PJ from San Diego, California, asks:

I understand that many women have classic UTI symptoms of burning, abdominal and back pain yet test normal on urinalysis and culture. I was referred like many to a Urologist for an additional urinalysis and culture via catheter, CT scans, and Cystoscopy. It appears that many still have negative test results however now suffer from horrific spasms as result of the catheterization- a symptom they now have in addition to burning with urination. It seems unusual that specialists speak little about this adverse reaction given that the pain can be acute and need medication. You might think a patient already suffering from urinary burning might want to make an informed decision prior to having the test and having received a negative CT scan.

I would like to see more information on bladder spasm pain as a result of a routine cystoscopy. What homeopathic remedies are known to be beneficial for this acute pain and what natural therapies are known to help until it passes? There are over the counter and prescription medications used from different drug families some containing a myriad of side effects and chemicals. I, like others, have concerns in regards to adding a prescription or drug to others and prefer to explore either homeopathic or other alternative therapies.

Dear PJ,

Thank you for this excellent question! I’m sorry to hear that you are suffering more after having the cystoscopy.

For those who don’t know, a cystoscopy is a test done by a urologist. A camera that is basically shaped like a urinary catheter is inserted through the urethra and into the bladder. The doctor can see the inside of the urethra and bladder very well. This is basically like a colonoscopy of the bladder.

Cystoscopy is performed to evaluate for cancer of the bladder or urethra, urethral strictures (scar tissue of the urethra), and congenital abnormalities (such as malposition of the ureters, which connect the kidney to the bladders). It is also done to evaluate the prostate and to look for signs of urinary tract obstruction. If there is a stone in the bladder or urethra, this can often be seen on cystoscopy.

Unfortunately, the risk management and reimbursement driven culture of medicine often leads doctors to be more concerned with ruling out life-threatening problems such as cancer and less concerned with actually achieving resolution for the patient, even if the diagnosis is unclear. This is why, as PJ says, informed consent by patients is truly the best solution–the physician is able to tell the patient what he or she can do and why, and it is ultimately the patient’s responsibility to make an informed choice. The real problem is that providing true informed consent is quite time-consuming, and not paid for by most insurance companies.

Another challenge is the lack of awareness of how patients really feel after we perform tests on them. I must say that issues such as you report have rarely come to my attention. I don’t know if this means they are actually rare or that patients just don’t seek follow-up or tell their doctors about them. In any case, it sounds as if you may be one of many people suffering from inflammation of the urinary tract and/or pelvic floor muscles. These problems are common and unrecognized causes of pain and urinary symptoms such as the burning you describe.

The best way to calm inflammation of the urinary tract is with a multimodal approach. I am not an expert on homeopathy, but belladonna is likely to be a helpful remedy. The best herbal remedy I know of is marshmallow root tea, which can be brewed 1 tablespoon in a cup of water four times a day. As for pharmaceuticals, phenazopyridine (sold over-the-counter as Azo and via prescripton as Pyridium) may provide some relief of the symptoms, though it does not treat the underlying cause in any way.

Most patients with urinary tract inflammation will benefit from an elimination diet. I really love the work of Tom Malterre and Alissa Segersten on elimination diets. The Interstitial Cystitis Association also has a great webpage on this with a more specific focus on foods likely to be irritating to the urinary tract.

Whole body anti-inflammatory measures such as following a gluten- and dairy-free diet, achieving a healthy omega-3 to omega-6 ratio (for example, by avoiding trans-fats and taking fish oil), and supplementing with anti-inflammatory foods and herbs such as turmeric, ginger, and Boswellia, are also likely to be helpful.

And, if your symptoms are coming from inflammation of the pelvic floor muscles, I highly recommend you seek out a physical therapist trained in pelvic floor muscle rehabilitation. Your urologist may know one.

Please note that I don’t recommend these approaches without a careful evaluation first. As mentioned, some people have the symptoms you describe because of issues such as infections or cancers that benefit from early diagnosis and treatment.

As I mentioned, your experience is not, to my knowledge, a common one, but is is important! Cystoscopy is an extremely valuable tool and the technology really does allow us to help many people. Most people who I encounter report that the cystoscopy is uncomfortable but that it does not cause pain afterwards. Before reading your question, I probably would not have thought about mentioning the side effects you describe, so I cannot fault your urologist for not doing so either. I am really grateful for the opportunity the Internet provides for us to learn more from each other and share more widely! My deepest wish is that this article will help you and others find relief.

Thank you, PJ, for asking the right questions!

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