PHYSICIAN SPOTLIGHT: Dr. Marcy Abel Talks Painful Bladder Syndrome & UTIs
Female Urology of Nashville is the first all-female urological group in the United States, their combined 40 years of experience treating women is exemplified from the moment you walk into the office for a visit with Dr. Abel, Dr. Allen, and Dr. Scarpero. Starting her career in a large urology group practice, as the lone female physician, Dr. Marcy Abel saw the need to focus on female pelvic health as “urology practices are generally geared towards prostate cancer and male health”. Thus, began her passion, and over 16 years, of treating complicated pelvic and bladder health issues.
We talked with Dr. Abel to understand how she discerns recurrent or chronic Urinary Tract Infections from Interstitial Cystitis (also referred to as Painful Bladder Syndrome). “In our practice,” Dr. Abel shares, “we see pelvic pain all day every day”. According to Dr. Abel it is not a single diagnosis but a combination of issues dealing with painful bladder, pelvic floor and vaginal pain that can contribute to a diagnosis of Painful Bladder Syndrome. “Pelvic pain has not been well understood and not well diagnosed but research suggests that it's prevalent in up to 12% of females” Dr. Abel notes.
Painful Bladder Syndrome and UTI Symptoms Overlap
Many women experience symptoms like bladder pain and urgency to pee, both of which are experienced with Painful Bladder Syndrome (Interstitial Cystitis) and UTIs. Clinicians who are not specialists often mistake the symptoms of bladder pain for recurrent or chronic UTI and will treat with courses of antibiotics. We asked Dr. Abel to break down some of the symptoms for us. “Many of our patients have a similar story, athletes like gymnasts or soccer players or mother’s that have damaged their pelvic floor muscles. For Painful Bladder syndrome, we hear symptoms like super pubic pain, and burning sensation that is relieved with voiding. For Pelvic Floor Disorders, we hear symptoms described as hesitancy, or the inability to pee, constipation, shooting pain in their vagina and the inability to relax their pelvic floor. Many women describe the feeling that if they do relax their pelvic floor something will fall out of them (downward pressure).” With the overlap of symptoms, it’s easy to see how some clinicians can overlook the nuance of a UTI from pelvic pain.
Appropriate Diagnostics Critical Element of Evaluation and Diagnosis
Often these women seek out the care of Dr. Abel and her team after years of symptoms. “Patients come to us having had 2 or 3, even up to 6 negative urine analysis results but their symptoms persist.” Dr Abel tells us many women are baffled because their doctors test their urine samples with “chemical strips” that have positive results. When the nurse calls them a few days later they are told to stop their antibiotics because their urine culture came back negative. “So, they are thinking, what do I do now?” Dr. Abel tells us, “As a specialist our nurse spends considerable time tracking down all past culture results for these females. With hindsight knowledge we are able to hone in on the constellation of symptoms that primary care doctors aren’t equipped to address. We use DNA tests (advanced molecular UTI diagnostics) for patients who have had a history of negative cultures but are still symptomatic. Because there is a false negative rate for urine cultures, it may be that many of these women have had repeated false negatives.
So much utilization of antibiotics with so few new antibiotics coming to market we are seeing a rise of multi-drug-resistant UTIs which is why advanced diagnostics combined with the full patient history of symptoms and a level of clinical expertise is vital to accurately diagnose these patients”.
“After 8 years of no answers, Sierra had her test results in just 48 hours.” Read more about a young woman’s fight to get the proper diagnosis and treatment for her chronic UTIs.
Reaching a Diagnosis
When symptoms have been present for 6 weeks, cultures have been negative and patients are still experiencing symptoms after antibiotic therapy, Dr. Abel uses her extensive experience and comprehensive analysis to make a diagnosis of IC. Once a diagnosis has been made, Dr. Abel tailors treatment and follow up for her patients. “IC treatment is broad, but we start with lifestyle interventions and retraining the bladder, for patients' pelvic floor we recommend Pelvic Floor Physical Therapy. Very few people have great pelvic floors. Some are too weak, others too tight. Often the most immediate thing is to treat the acute flare with urinary analgesics and other bladder treatments to get patients relief. There are long term medications that help with neuropathic nerve endings, but Bladder Pain is unfortunately a chronic condition. As such, we remind patients of management and follow up, because even if the symptoms are mild if they don’t stay on top of them, they will not get better on their own.”
If you are experiencing continued symptoms which include bladder pain and frequent urination, talk to a specialist in women’s pelvic health, like the team at Female Urology of Nashville, and explore your testing options to help gain answers and hopefully relief.
