Persistent Pain and Urgency: A Urology Case Study

Pain at the base of the penis and a sensation of bladder fullness with a strong urge to urinate have shown poor treatment outcomes?

Last December 22, after engaging in sexual intercourse, I suddenly began experiencing frequent urination.
On the same day, I took antibiotics, which alleviated the frequent urination.
Subsequently, after being treated by multiple doctors, I was diagnosed with urethritis, overactive bladder, and a wound on the prostate, but the treatment results were unsatisfactory.
Three weeks ago, I underwent examinations at the China Medical University Hospital, where I was diagnosed with acute prostatitis and treated with antibiotics and Tylenol.
The pain or heat sensation at the base of the penis has decreased, but two weeks ago, I started to notice that after drinking water, I quickly felt the urge to urinate, experienced lower back pain, and had difficulty urinating.
Additionally, there was pain at the base of the penis during or after urination, which made me hesitant to drink water.
Ten days ago and today, when I experienced frequent urination, taking antibiotics immediately helped relieve the symptoms.
Doctor, what disease could this be? Typically, urinary tract diseases should alleviate symptoms with treatment; why do I seem to be getting worse?

A Long, 40~49 year old female. Ask Date: 2020/03/01

Dr. Li Xinyi reply Urology

It sounds like prostatitis.
Oral antibiotic treatment for prostatitis may require at least one month.
It is essential to follow the doctor's advice, keep track of the treatment, and take the medication as prescribed.
Otherwise, there is a risk of developing antibiotic-resistant strains, which can lead to more severe symptoms and more difficult treatment.
Additionally, there may be an underlying infection that has not been diagnosed.
It is recommended to consult a urologist for examination and to discuss treatment options thoroughly.
Lastly, it is important to note that during a urinary tract infection, one should not reduce fluid intake out of fear of urination; instead, it is crucial to drink plenty of water and urinate frequently.

Reply Date: 2020/03/01

More Info

Your symptoms and medical history suggest a complex interplay of urological issues that may be contributing to your persistent pain and urinary urgency. Based on your description, it seems you have experienced a range of symptoms including frequent urination, pain in the root of the penis, and difficulty urinating, which have not responded well to various treatments.
Initially, it is important to understand that the urinary system is intricately connected to both the bladder and the prostate, particularly in males. Acute prostatitis, which you were diagnosed with, can lead to significant discomfort and urinary symptoms. The inflammation of the prostate can cause pain that radiates to the pelvic area, lower back, and even the genital region. This pain can sometimes be exacerbated by activities such as sexual intercourse, which you mentioned preceded the onset of your symptoms.

The fact that your symptoms improved with antibiotics suggests that there may have been an infectious component to your prostatitis. However, the recurrence of symptoms, particularly the urgency and pain after drinking water, could indicate that there is still underlying inflammation or irritation in the bladder or prostate. It is also possible that you are experiencing a condition known as bladder overactivity or hypersensitivity, which can occur after an episode of prostatitis.

In terms of why your symptoms seem to worsen rather than improve with typical urological treatments, there are several possibilities. First, if there is residual inflammation in the prostate or bladder, it may not respond to standard antibiotics or anti-inflammatory medications. Additionally, psychological factors such as anxiety about urination can exacerbate the sensation of urgency and pain. This is particularly relevant if you have developed a fear of drinking water due to the pain associated with urination.

Given the complexity of your symptoms, it would be advisable to pursue a comprehensive evaluation with a urologist who specializes in chronic pelvic pain syndromes. They may recommend further diagnostic tests, such as a cystoscopy, to visually inspect the bladder and urethra for any abnormalities. Additionally, they might consider other treatment options, such as pelvic floor physical therapy, which can help alleviate pain and improve bladder function.

In the meantime, it is essential to maintain adequate hydration, as dehydration can lead to concentrated urine, which may irritate the bladder and worsen symptoms. If you find that drinking water exacerbates your pain, consider trying smaller amounts more frequently rather than large quantities at once.
Lastly, if you are experiencing significant distress or thoughts of self-harm due to your symptoms, it is crucial to seek support from a mental health professional. Chronic pain can take a toll on mental health, and addressing these feelings is an important part of your overall treatment plan.

In summary, your symptoms may be indicative of ongoing prostatitis or bladder overactivity, and a thorough evaluation by a urologist is essential for proper diagnosis and treatment. Addressing both the physical and psychological aspects of your condition will be key to finding relief and improving your quality of life.

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