Hello, I am a 31 y.o. woman who was recently at Mayo Clinic for consideration of an unresponsive UTI. I was told that I had trigonitis in addition to them finding a small amount of a bacteria resistant to the antibiotics I had been given. My problems began about six weeks ago when I developed what felt like a UTI. Prior to this I had experienced them infrequently, maybe 3-4 times in my life. Initially, I saw a N.P. at home who started tx. me with Sulfa. There was no response. Then I was given Cipro for ten days, which also did not affect the symptoms. SInce my husband and I are thinking of having children soon, I went to a doctor I know at Mayo. Once there, they cultured my urine, which reflected an "under the infection status" of a bacteria which was not sensitive to the antibiotics they gave me. They did vaginal ultrasounds, a cytoscopy, and x-rays of my U.T. with the dye injected into my bloodstream. They tested me for chlamydia infection, considered P.I.D.,and gave me a thorough gynecological exam. The results were all normal, i.e. showed nothing, except for the bacteria and the urologist's report that the bottom of my bladder appeared to demonstrate the condition they called "trigonitis". THeir recommendation was for me to take a course of an antibiotic that the bacteria was not resistant to and wait and see what happened. They discussed with me that trigonitis is treated with a certain medication that is taken for five days following the onset of symptoms, but that it would make sense to wait and see what happened from here before anything else was done. My symptoms disappeared for about ten days before I began the antibiotic they prescribed and are now reemerging, while I'm on the antibiotic. I have a mild feeling of urgency/inflammation almost all the time, and frequency that changes - sometimes I go every twenty minutes or so, and other times I feel the urgency but my frequency is more normal. I also have a mild achey lower back pain that comes and goes. I feel tired when the symptoms are present, but not extremely. No headaches or other symptoms are present. Never had blood in my urine or other problems related to this. I am wondering if I might have I.C., or if it's just emerging. Additionally, I am wondering about being told I have trigonitis. Is this a current diagnosis? How is it different then I.C.? Do you have other recommendations for future testing, etc. Thank you for your time. It's greatly appreciated. Gen ------------------------------------------------------------
Dear Gen,
“Trigonitis” is an older term that is not often used today. It describes an inflammation of that triangular part of the bladder called “the trigone” where the urethra and the ureters come together. Ask the urologist who made the diagnosis for a more specific explanation for your situation.
You may have a condition known as interstitial cystitis(IC) This is a chronic inflammation of the bladder wall and unfortunately there is not a known cure. It differs from common cystitis in that the later is caused by a bacterial infection which can be treated by bacterial antibiotic therapy. Your urologist was correct by performing an IVP and cystoscopy to rule out cancer or anatomic abnormalities which could also be a cause for your irritative symptoms. Urodynamics was done to make sure your bladder functions properly and that it is not unstable. It is also important to note that IC is not a psychosomatic disorder nor is it caused by stress.
IC can affect people of any age, race or sex. It is, however, most commonly found in women. A 1987 epidemiological study estimated that 450,000 people may be affected by the disease. The symptoms include:
-Frequency-Day and/or night urination (up to 60 times a day in severe cases.) In early or very mild cases, frequency is sometimes the only symptom.
-Urgency-The sensation of having to urinate immediately may also be accompanied by pain, pressure or spasms.
-Pain-Can be in the abdominal, urethral, or vaginal area. Pain is also frequently associated with sexual intercourse.
-Other Disorders-Sometimes patients also report experiencing symptoms such as muscle and joint pain, migraines, allergic reactions, colon and stomach problems as well as the more common symptoms of IC described above.
Diagnosis is very difficult and must follow several steps:
1)Urine cultures must be negative
2)Rule out other associated disease
3)cystoscopy-routine cystoscopy in the clinic may not be sufficient to make a diagnosis of IC. It is usually necessary to distend the bladder under general anesthesia in or to see pinpoint hemorrhages on the bladder wall a hallmark of this disease. It may even be necessary for a biopsy to be take at that time as well.
Treatments
1)Bladder distention
2)Oral medication-anti-inflammatory drugs, antispasmodics, antihistamines and muscle relaxants.
3)DMSO (Dimethlyl Sulfoxide)-bladder instillation
4)Elmiron-(Sodium Pentosanpolysulfate)
5)Anti-depressants
6)Diet
7)Tens Unit
8)Silver Nitrate
9)Clorpactin WCS-90
10)Self Help- biofeedback
11)Surgery
Recommendations:
I agree with your first urologist’s work-up thus far. . It sound like a cystoscopy under anesthesia with hydrodistention might help with a diagnosis, it may also be therapeutic at the same time.
I will enclose an address of the IC association. You may want to contact them for more information. Interstitial Cystitis Association, P.O. Box 1553 Madison Square Station, New York, NY 10159. (212) 979-6057
This information is provided for general medical education purposes only. Please consult your physician for further diagnostic treatments and options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1-800-653-6568).
Sincerely
HFHS M.D.-AK
*keyword: frequent urination
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