Chronic Prostatitis and Hematuria: Symptoms and Treatment

Chronic prostatitis and hematuria?

Hello, doctor.
Since last month, I have experienced occasional pain during urination.
Initially, I thought it was a urinary tract infection and did not seek medical attention, instead opting to drink plenty of water.
However, two weeks ago, I felt a sharp pain while urinating before bed; the urine color was normal at first, but the last two drops had a reddish tint.
The next day, I visited a urologist, and an X-ray showed no stones.
The urine test results were normal, and there was no pain upon pressing the bladder or lower back.
The doctor diagnosed me with urethritis and prostatitis, prescribing a week of antibiotics and three days of anti-inflammatory pain medication.
During this week, my urination was normal, but I felt slight tightness or warmth in the perineum.

After a week, I returned for a follow-up, and the doctor indicated that this might be chronic prostatitis.
I was advised to undergo physical therapy with hot water soaks and was prescribed a week of muscle relaxants.
I asked the doctor if I should be concerned about serious issues like prostate cancer, and he reassured me that there was no need for concern, especially since my urine test last week was normal.

However, two days after my follow-up, I experienced normal urination, but on the third day in the afternoon, I suddenly felt pain again while urinating, and the last two or three drops were blood-tinged.
I would like to ask the doctor if, given that my urine test was normal previously, I should schedule an earlier follow-up appointment due to the recurrence of hematuria, or if this is a common symptom of chronic prostatitis and I should continue with the prescribed treatment as directed.
Thank you.

Niming, 30~39 year old female. Ask Date: 2019/02/24

Dr. Xu Wencang reply Urology

After taking the medication, follow up at the outpatient clinic.

Reply Date: 2019/02/24

More Info

Chronic prostatitis is a complex condition that can significantly impact a patient's quality of life. It is characterized by pelvic pain and urinary symptoms, which can include pain during urination, frequent urination, and sometimes hematuria (blood in urine). Given your symptoms and medical history, it is essential to understand the potential causes, diagnostic approaches, and treatment options available for chronic prostatitis, especially in the context of hematuria.

Symptoms and Diagnosis
Chronic prostatitis can manifest in various ways. Common symptoms include:
- Pelvic Pain: This can be localized to the perineum, lower abdomen, or lower back.

- Urinary Symptoms: These may include urgency, frequency, and pain during urination.

- Sexual Dysfunction: Some men may experience pain during ejaculation or other sexual difficulties.

In your case, the presence of hematuria (blood in the urine) alongside these symptoms raises some concerns. While hematuria can occur in chronic prostatitis, it is crucial to rule out other potential causes, such as urinary tract infections, kidney stones, or even more serious conditions like prostate cancer, especially given your elevated PSA levels in the past.

Diagnostic Steps
1. Urinalysis: A thorough urinalysis is essential to check for signs of infection, blood, or other abnormalities.

2. Imaging Studies: While X-rays may not show soft tissue issues, ultrasound or CT scans can be more informative in ruling out structural problems.

3. Prostate Examination: A digital rectal exam (DRE) can help assess the prostate's size and tenderness.

4. PSA Testing: Regular monitoring of PSA levels is important, especially if there is a history of elevated levels.

Treatment Options
The treatment for chronic prostatitis often involves a multi-faceted approach:
1. Antibiotics: If a bacterial infection is suspected, a course of antibiotics is typically the first line of treatment. However, chronic prostatitis may not always respond to antibiotics, especially if it is non-bacterial in nature.

2. Anti-inflammatory Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and inflammation.

3. Physical Therapy: Pelvic floor physical therapy can be beneficial for managing pain and improving urinary symptoms.

4. Heat Therapy: As your doctor suggested, applying heat to the pelvic area can help relieve discomfort.

5. Muscle Relaxants: These can help reduce pelvic muscle tension, which may contribute to pain.

6. Lifestyle Modifications: Dietary changes, such as avoiding caffeine and alcohol, can also help manage symptoms.

When to Seek Further Medical Attention
Given your recent experience of hematuria returning after a period of normalcy, it is advisable to consult your urologist sooner rather than later. While it may be a continuation of chronic prostatitis symptoms, the recurrence of blood in your urine warrants further investigation to rule out any other underlying issues.
In summary, chronic prostatitis can indeed lead to a variety of symptoms, including hematuria. While your current treatment plan is appropriate, the return of blood in your urine is a signal to seek further evaluation. Regular follow-ups with your healthcare provider are crucial to monitor your condition and adjust treatment as necessary. Always prioritize open communication with your healthcare team regarding any changes in your symptoms.

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