[20F] Experiencing urinary discomfort and unexplained bleeding

Patient Description

A 20-year-old female is experiencing an uncomfortable, frequent urge to urinate with pain described as a shock in the lower stomach, particularly severe after urination. This has been ongoing for 2 days, worsening at night. The patient has started bleeding, which is not heavy but noticeable when wiping, and it is unclear if it is menstrual blood. She also reports increased fatigue and chills, with some pain in the middle of her lower back. The patient recently took antibiotics for fluid in the ears and nausea, with two doses remaining. There is no history of new sexual partners, no recent injuries, no fever, and no known drug allergies or chronic illnesses. The patient is not currently on any medications.

Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible explanations for your symptoms:

Urinary Tract Infection (UTI): This is a common condition where bacteria enter the urinary tract, causing symptoms such as a frequent urge to urinate, discomfort or pain during urination, and lower abdominal pain. UTIs can sometimes cause lower back pain and fatigue. If the infection spreads to the kidneys, it can cause chills and fever, although you've mentioned you don't have a fever.
- UTIs are typically treated with a short course of antibiotics.
Interstitial Cystitis: This is a chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain, ranging from mild discomfort to severe pain. The condition is a part of a spectrum of diseases known as painful bladder syndrome.
- Treatment can involve medications, physical therapy, and sometimes surgery.
Kidney Stones: These are hard deposits made of minerals and salts that form inside your kidneys. Kidney stones can cause severe pain in your side and back, below your ribs, and can also cause pain during urination and blood in the urine.
- Treatment can involve pain medications, drinking lots of fluids, and in some cases, medical procedures.
Menstrual Cramps: Some of the symptoms you're experiencing could be related to your menstrual cycle. Menstrual cramps can cause pain in the lower abdomen, which can be severe. They can also cause back pain and general discomfort.
- Over-the-counter pain relievers are often effective in reducing the pain.

Please note that these are possibilities and not a definitive diagnosis.

What you can do

While waiting for your appointment with a healthcare professional, here are some things you can do:

Drink plenty of water: This can help flush out bacteria if you have a UTI.
Avoid drinks that may irritate your bladder: These include coffee, alcohol, and soft drinks containing citrus juices or caffeine until your infection has cleared.
Use a heating pad: This can help reduce abdominal discomfort or lower back pain.
Over-the-counter pain relievers: These can help manage pain, but they should not replace a visit to the doctor.