Incomplete urination

[Guest guest]

Here's a new case I need some help with.

 

31 yo, female.

Chief Complaint: incomplete urination, burning/stinging sensation after urinating that improves as the bladder fills, slightly slowed stream, sharp pain on intercourse

 

History:This all started 4 years ago when she got a uti that wasn't treated properly initially and then needed many months of antibiotics to clear the infection. Once the infection cleared the symptoms of burning, frequency, etc persisted. She was treated with more antibiotics that didn;t help. Cystocopies showed no inflammation but one urologist diagnosed her with interstitial cystitis anyway. Another urologist dx her with urethral stricture but 3 dilations did nothing. Homeopathy, acupunture, biofeedback didn't help either. Kegel exercises have brought her stream almost bakc to full force. She is now on a drug, Elmiron, that controls but doesn't eliminate the burning.

She urinates every 2 hours unless she drinks too much which will make her urinate every 15 minutes. Occasional nocturia. The urine has no unusual color, lack of color or cloudiness.

 

Systems Overview:

Digestion:tired after eating, Bowel movements- 3x/day, loose consistency, strong odor, occasional urgency

Respiratory: constant phlegm in throat; throat is often dry; small nodules on the vocal cords; daily nosebleeds since childhood now effectively treated with saline spray, dry nasal passages

Cardiac: palpitations w/ exercise; heart murmur

GYN: 30-40 day cycle. 6 days of bleeding( 2 days heavier, 4 days spotting). Dark flow with clots. Minor cramping in the groin. Premenstrual acne outbreaks, breast tenderness and nipple sensitivity. Occasional vaginal dryness. History of chlamydia in the last 3 years; current tests for chalymidia are negative.

Emotional: Describes herself as uptight. Feels that she is not connected with her body.

Sleep: 7-8 hours; takes 1/2 hour to fall asleep.

General: Cold feet. Runs cool. Acne on forehead, back and chest. Bruxism. Low back pain when fatigued. Occasional tinnitus.

 

Examinations:

Pulse: Slippery in all positions.

Tongue: Overall pale, red tip, irritated and red in the posterior 1/3rd. Overall swollen, teethmarks. Thickish white coat, peeled patch on the left side in the back.

Central depression. Cleft tip. Canker on tip.

General observation: A small wiry woman. White pale face with pale malar flush.

 

Assessment: Dampheat and blood stagnation in the lower jiao. K xu(yin/yang); yin xu heat wafting up and drying the lungs (leading to epistaxis and thickened fluids/phlegm). Liver qi stagnation. Spleen qi xu.

 

Upper Jiao: heat, dryness, phlegm with nodulation- Is the heat and dryness up here from Liver qi stagnation brewing heat and sending it to the Lung, or is it from a yin xu?

Middle Jiao: Sp qi xu, Liver qi depression.

Lower jiao: I know that there is heat here from the burning but is it the heat of dampheat or is it yin xu heat? Would the burning of any kind of heat be improved as her bladder fills? Something in me wants to say that this is more of a yin xu symptom. Then there are the cold feet which could be from a certain amount of yang xu.

 

My idea of herbs to start her with are as follows:

xuan shen

sheng di

dang gui

che qian zi

niu xi

ze xie

yi yi ren

cang zhu

huang bai

dan shen

tao ren

ban xia

qing pi

chen pi

zhi gan cao

 

Can anybody help me sort this case out?

Thanks.

Kristin

[Guest guest]

Dear Kristin,

 

This reminds me of my patient with interstitial cystitis. Although most

literature says IC is almost always kidney deficiency (usually yang,

sometimes yin), my patient also had signs of stagnation (all symptoms worse

before period), and damp heat (yellow coating on tongue). Your patient has

even more pronounced symptoms of damp heat (foul smelling bm's, cancer sores,

burning, etc.). So, I used herbs for damp heat, thinking I must clear that

first before trying to tonify kidneys. It worked beautifully. She stopped

having bladder symptoms within a few days. She is still on the herbs, though

she moved away and had to stop acupuncture.

 

So I would think your patient, especially the way you describe her physical

constitution, and emotional make up, has more excess than deficiency and

should be treated accordingly.

 

Good luck.

 

Julie