Chronic Prostatitis: Symptoms, Diagnosis, and Treatment Options

Chronic prostatitis?

Hello, Doctor.
I would like to ask some questions.
Recently, I have been experiencing occasional soreness in the perineum and urethral opening, and when I urinate, there is a slight burning sensation.
I went to a urologist for an examination, and both urinalysis and bacterial cultures were sterile.
I have been on antibiotics for a week, but there has been no improvement.
The doctor diagnosed me with chronic prostatitis.

1.
Since I have had urinalysis and bacterial cultures, is it still necessary to test prostate fluid and semen? The doctor did not mention testing these two.

2.
The doctor suggested extracorporeal shock wave therapy, but since it requires out-of-pocket expenses, I would like to know if it is effective.

3.
I work in a physically demanding job, only drink water, and exercise in the evenings.
I cannot understand how I suddenly developed inflammation.
Could it be due to overexerting my body? Thank you for your response.

Hu, 20~29 year old female. Ask Date: 2022/02/09

Dr. Li Xinyi reply Urology

Based on your description, it could be chronic prostatitis, but it is also possible that it is an incomplete treatment of a sexually transmitted infection.
If there has been any risky or unsafe sexual behavior, it is important to inform your physician accurately.
Semen analysis and prostate fluid examination can be conducted, but they are often not very useful.
Excessive fatigue or overexertion can also lead to prostatitis.
As for extracorporeal shock wave therapy, it is advisable to consider it only after the infection has been completely resolved.

Reply Date: 2022/02/09

More Info

Chronic prostatitis, particularly the non-bacterial type, can be a challenging condition to manage. It is characterized by pelvic pain and urinary symptoms without evidence of a urinary tract infection. Your symptoms, including perineal and urethral discomfort, along with a burning sensation during urination, are consistent with this diagnosis.
1. Need for Further Testing: While your urine tests and cultures have returned negative, it is still advisable to consider testing prostate secretions. The analysis of prostatic fluid can provide additional insights, especially in cases of chronic prostatitis. This fluid can be obtained through a prostate massage during a digital rectal exam. It may reveal inflammatory cells or other abnormalities that are not present in urine tests. However, if your doctor has not recommended this, it may be due to the clinical judgment that your symptoms and current test results do not warrant further invasive testing at this time.

2. Extracorporeal Shock Wave Therapy (ESWT): This treatment has gained popularity for chronic prostatitis and pelvic pain syndrome. The therapy involves using shock waves to promote healing and reduce pain in the pelvic region. Some studies suggest that it can be effective in alleviating symptoms, but results can vary from person to person. If you are considering this option and are concerned about the cost, it may be beneficial to discuss with your healthcare provider about the potential benefits versus the costs, as well as any available alternatives.

3. Lifestyle Factors: Chronic prostatitis can be influenced by various lifestyle factors, including physical stress and overexertion. Engaging in heavy labor or not allowing adequate recovery time can contribute to pelvic muscle tension and inflammation. Additionally, factors such as stress, anxiety, and dietary choices can exacerbate symptoms. It is essential to maintain a balanced lifestyle, including regular exercise, adequate hydration, and stress management techniques.
In summary, chronic prostatitis can be multifactorial, and while your current treatment may not have yielded results, it is crucial to continue working with your healthcare provider to explore all available options. This may include further testing, considering alternative therapies like ESWT, and making lifestyle adjustments to support your overall health. If symptoms persist or worsen, seeking a second opinion from another urologist may also provide new insights or treatment strategies.

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