Perineal Pain: Possible Causes and Next Steps in Treatment - Urology

More Info

---

Perineal pain can be a complex issue with various potential causes, especially considering your recent medical history and the medications you are taking. The symptoms you describe, including a feeling of heaviness in the lower abdomen, erectile dysfunction, and transient pain in the perineal area after urination, can be attributed to several factors.

Firstly, it’s important to note that Sertraline (Zoloft), a selective serotonin reuptake inhibitor (SSRI), can have side effects that include sexual dysfunction, which may manifest as erectile difficulties and changes in ejaculation. These side effects can persist even after discontinuing the medication, as the body may take time to readjust. If you have recently stopped taking Sertraline and are still experiencing these symptoms, it may be worth discussing with your prescribing physician the possibility of alternative medications or strategies to manage your mental health without these side effects.

Your urologist's assessment of possible bladder inflammation is also relevant. While benign prostatic hyperplasia (BPH) is common in older men and can lead to urinary symptoms, the absence of pain during urination and the lack of frequent urination suggest that your urinary tract may not be the primary issue. However, the transient perineal pain you mentioned could indicate a form of prostatitis or pelvic floor dysfunction, which can sometimes occur alongside BPH.

The fact that you have consulted with an internal medicine physician who suggested a potential gastrointestinal issue adds another layer of complexity. Conditions such as irritable bowel syndrome (IBS) or other gastrointestinal disorders can sometimes present with referred pain to the pelvic area, and they can also affect urinary function indirectly.

Given the multifaceted nature of your symptoms, it may be beneficial to consider a multidisciplinary approach. Here are some potential next steps:
1. Return to Urology: Since your symptoms involve the urinary and reproductive systems, a follow-up with your urologist may be warranted. They can perform further evaluations, such as a prostate exam, urine culture, or even a cystoscopy if necessary, to rule out any underlying conditions.

2. Pelvic Floor Physical Therapy: If pelvic floor dysfunction is suspected, a referral to a physical therapist specializing in pelvic health may be beneficial. They can help address muscle tension or dysfunction that could be contributing to your symptoms.

3. Gastroenterology Consultation: If gastrointestinal issues are still a concern, consulting a gastroenterologist could help rule out conditions like IBS or other functional gastrointestinal disorders.

4. Psychiatric Follow-Up: Since your symptoms began after starting Sertraline, it may also be helpful to discuss these ongoing issues with your psychiatrist. They can evaluate whether a different medication or therapeutic approach might alleviate both your mental health symptoms and the side effects you are experiencing.

5. Lifestyle Modifications: In the meantime, consider lifestyle changes that may help alleviate some symptoms. This includes staying hydrated, avoiding irritants like caffeine and alcohol, and practicing relaxation techniques to reduce pelvic tension.

In summary, your symptoms could stem from a combination of medication side effects, pelvic floor dysfunction, and possibly gastrointestinal issues. A collaborative approach involving urology, gastroenterology, and mental health professionals may provide the most comprehensive care and lead to a better understanding of your condition. Always ensure that any changes to your medication or treatment plan are discussed with your healthcare providers.