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My mother was diagnosed with cystitis and given medications for 2 months but sometimes she has episodes of pain in abdomen that relived after taking sodium flavoxate occurs like 2 3 times in a month

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recurrent cystitis abdominal pain episodes treatment evaluation differential diagnosis

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Now I have enough information to give a thorough, clinically organized response.
Based on what you've described, there are a few important points worth addressing carefully.

Understanding Your Mother's Situation

What is Flavoxate (Not "Sodium Flavoxate")?

The medication is called flavoxate (brand names: Urispas, Genurin). It is an antispasmodic that relaxes smooth muscle in the bladder wall. It relieves symptoms like:
  • Bladder spasm
  • Painful urination
  • Urinary urgency and frequency
It does not treat infection - it only relieves spasm/pain. The fact that it relieves her abdominal pain 2-3 times a month tells you something clinically important.

The Key Clinical Concern: Why is she still having pain after 2 months of treatment?

There are several possibilities to consider:

1. Recurrent/Incompletely Treated Bacterial Cystitis

  • Recurrent UTI is defined as 3 or more episodes per year, or 2 in 6 months (Textbook of Family Medicine, 9th ed.)
  • Common in women due to shorter urethral length and proximity to bowel flora
  • If the original antibiotic was chosen empirically (without urine culture), the bacteria may be resistant, leading to incomplete clearance
  • What to do: A fresh urine culture with sensitivity testing is the most important next step - not just urinalysis, but a proper midstream culture

2. Interstitial Cystitis / Bladder Pain Syndrome (IC/BPS)

This is the diagnosis that must be considered when:
  • Symptoms resemble cystitis but urine cultures keep coming back negative
  • Pain is episodic, related to bladder filling
  • Flavoxate provides relief (it works by reducing bladder muscle spasm, which is a feature of IC/BPS)
IC/BPS is a chronic inflammatory bladder condition - it is commonly misdiagnosed as recurrent bacterial cystitis for months or even years. It requires evaluation by a urologist and does not respond to antibiotics.

3. Other Causes of Episodic Lower Abdominal Pain in Women

If the pain is not clearly bladder-related, the differential includes:
  • Urinary tract stones (urolithiasis) - episodes of colicky pain, often relieved by antispasmodics
  • Ovarian cysts (in pre/perimenopausal women)
  • Uterine pathology (fibroids, endometriosis)
  • Irritable bowel syndrome - can mimic bladder pain
  • Pelvic floor dysfunction

What Should Be Done Now

Here is a practical step-by-step approach for your mother:
  1. Repeat urine culture (midstream clean-catch) - to confirm whether there is still active bacterial infection, and to identify the organism and its antibiotic sensitivity. Avoid treating based on symptoms alone.
  2. Ultrasound of kidneys, ureters and bladder (KUB ultrasound) - to look for stones, bladder wall thickening, or structural abnormalities.
  3. Review her medications with the doctor - 2 months of antibiotics without clear cure warrants reassessment. If cultures were never done, they should be done now.
  4. Referral to a urologist if:
    • Cultures are persistently negative but symptoms continue
    • Symptoms recur after completing antibiotics
    • She is above menopause age (post-menopausal women are at higher risk of IC/BPS and also of recurrent UTIs due to reduced estrogen in the urogenital tissue)
  5. Note her age and menopausal status - post-menopausal women benefit from topical vaginal estrogen to reduce recurrent UTIs by restoring urogenital tissue health, per current evidence (Textbook of Family Medicine, 9th ed.; Comprehensive Clinical Nephrology, 7th ed.)

Important Note on Flavoxate

Flavoxate relieves spasm but does not treat infection. If the pain repeatedly comes back and is repeatedly relieved by flavoxate, that suggests the underlying cause is bladder irritability or spasm (which could be IC/BPS, stones, or residual inflammation), rather than active infection each time.
Bottom line: Your mother needs a urine culture now, a bladder/kidney ultrasound, and ideally a urology referral if these episodes keep happening. Two months of antibiotics without definitive cure and recurrent painful episodes is a pattern that warrants a proper evaluation beyond empirical treatment.
This is medical information for educational purposes. Please consult her doctor or a urologist to guide her management based on her complete clinical history and test results.
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