What Type of Specialist Can Help? Dr. Nicholas Fogelson on UTI & Pain, Part 1

Dr. Fogelson cites UTI and interstitial cystitis specialist Ruth Kriz as part of his inspiration for how he tackles chronic UTI in his patients. He incorporates MicrogenDX testing, longer-term antibiotics, and bladder instillations in his treatment. He also strives for a functional medicine (holistic) view of the issue. This means that he examines how diet (e.g. a vitamin D deficiency) can alter the acidification of the bladder and influence bacterial growth. He views anti-biofilm medications, antibiotics, and dietary modifications as a triumvirate of attack against chronic infection. However, as the mechanisms of chronic UTI are still largely unknown, he underscores that even this approach will not work for everybody.

As aforementioned, Dr. Fogelson’s subspeciality is neuropelveology. Neuropelveology is the study of how the nervous systems work specifically within and in relation to the pelvis. In neurological terms, there are two types of pain: visceral pain and somatic pain. Visceral pains are generally described as dull aches. They travel through the sympathetic nervous system and enter the spinal cord at specific sites called nerve plexases. Comparatively, somatic pains are sharper pains localized in precise areas. If you injure a somatic nerve, you will experience the pain at the tip of that nerve, even if that is not where the injury is. This is one type of “referred pain,” which is when pain is felt in an area different from where the problem resides due to nerve dysfunction.

Bladder pains are usually visceral. The issue with visceral pains is that there can be confusion as to the source. This is because different organs share the same neural pathways to the brain, where all pain is registered. For instance, the bladder, uterus, and lower colon all use one pathway. As a result, a problem with one of these organs may present as pain in a different, healthy organ. This is another kind of referred pain.

Neuropelveologists use clues from the type and placement of pain that the patient describes to inform treatment. For instance, this may include a spinal MRI to rule out a slipped or herniated disk. When necessary, Dr. Fogelson recommends surgery to correct neuropelvic issues. However, he emphasizes that such surgeries should be performed with caution as opposed to as an experimental solution. He also posits that neuropelveology is not a “magic wand” and that it does not offer explanations to all patients experiencing pelvic pain.

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