it.

      We are taking a break after every cero diagnose investigation, but will continue since neuropathic pain treatment or acupuncture doesn't help either....we will go for MR venography next (checking blood supply or jam)

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    • Posted

      May I ask what's the problem with your daughter?

      When they were getting me ready at the lab, I was complaining bout my IV and then *poof* I was fast asleep and woke up groggy muttering silly stuff. I learned that that my EDG and colonoscopy are normal except that they saw through colonoscopy dome scratches which they think is due to pain reliever I have been taking (arcoxia). They have sent samples to the lab to see what medicine I can take. They are now requesting for MRI which I need to have through another hospital as it isn't available here. I'll be discharge tomorrow they say.

      It's kinda frustrating, because I felt like I'm being doubted even if the pain is real. But, they seem to make me think it's all in my mind, or perhaps I bump somewhere. 😑

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