Possible Prostate Inflammation Symptoms and Treatments

Suspected prostatitis?

Hello, Doctor.
To help you accurately assess my potential condition, I have provided a detailed medical history.
Initially, I experienced a urinary tract infection due to unprotected sexual intercourse, which resulted in burning during urination and white discharge from the urethra.
I visited a urology clinic and took antibiotics for four days, but I still experienced occasional itching.
Due to a busy schedule, I returned for a follow-up appointment a month later when the symptoms worsened.
After taking antibiotics for about two weeks, I was almost symptom-free.
However, about five days later, I began to experience mild swelling and pain around the base of the penis (without increased frequency of urination).
After three or four days, I returned to the same urology clinic, and the doctor suggested it might be muscle strain or inflammation.
Unfortunately, the symptoms did not improve; the swelling and pain sometimes radiated to other areas of the lower body, and after a while, I developed mild urinary frequency.
This was not typical urgency but a slight urge accompanied by a dull sensation.
After urination, I felt somewhat relieved, and it occurred approximately once an hour, with the urine volume being about half of what it normally is (the two "@" refer to about a month’s time).
Two days ago, I visited the urology clinic again, and a urinalysis showed normal results (the type of test where results are available immediately).
The doctor suspected prostatitis and prescribed TINTEN extra, SONGORA, WEIDOSON, TAMLOSIN D, and DITROPAN (the doctor mentioned taking DITROPAN for urinary frequency, but I did not take it since my symptoms were mild).
Additionally, over the past week or two, I have experienced increased flatulence (which relieves the swelling and pain after passing gas) and discomfort in the anal area, which worsens after prolonged sitting.
Therefore, I visited a gastroenterologist today.
The doctor performed a digital examination and noted mild hemorrhoids, prescribing medication and suppositories for that condition.
Currently, I am taking medications from both the gastroenterology and urology departments.
My remaining symptoms include increased flatulence and perineal and anal swelling and pain after sitting for long periods.
The swelling and pain have significantly improved after taking a hot shower for one to two hours.
Could you please help me understand what condition I might be experiencing? Or do you recommend any further tests?

QQ, 10~19 year old female. Ask Date: 2020/03/28

Dr. Li Xinyi reply Urology

It sounds a bit like an untreated sexually transmitted infection, but I am not aware of what tests you have undergone or what type of antibiotic treatment you received.
I can only recommend that you return to a urologist for a thorough examination and discuss treatment options with the physician.
If you feel that communication with your previous doctor was poor, I can only suggest that you try a different clinic.

Reply Date: 2020/03/28

More Info

Based on your detailed medical history and symptoms, it appears you may be experiencing a complex interplay of issues related to your prostate and possibly other pelvic structures. Your symptoms, including burning during urination, white discharge, pelvic discomfort, and changes in bowel habits, suggest that you might be dealing with a form of prostatitis, specifically chronic pelvic pain syndrome (CPPS), which is often non-bacterial in nature.

Understanding Your Symptoms
1. Prostatitis: This condition can manifest as pain in the pelvic region, urinary symptoms (like increased frequency and urgency), and discomfort in the genital area. It is often categorized into bacterial and non-bacterial types. Given your history of antibiotic treatment without significant improvement, it is likely that you are dealing with non-bacterial prostatitis or CPPS.

2. Pelvic Floor Dysfunction: The discomfort you describe, particularly the pain radiating from the base of the penis and into the pelvic area, could also be indicative of pelvic floor muscle tension or dysfunction. This can occur after episodes of sexual activity or due to stress and anxiety, which you mentioned as part of your background.

3. Irritable Bowel Syndrome (IBS): The increase in flatulence and discomfort after prolonged sitting may suggest a gastrointestinal component, such as IBS or even mild hemorrhoids, which your gastroenterologist noted. The connection between pelvic pain and gastrointestinal symptoms is not uncommon.

Recommended Actions
1. Continued Monitoring: Since your symptoms have not fully resolved, it is essential to continue monitoring them closely. Keep a symptom diary to track when your symptoms worsen or improve, which can help your healthcare provider make more informed decisions.

2. Pelvic Floor Physical Therapy: This can be beneficial for managing pelvic pain and discomfort. A physical therapist specializing in pelvic health can help you learn exercises to relax and strengthen the pelvic floor muscles, which may alleviate some of your symptoms.

3. Medication Review: You mentioned being prescribed multiple medications. It’s crucial to discuss with your urologist the effectiveness of these medications and whether any adjustments are necessary. Sometimes, medications like alpha-blockers (e.g., Tamsulosin) can help with urinary symptoms, but they may not address pain directly.

4. Lifestyle Modifications: Incorporating regular exercise, stress management techniques (like yoga or meditation), and dietary adjustments (avoiding irritants like caffeine, alcohol, and spicy foods) can significantly improve your symptoms.
5. Further Testing: If your symptoms persist, you may want to discuss further diagnostic tests with your urologist. This could include imaging studies (like an ultrasound or MRI) to rule out any structural issues or further evaluations to check for other potential causes of your symptoms.

6. Follow-Up with Specialists: Since you are experiencing symptoms that overlap between urology and gastroenterology, maintaining communication between both specialists is essential. They can collaborate to ensure that all potential causes of your symptoms are being addressed.

Conclusion
Your symptoms are multifaceted, and while they may be frustrating, they are not uncommon in individuals experiencing chronic pelvic pain. It is essential to remain proactive in your treatment and to communicate openly with your healthcare providers about your symptoms and any changes you experience. With the right combination of therapies and lifestyle adjustments, many individuals find significant relief from their symptoms over time.

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