Bladder Spasm - UTI Symptoms but no Bacteria: What Worked for Me
I Have UTI Symptoms but no UTI - My Doctor Says it's Bladder Spasm aka Over Active Bladder
You go to the doctor with what you're sure is a bladder infection, only to find out it's not. A urinalysis shows that there is no bacteria present. So what could be causing you to feel like you constantly need to urinate?
When I was in this situation, I found out that antibiotics don't help; in fact, they may make things worse. Often a doctor will prescribe antibiotics for UTI symptoms without performing a urinalysis, but that can be a mistake if you're actually dealing with a condition like a bladder spasm or, worse yet, interstitial cystitis.
Antibiotics kill off the good bacteria in your body along with the bad. After what I have been through, I would recommend that you insist on a urinalysis before taking antibiotics for urinary symptoms.
Through research and trial and error, I found the things that worked for me. I now have been pain-free for over a year and a half, and I am not taking any medications.
Many women find themselves in a situation like the one I have described at some point in their lives. Their GP or gynecologist may not be very knowledgeable about it. Trying to get information about urinary symptoms that are not caused by bacteria and getting the appropriate treatment can be very frustrating.
When I wrote this article in 2012, I had just recovered from a months-long flare. While I was suffering, I was desperately searching the Internet for some kind of advice. I had to really dig deep to get anything at all. I am happy to see that now there is actually some advice available from medical websites such as Web MD. I hope this will lead to less suffering. Still, I think it is helpful to hear from a patient's perspective.
This article covers causes and treatment options for people who are having UTI symptoms without bacteria present and will include the following topics.
- Bladder spasm or overactive bladder
- Symptom relief
- Foods to avoid
- Supplements to take
- When to see a urologist
- Interstitial cystitis (IC)
- Urethral syndrome
I am not a medical professional. I am sharing my experience in the hope that it helps someone else who is going through this. Every person and every bladder is different. As my urologist pointed out, there are many things that can cause the same symptoms, and the cause of bladder pain can be hard to diagnose.
First Aid - How Can I Relieve My Bladder Symptoms?
I'll get into more details later, but if you are suffering right now, this is what I would recommend:
- Drink baking soda mixed with water: The first line of defense for me is to drink 1/4 tsp of baking soda (do not exceed two teaspoons of baking soda a day) dissolved in a small amount of water. This neutralizes the acid in your urine. I started feeling better within ten minutes. I read about it in a book, and it helped me much more than anything any of the doctors I had been going to for months had suggested.
- Take a hot bath: I found soaking in a hot tub to be very palliative.
- Relax your pelvic floor muscles: The muscle you want to relax is the same muscle you work when doing kegel exercises. Locate the muscle you use to stop your urine flow by tightening it once, then consciously relax it. It seems like it's too simple, but I was really surprised how much better this made me feel.
- Don't strain to urinate: This is really important. You've probably been straining to empty every drop when you urinate; try not to do that because it's making things worse. The muscles in that area are all tense, and the nerves are overstimulated. So instead, you need to calm them down.
- Do not drink cranberry juice or other fruit juice! Cranberry juice is very acidic and will irritate your bladder. Many people who develop these symptoms have been drinking large quantities of cranberry juice; if you are doing so, stop immediately.
- Avoid certain drinks and foods:
- Immediately stop consuming all carbonated drinks, alcohol, and coffee.
- Do not eat any chocolate. In addition, avoid spicy food and citrus.
- Drink plenty of plain water, but do not force yourself to drink gallons. Simply drink a glass whenever you think about it.
Why Don't Doctors Believe Women With Urinary Symptoms?
In my experience, most doctors, especially male doctors, do not perceive these symptoms in a female as a serious medical matter, certainly not an emergency. After all, your vital signs are all fine, an examination doesn't find anything amiss, and nothing is showing up in your blood or urine. Therefore, you're fine.
For many years doctors were taught that urinary symptoms with no discernible cause were psychosomatic. As late as 1984, they questioned whether interstitial cystitis was even a real medical disorder. Tests showed that women with such symptoms were anxious and depressed. Gee, I wonder why that would be? I think the medical community is far too ready to dismiss symptoms they can't explain as being "all in your head."
It's easy to get overwhelmed and very emotional when you don't feel that your complaints are being heard. You're extremely uncomfortable, it's very hard to get any sleep, and you're physically and emotionally frazzled. But try to get a grip on yourself.
If you show up at a doctors office in that condition, it will be even harder to be taken seriously. (In fact, when I went to the ER in tears, I was prescribed Xanax by a doctor who obviously thought I was just hysterical.) Also, the pain cycle can feed on itself, and the more emotionally worked up you get, the worse you may feel. Believe me, it will get better.
What is Bladder Spasm or Overactive Bladder Syndrome (OAB)?
The urologist I went to called my problem a "bladder spasm," and he took great pains to explain to me how difficult it is to find the cause and right treatment for symptoms like urinary frequency and urgency. He also said that many women have episodes of bladder spasm at some time in their lives but recover from it completely. According to the American Urological Association, an estimated 33 million Americans have an overactive bladder.
The most common symptoms of bladder spasm (also known as overactive bladder syndrome) are:
- Increased urinary frequency and urgency
- Urethral burning
- Pelvic pain
- Leaking urine
I never experienced any leaking or loss of control. Not everybody has all symptoms. It usually starts with frequency and urgency.
What Does Bladder Spasm Feel Like?
For many people with bladder spasm, like me, it is just a constant feeling of needing to urinate; even after you have just gone, the feeling does not go away. In fact, the only time I felt good was when I was actually urinating.
What Causes Bladder Spasm?
There really isn't an easy answer to that question. Often there doesn't seem to be any discernible cause. It is idiopathic, which means it has no known cause. However, there are a few things that seem to put a patient at higher risk for bladder spasm. They include:
- Frequent UTIs
- Catheter use
- Difficult childbirth
- History of pelvic surgery
Can UTI Symptoms Linger After Antibiotics?
Yes, they can! Irritation in the bladder can remain, even after the infection has cleared up, it takes time for the tissue in the bladder to heal. And maybe, you didn't have a UTI after all. Unfortunately, this is a common occurrence. Doctors often prescribe antibiotics based on a patient's symptoms without ever performing a urinalysis.
What are Common Food Triggers for Bladder Spasm or Interstitial Cystitis?
- Fruits other than pears
- Alcoholic beverages
- Tomatoes and tomato sauce
- Spicy foods
- Carbonated beverages
- Aged cheese
- Sour cream
- Corned beef
- Cured meats like salami, bacon, or ham
- Salad dressing
- Tree nuts
- Artificial flavors
- Vitamin supplements—especially Vitamin C
Healing an Irritated Bladder: What Worked for Me
The healthy bladder is coated with a mucosal tissue called the glycosaminoglycan layer, generally referred to as the GAG layer. This layer protects the bladder from direct contact with urine. The GAG layer can become damaged by bacteria or other trauma, such as pelvic surgery, repeated infections, or a complicated pregnancy. I went on a regimen designed to heal the GAG layer.
First of all, go on a low-acid diet. If you look up an Interstitial Cystitis diet or IC diet, you will get a lot of varying advice on this. Different people seem to have different triggers. The ones I mention above, in the "common food triggers" section, should be avoided. Most of them definitely affected me.
One book I read said, "If you wouldn't put it on an open wound, don't eat it," and this resonated with me. So things like hot spices, lemon and vinegar would be off limits. If I ate acidic food, I could feel my bladder burning within 10 minutes.
This list is a good starting point. Pay attention to you body. If you feel worse, ask yourself, "What did I eat?"
What to Eat While Dealing With Bladder Pain
It can be hard, with just a list of things you can't have, to figure out what to eat. There are plenty of foods you can still eat.
- Any meat, poultry, fish, or shellfish is OK, except cured meats like bacon or salami.
- Most vegetables other than tomatoes, onions, or hot peppers are fine.
- You can still eat bread, other than rye and sourdough.
- Dairy foods including milk, butter, cottage cheese, American cheese, and vanilla ice cream work. You can start adding some of the milder aged cheeses in small amounts once you start feeling better.
- Pasta, rice, and most cereals are OK.
- Salads can be a problem because of the dressing, but you can try them with herb-infused olive oil and coarse salt.
When you feel better, start slowly adding back foods one at a time. It can be tempting to just go back to your regular eating pattern, but you don't want to have to start over. I started with a little mayonnaise on my sandwich because I really missed it. Add one food at a time, and take it very slowly.
Don't Sabotage Yourself
Don't give in and reach for the foods that are hurting you. I really sabotaged myself for a while because I would not give up that one cup of coffee in the morning. Once I got past that, I started to get better. Don't undermine your recovery with that one glass of wine or cup of coffee, the way I did. Just stop. If all goes well, this will be a temporary situation. You can go back to enjoying those things later, but for now, you have to get this situation under control.
Instead of your regular acidic indulgences, milk or vanilla ice cream can be pleasant and very soothing. Make sure you get a brand of ice cream that does not contain a lot of chemicals.
Some Hot Drinks You Can Try
- Have hot vanilla milk in the morning instead of coffee. Just put a drop of pure vanilla extract and a little sugar or honey in a mug of hot milk.
- Some good tea options are marshmallow root, chamomile, catnip, licorice, ginger, or peppermint. They are usually well tolerated and can be beneficial. Make your teas weak until you are sure they don't bother you.
- Sometimes, just sipping a cup of hot water is comforting, and it helps keep you hydrated.
What Supplements I Used
Based on what I read in books and researched on the Internet, I used the supplements and products listed below:
- Glucosamine and Chondroitin (400 mg 3x per day): It coats the GAG layer, giving it a chance to heal.
- Calcium Citrate + Vitamin D (200 mg 2x per day): It helps your body excrete oxalates more efficiently, which helps prevent vulvodynia, an associated condition that is also very unpleasant.
- Bromelain (100 GDU 3x per day): Bromelain is an anti-inflammatory enzyme.
- Quercetin (100 mg 3x per day): Quercetin is another anti-inflammatory agent.
- Prelief: Prelief is an antacid that you can take before eating acidic foods. I would not recommend eating acidic foods, even with it, until you get your symptoms somewhat under control. But I did use it occasionally as a precautionary measure if I needed to eat out, and I used it more often as my bladder improved and I was able to return to a more normal diet.
You might want to start off with the glucosamine and chondroitin and work your way down the list. Add one supplement at a time and wait a few days before adding the next one, just to make sure it's not a trigger for you. I used 21st Century Glucosamine 250 mg and Chondroitin 200 mg, just because it didn't have a lot of extra ingredients in it. I don't think the brand matters so much, but look out for added vitamin C in some of them.
One prescription medication I took for a short time that did help me was Ditropan (oxybutynin chloride). It is supposed to relax your bladder muscles to prevent urgent, frequent urination. At first, I was taking 5 mg a day, and it wasn't helping. But when my doctor raised it to 10 mg a day, it gave me some relief.
You Don't Have to Live With Cystitis
I found great advice in this book; it was recommended to me by my urologist. I found it to be very helpful and informative. It goes into depth about the causes of cystitis, how to reduce bladder pain, and how your diet can impact the condition.
When to See a Urologist
Once your GP recognizes that you don't have a garden-variety bladder infection, you will probably be referred to a urologist. All of this takes time, and it will likely be a couple of months before you actually see the urologist. That can seem like a lifetime when you are suffering. Usually, the first thing they will want to do is a cystoscopy, during which a tube with a camera on the end is inserted through the urethra into the bladder to examine it. My urologist made an appointment for me to have that test, but it was six weeks out. He said that if I got better before then, I should call and cancel.
The idea of that test really freaked me out, given the way I was feeling. Reading about other people's experiences on the interstitial cystitis forum, I wasn't optimistic about the outcome. I didn't see a lot of positive comments about how great things were after the diagnosis. Everyone seemed to be on a lot of drugs that were marginally effective at controlling their symptoms, and it sounded like a life sentence to me.
I did get a lot of great information from the IC forum, but I had to do a lot of searching around. I have tried to condense the information here for people having their first experience with bladder inflammation.
Could It Be Interstitial Cystitis (IC) or Bladder Pain Syndrome?
If you are researching these symptoms on the Internet or talking to your doctor, you may have heard of interstitial cystitis (IC) also known as bladder pain syndrome. It is a chronic inflammation of the lining of the bladder. According to the National Institute of Diabetes and Digestive and Kidney Diseases, IC may affect between 3 million and 8 million women and between 1 million and 4 million men in the United States.
What Are the Symptoms of IC?
If you have urinary frequency and urgency, urethral burning, and pelvic pain, you probably have cystitis, which is bladder inflammation. If it doesn't go away—lasts more than six weeks—and no other cause can be found for it, then it may be interstitial cystitis. Some people experience UTI-like symptoms constantly while others experience it intermittently. IC can cause pain during intercourse and can be accompanied by other health issues such as irritable bowel syndrome, fibromyalgia, and other pain-related diseases.
What Is the Cause of IC?
The cause of IC is unknown, and although it can be treated, there is no cure. But take heart, just because you have urinary symptoms without bacteria does not necessarily mean that you have IC.
How Is IC Diagnosed?
Interstitial cystitis is often mistaken for a urinary tract infection. Patients often go as long as four years between the time they first experience symptoms and the time they receive their diagnosis. It most commonly affects women, although men can get it too.
IC is diagnosed by ruling out other conditions, such as bladder infections or bladder cancer. Also, when it is advanced, it can be diagnosed by cystoscopy, as there will be visible ulcers on the lining of the bladder. For a cystoscopy, you will have to see a urologist. Not all doctors believe a cystoscopy is necessary or an effective way to diagnose the condition since the exam can be normal but you still may have IC.
What Are Treatment Options for IC?
IC is a chronic condition for which there is no cure. There is not a single treatment that works for everyone. There are two FDA-approved treatments for IC: an oral medication called pentosan polysulfate sodium and a once-weekly treatment where dimethyl sulfoxide (DMSO) is placed directly into the bladder through a catheter. However, some doctors may try other treatments if their patients don't respond to these medications.
Diet changes are also effective in many people with IC, and an elimination diet is recommended to see which, if any, foods are triggering your symptoms. While doing an elimination diet, it's important to also keep a food journal that tracks what foods you're eating and how you feel after eating them. This journal will become especially important when you start reintroducing foods.
Here are some more natural treatment/pain relief options:
- Heat/cold therapy: When spasms are felt, use heat packs to soothe the muscles and bladder wall. Use an ice pack for burning sensations to reduce inflammation. Remove heat and cold packs every 20 minutes and alternate.
- Physical therapy: Pelvic floor muscles tend to be very tight in IC patients, so seeing a pelvic floor PT can help relax those muscles. PTs can also teach patients bladder retraining exercises.
- Aloe vera: Some OB-GYNs recommend that aloe pills to reduce the intensity of flares.
- Take a warm bath: A warm bath with Epsom salt and baking soda can help relax pelvic floor muscles and soothe bladder pain and inflammation.
De-stressing is important for people suffering from IC. Stress causes inflammation, leading to increased IC symptoms. Set aside time to relax every day.
Most people's symptoms improve once they find an effective treatment but not all patients become symptom-free.
What Is Urethral Syndrome?
People with urethral syndrome experience similar symptoms to those with bladder spasm or OAB. Also, like Bladder Spasm, people with urethral syndrome have very tight pelvic floor muscles. The difference is their symptoms originate in the urethra instead of the bladder. It can be caused by bacteria, but it is often caused or aggravated by chemical or physical irritation, such as scented feminine products or rough sex.
People with IC or OAB often have urethral syndrome as well. I believe this is largely because of the constant peeing and wiping. Be careful to use a soft, unscented toilet paper that doesn't irritate you. If you are traveling, bring your own along with you. Gas station toilet paper is notoriously cheap and scratchy.
- lower abdominal pain
- a sense of urgency to urinate
- frequent urination
- blood in urine (often microscopic)
- pain during urination
- pain during sex
- Stop using products or doing things that irritated the urethra.
- Doctors may order antibiotics, anesthetics, antispasmodics, antidepressants, and alpha-blockers.
I believe that many of the things I recommend for bladder spasm can also help those with urethral syndrome. It is another malady that is not well understood by medical science, and it was also considered psychosomatic until recently. If tests show that the patient has an infection, they should be treated with appropriate antibiotics.
Don't Lose Hope
Now, looking back, I think most people who get over their problems never go back to the forum to share their story, so just because you don't see many success stories doesn't mean they don't exist. I did get some good advice for dietary changes and supplements from the IC forum, but I had to do a lot of digging. I've tried to condense the information that helped me here to make it more accessible.
I never did have the cystoscopy. I was able to get my symptoms under control and opted not to have it. The cause of interstitial cystitis is mysterious, and I was never diagnosed with it, but I feel as though if I had continued to irritate my bladder, I might have developed that chronic condition.
From my reading and research, it sounds like it's important to get your symptoms under control early. Dietary changes when you first experience symptoms can prevent your condition from progressing. Patients who have had an irritated bladder for a longer period of time experience less relief from dietary changes.
If it turns out you do have interstitial cystitis, there are medications and treatments that may be beneficial to you.
If you're really suffering right now, you're probably having a flare. It won't last forever; it will pass. It will take time for your bladder to heal, so don't expect a miracle cure overnight. I have experienced two flares that lasted several months each. I am able to eat a normal diet now, even coffee and chocolate. But if I had to give them up forever to prevent that kind of pain, it would be well worth it. Now I know what I have to do when that feeling comes back.
UTI vs. Bladder Spasms vs. Interstitial Cystitis
Urinary Tract Infection
Bladder Spasm/Overactive Bladder Syndrome
Interstitial Cystitis/Painful Bladder Syndrome
How It's Defined
A bacterial infection in any part of your urinary system. Most infections involve the lower urinary tract—the bladder and the urethra.
Urgency, with or without urge incontinence, usually with frequency and nocturia.
A chronic inflammation of the lining of the bladder
Bacteria enter the urinary tract through the urethra and begin to multiply in the bladder
The cause is often not known, but it can result from frequent UTIs, complications from a catheter, or a side effect of a medication. A less common cause is a nerve disorder.
Causes are unknown
Characterized by a burning sensation when you urinate; the need to urinate frequently. cloudy or odd-smelling urine
Characterized by an increase in urinary frequency and urgency, urethral burning, pelvic pain, and sometimes leaking urine
Characterized by pelvic or bladder pain; an urgent need to urinate; the need to urinate more frequently
How It's Diagnosed
Analysis of a urine sample
After ruling out an infection, there are a number of different tests doctors can do to diagnose this condition.
There is no standard test to diagnose for IC. Your doctor will first rule out an infection before deciding which test (if any) to use to determine your diagnosis.
Typically, antibiotics are used to treat this infection.
Lifestyle changes, physical therapy, medication
There is no cure. Treatment options include diet changes, pelvic floor physical therapy, heat/cold therapy, aloe vera, or medication.
There is Great Advice in These Comments
I have had many people visit this page and leave comments. If you need more advice, I would recommend looking through them.
The list is long, but there is some great wisdom to be gained from others who have experienced persistent bladder pain.
Questions & Answers
I have had pain for 2 months in my bladder. It constantly feels swollen and urethra feels tingly. I have no trouble urinating. After I do urinate though my bladder feels sore and urethra twinges. I have also found I don't feel any different when I eat different types of food. When you did eat though foods did it cause symptoms right away? How long did you live with the symptoms? Should I still cut out that food from my diet?
If you are extremely symptomatic, you won't feel better right away when you change your diet, although very acidic food could make you feel worse.
It sounds like your urethra is irritated. Be careful what kind of toilet paper and feminine products you use (soft and nothing scented). I also found tampons to be very irritating. Also pay attention to relaxing those pelvic floor muscles.Helpful 9
I had a UTI for months because my doctor didn't diagnose it in time. I then went to another doctor who treated it after I'd had it for three months. Now, my bladder isn't working regularly, and I am only 14, so it really messes me up. Do you think that my bladder tissue is still healing from the UTI?Helpful 7
Only thing at present that I am able to eat at present is potatoes. Can’t take dairy due to stomach issues. Any suggestions as to what to add next. Also, where can I read more about Glucosamine 250 mg and Chondroitin?
I'd go to vegetables and/or meat. You need that variety of proteins and vitamins. Here is a good link for Glucosomine, chondroitin and quercetin in relation to bladder pain.Helpful 3
Were you able to drink green tea when you quit coffee? I need some tea type of substitute for my coffee.
When I first quit coffee, I took a little caffeine in tablet form, and weaned myself off of it; I just could not function without it. It probably wasn't the best thing, but it didn't seem to have the negative effect on my bladder of drinking coffee.
As a hot drink in the morning to replace coffee, I would have vanilla milk, a very weak catnip tea, or just hot water. If you want to try tea, make it very weak, just dip the bag enough to add a little color to the water.Helpful 3
A microscopic amount of blood in my urine was found, and now, I have a persistent urge to urinate. It's frustrating because my ultrasound came out normal; there are no bacteria in my urine. I’m really nervous that this is going to be an on-going thing. I will try some of the things that worked for you, and I hope I get some relief. I will see a urologist in two weeks. Can these spasms come and go randomly? How long did it last for you?
I'm so sorry you're not feeling well. Symptoms can come and go. Usually, it doesn't go away suddenly once you have severe symptoms, but they can get better gradually. Symptoms can come on suddenly though. That's the time to examine your diet and any other behavior or things in your environment that could give clues to what caused it to flare up.
For me it took three or four months once I got on the program I have described, but for many, it takes longer. We can't even be sure we are all dealing with the same problem since many things can cause the same symptoms.Helpful 2
© 2012 Sherry Hewins