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Differential Diagnosis: Interstitial Cystitis, Urethritis, and Pelvic Inflammatory Disease

  • Interstitial cystitis (painful bladder syndrome), due to pain associated with bladder filling as well as urinary urgency and frequency. Urethritis due to typical symptoms of urinary tract infection (UTI) such as frequency and dysuria. Pelvic inflammatory disease (PID) due to abdominal or suprapubic pain.

On physical examination of a patient with a urinary tract infection, you may notice fevers, pelvic pain or tenderness on palpation, costovertebral angle tenderness (CVA) if pyelonephritis is considered, pain on urination, burning on urination, back pain or hematuria.  Patients may also present with shaking and chills, nausea, and vomiting (Ferri, 2018).

Patients with these urinary symptoms and findings should have a urinalysis with microscopic to confirm organism type and guide antibiotic selection in complicated UTI or pyelonephritis, along with a urine culture and sensitivity.  Other test to consider are a postvoid residual (PVR) if suspicion of urinary retention or incomplete bladder emptying is suspected, renal ultrasound only for those patients whose treatment has failed or who have unusually severe or persistent symptoms.  In some cases, a renal ultrasound may be considered for those patients whom conventional treatment has failed or who have unusually severe or persistent symptoms.  For patients that symptoms do not respond to antimicrobial therapy after more than seven days, a CT scan of the retroperitoneum may be indicated to rule out renal or perirenal abscess, or a cystoscopy to visualize the bladder and rule out lower tract abnormalities (Lee, 2017).

Patient will be educated on aggressive hydration, urinating when needed, and proper hygiene when wiping.  Patient may also take over the counter oral phenazopyridine three times a day as needed for relieve of discomfort (Ferri, 2018).  Patients should take their prescribed antibiotics until finished.  Patients should be instructed to follow up in 48 to 72 hours if symptoms have not improved or worsen, or for those patients with recurrent urinary problems or resistant to treatment, a referral to a urologist may be warrant. Patients should also be educated on ways to help reduce their risk of urinary tract infections, those steps according to the Mayo Clinic (2017) consists of:

  • Drinking plenty of water to help dilute the urine and allow bacteria to be flushed from their urinary tract.
  • Properly wiping from front to back to prevent bacteria from spreading from the vagina and urethra in women.
  • Emptying their bladder after intercourse to help flush bacteria.
  • Avoiding any potential irritating feminine products such as douches, powders, deodorant sprays, or other feminine products in the genital area that can irritate the urethra.

First-line antimicrobial empiric therapy of acute uncomplicated cystitis is nitrofurantoin (Macrobid) 100 mg by mouth twice a day for five days. According to Hooton & Gupta (2017), this medication should be avoided if there is suspicion for early pyelonephritis or if the creatine clearance is less than 30mL/minute.  They further state that observational studies have suggested that the agent is effective and safe with mild renal impairment, even in older women.  This drug is safe for patient K.N. to take with her allergy to sulfa medications.

Patient will be educated on aggressive hydration.  Patient may take over the counter oral phenazopyridine three times a day as needed for relieve of discomfort, (Ferri, 2018).  Rest as needed.


Ferri, F. F. (2018). Ferri’s clinical advisor 2018. Philadelphia, PA: Elsevier.

Hooton, T., & Gupta, K. (2017). Acute uncomplicated cystitis in women. Retrieved from

Lee, U. (2017). Urinary tract infections in women diagnostic tests – Epocrates online. Retrieved from

Mayo Clinic. (2017). Urinary tract infection (UTI) – symptoms and causes. Retrieved from

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