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Urinary Tract Infection (UTI)

Signs and Symptoms

A variety of signs and symptoms may suggest lower and/ or upper urinary tract infection (UTI).

Cystitis involves the lower urinary tract, and typical signs/ symptoms include (Mayo Clinic 2012a; University of Maryland Medical Center 2011; WomensHealth.gov 2008)

  • A painful stinging or burning sensation during urination
  • The need to urinate more frequently
  • Cloudy, red, pink, or dark-colored urine
  • Discomfort or pressure in the lower abdomen
  • Urine with a strong odor
  • Pain in the pelvic area (women) or rectum (men)
  • Fever

Pyelonephritis is a serious infection involving the upper urinary tract (kidneys). Signs/ symptoms of pyelonephritis include (Hooton 2012; National Kidney and Urologic Diseases Information Clearinghouse 2012a; Mayo Clinic 2011)

  • High fever
  • Flank/Abdominal pain
  • Chills
  • Vomiting
  • Frequent/Painful urination

Interstitial Cystitis/ Painful Bladder Syndrome

While pelvic pain, urinary urgency, and nighttime urination are associated with UTI, these symptoms may be the result of a different, somewhat more obscure condition called interstitial cystitis or, sometimes, painful bladder syndrome (Vij 2012; Moutzouris 2009; Miller 2012; Quillin 2012; Ching 2012).

As with UTIs, interstitial cystitis affects women more often than men and can considerably decrease quality of life. Unfortunately, opinions about interstitial cystitis, and the techniques used to diagnose and treat it, are somewhat inconsistent within conventional medicine; this leads to delayed diagnosis in many cases. One reason for this is that a specific cause has not been identified; upon examination, bacteria are not present in the urine of those with interstitial cystitis. Inflammatory damage to the bladder lining (urothelial cell barrier) and some level of immune system derangement are thought to be involved, but the origins of these phenomena are unclear (Moutzouris 2009; Vij 2012; Quillin 2012; Miller 2012).

Since little is understood about the development of interstitial cystitis, protocols for its treatment lack a robust evidence base and often hinge upon physicians’ clinical experience or data from relatively small clinical trials. After diagnosing a patient with interstitial cystitis, which can only be accomplished by ruling out other causes of symptoms since no laboratory test can identify the condition, physicians may prescribe a number of therapies, including (Moutzouris 2009; Vij 2012; Quillin 2012; Miller 2012)

  • Some antidepressants (eg, amitriptyline)
  • DMSO (injected into the bladder)
  • Antihistamines
  • Behaviorial therapy (eg, retraining voiding patterns) (Parsons 1991)
  • Pentosan polysulfate sodium (Elmiron®)
  • Transcutaneous electrical nerve stimulation (TENS)
  • Intravescial lidocaine (ie, injection of the local anesthetic lidocaine into the bladder)
  • Corticosteroids
  • and many others

Despite the fact that an estimated 180 different strategies have been tried as potential treatments for interstitial cystitis, only very few have been shown to be effective. One such drug is pentosan; it is FDA-approved to treat interstitial cystitis and is marketed under the brand name Elmiron® (Moutzouris 2009). Pentosan is thought to work by supporting the integrity of the urothelial layer in the bladder (Teichman 2002).