Thanks for your query at DoctorSpring.com
There are two separate issues here.
The first is the erratic spotting and bleeding, and the recent post coital bleeding.
Here, you could be having a cervical / uterine polyp, fibroid, cervical lesion, growth etc.
The second is the frequency of urination with slight blood in the urine.
That could indicate a possibly UTI.
Only a thorough workup would tell you the precise diagnosis.
I would recommend you to consult a gynecologist.
Have an internal exam, a Pap smear and a pelvic ultrasound scan at the very least.
Also, please submit an early morning urine sample for urine routine microscopy and urine culture and sensitivity.
Please upload the reports as soon as you have them in hand.
All the best
Please feel free to discuss further.
Patient replied :
Hi Dr. Vazirani,
Thanks for your response. While I do not have any forms to upload, I can tell you that after a clinical visit today my urine tests came back clean, and I tested negative for pregnancy (yet again). Do you think it's possible though, that the urine test missed the ectopic pregnancy due to low hcg levels? I've heard this can happen from time to time, but my doctor seemed pretty confident that it wasn't a pregnancy and declined to do an ultrasound. I've discovered that most facilities in the area will refuse to give me an ultrasound wthout a positive pregnancy test. And her cursory internal exam didn't yield anything significant.
As of today, my main symptoms still include nausea, lower back and side flank pain (mosyly on the right and sometimes around the naval), as well as lower abdominal and uterine cramps. I should also metion that most of the UTI symptoms have improved, though I still feel some aches and pains in my sides and back. I did read that kidney stones often produce these symptoms and are caused by vitamin C overdose. I am on a pretty heavy supplement regimen right now, so this could be a slight possibility?
All of your previous suggestions (polyps, growths...etc.) seem like afflictions with identifiable sources, but nothing was found (again, there was no ultrasound). I really am hoping that it is not an ectopic pregnancy, but I can think of nothing else that can account fro my symptoms collectively (except for maybe a cyst). It is still early enough for me to go on methotrexate regimen (I would suspend all of my other medications) to get rid of a possible EP, but aside from my symptoms, I have no real substantive reason (no tests) to suspect that I am pregnant.
What would you advise as a next step, or do you have any further thoughts on what might be going on?
Do you mind writing in with a timeline of the bleeding.
WIth dates, date of period, date of spotting, post coital bleed etc.
Just like a time line ?
That would help me to review the situation further.
Looking forward to hearing from you.
Patient replied :
So, here is a short timeline. I started spotting on March 6 about three days before my period. Following that period which stopped on the 13th, I experienced some cramping and nausea. About a week before my most recent period on April 6th, I experienced some slight spotting. After the end of my period on the 9th, I experienced some post-coital bleeding on the tenth as well as some blood in my urine. Although the cramps and nausea have not subsided, I haven't experienced anymore bleeding since then. I am going today to get blood work done.
Thank you for the update.
Well, a blood B HCG test and a pelvic ultrasound scan done transvaginally - these 2 should be the immediate next steps, and then you take it from there, depending on the results.
I do not think an EP is very likely, but it HAS to be ruled out with erratic bleeding/ spotting.
Well, the other conditions I listed too have to be ruled out with a scan and a Pap smear.
Vitamin C overdose can lead to kidney stones but they would not cause post coital bleed and you would not have clear urine results.
So please get the other tests done, and then we can see how it pans out.