Part2: conditions of pain (Urinary tract pain)

By.Rania Al-khateeb

Obstruction to the
ow of urine, can
form in any place

not urolithiasis in the UT

It's cysitis Fever chills colickypain

Urinary tract pain (not common), the pharmacist will countered this condition with patients
who have colicky pain, this is because of multiple reasons, it could be: urolithiasis or acute
uncomplicated cystitis ( in ammation of the bladder).

Cystitis is the medical term for in ammation of the bladder. Most of the time, the
in ammation is caused by a bacterial infection, and it's called a urinary tract infection
(UTI).

Urolithiasis and cystitis patients, should be referred to a urologist, OTC intervention for
temporary relief.

Pink, red, or brown urine with foul smell: not always, depending on the damage that is caused
by the stones (overlapping symptom between urolithiasis and cystitis).

Ask the patient about the frequency of going to the toilet? (becomes more), is the voiding
complete? (Fluctuates more and less, more and less)
 no help
no harm

TIP
OF
Unapproved herbal remedy, because the primary active ingredients found in the cystone are
herbal in nature, helps in relieving the pain, it helps in disintegration of the urinary stones, it
acts as anti-in ammatory agent, it helps to remove the toxins that have been accumulated
because of urine accumulation, it helps in dissolving the calculi (multiple uses have been
claimed)…> better urine ow, less of colicky pain.

-Urinary stones that form in Urinary tract due to inadequate hydration …> crystallization of
calcium oxalate/ Uric acid.

-When the urine become acidic due to dehydration, these salts become concentrated and
become insoluble…> Turn into ne crystals…> renal stone.

How do we solve this problem ?

Main OTC treatment: alkalinize the urine, dissolve the formed stone, and the pain will alleviate.

(Alka UR) (Ural) (URICOL).

-URICOL formula: hexamine 500mg, piperazine 190mg, khelline 1.8mg…> one sachet (TID) for
urolithiasis.

-Ural powder (Urinary alkalinizer), available as sachet, formula:

Sodium bicarbonate, sodium citrate anhydrous, citric acid anhydrous, tartaric acid

-Urinary alkalinzing Agents, in general:

Potassium citrate, sodium citrate, sodium bicarbonate for urolithiasis or for cystitis.

Alert 🚨 : take care in people with HTN who takes ( ACE, potassium sparing diuretic).

-Cystone: 2 wk: very mild.

At least for 3m: to get rid of stones completely.

2 tab (TID) for 2wk- 3mo.

-Ural dose/ Uricol: maximum 2-3 days…> mask the pain …> then refer to dr.

How do we de ne cystitis?

In ammation of bladder or urethra because of infection.

-Cystitis is less common in men because they have a longer bladder.

Caused by ( E.coli, staphylococcus proteus infection).

…> from the micro ora of the host, they become pathogenic, then from the anal area they get
acsses into the Urinary bladder, then they replicating and proliferating…> and start causing
fever/ chills…> infectious condition.

-Females more coming with UTI as compared to the males.

-Cystitis is more predominant in women, get confused between cystitis and vaganitis:
infection of the vagina.
• if she’s newly married it’s absolutely vaginitis, if she has discharge from the vagina
( you should ask the patient)

• Ask for duration (important), if it’s more than 5-7 days, refer to dr ( pylonephritis ):
in ammation of the kidney (because of infection or stones).

• See the age of the patient: more commonly in newly married or elderly (hygienic
conditions), complicated cystitis in older than 70 years old…> they will go to the dr directly.

• Presence of fever/dysuria/ frequent urinating:

-Fever commonly with cystitis or pylonephritis

-if urolithiasis patient comes with fever (very rare)…> refer to dr.

-Cystitis patients need antibiotics prescribed by the dr only.

OTC treatment: Urinary alkalinizer can be given (2-3 days only)…> then refer the patient to
the dr.

-Any case of UT conditions always advice the patient to drink a lot of water at least 5
liters daily either to alkalinize the urine (stones will dissolve faster) or to wash down the
infection.
 Part 3: Condition of pain (primary dysmenorrhea)

2X

-Not all the girls are having dysmenorrhea, only 60-65%.

-Symptoms can appear at the onset or before the onset of menstruation, it depends on the
body nature.

-primary dysmenorrhea can be treated OTC, secondary dysmenorrhea can’t be treated OTC.
-primary dysmenorrhea: cramping pain due to menstruation, rst few days of period.
-secondary dysmenorrhea: due to pelvic pathological conditions (in ovaries, uterus,
endometrium), it can be in any duration during the period.
It can happen if there is a tumor…> more serious condition.

-primary dysmenorrhea can start at menarche: rst menstrual cycle, or shortly after
menarche (after one year for example).
 synthesized in
uterine
muscles

Excessive
vasoconstriction vasopressin

I 2 3 normal Process

exclusions

Gradually increase

depends on the body nature

Di erential diagnosis:

Age: women about the age of 30 years old we have to be careful with them, because they may
have either primary or secondary dysmenorrhea.

Less than 30 years of age, you can treat them with Analgesic agents without any fear.

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severe
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Pain
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referred pain
1-Age: P.D starts at menarche. It doesn’t not start at age (30-40).

2-nature of pain: intermittent or persistent ( for 3 days or lasts for 7 days of mensturation).

3-Severity of pain: the severity of pain is higher in P.D than the S.D.

P.D: variable pain (more severe), S.D: dull and variable pain.

4-onset of pain: P.D, at the beginning of mensturation. S.D, at any interval of period.

Pain experienced 10-15 days before

the onset of period.
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1-200 mg (4-6hr) for 2-3 days of ibuprofen is enough, if the patient has to start at the onset
(from the rst symptom of the mensturation).

2-Buscopan: smooth muscle relaxant, soothing the smooth muscles and the cramps will be
relieved.

1-low dose contraceptives: is useful but must be prescribed by the dr.

2-antispasmodics: no proof , but it’s useful.

3-Naproxen proved to have better bene ts, have less SE than ibuprofen, choose between
naproxen and ibuprofen.