Is It Just Prostate Issues? Urological Pain in Men

Is it really just a prostate issue?

Hello, Director: One of my elementary school teachers, who is over sixty years old, has suffered from urinary tract issues for many years.
He experiences pain in the glans and anus every time he urinates.
He has seen numerous doctors, most of whom have diagnosed him with benign prostatic hyperplasia (BPH) and prescribed various medications without improvement.
He even fainted for several hours due to the blood pressure-lowering effects of a medication prescribed by a doctor (he generally has low blood pressure).
He has switched hospitals multiple times and undergone several urine tests, all of which returned normal results, showing no signs of inflammation or frequent urination.
Most doctors have concluded that it is due to age-related prostate issues and have prescribed medication without further investigation, leading to years of suffering.
I would like to ask the director: can benign prostatic hyperplasia alone cause pain in the glans and anus, or could there be other underlying causes? Which specialty should he consult? Additionally, since he does not have any symptoms of spasms, would a medication labeled as an antispasmodic be beneficial for his condition?

mr.jou, 40~49 year old female. Ask Date: 2003/07/22

Dr. Xu Weikai reply Urology

Hello Mr.
Jou, may I ask if you experience pain throughout the entire urination process, or is it during a specific phase (initial, mid, or final)? I would like you to try a treatment: when you start to feel pain at the glans during urination, apply firm pressure with your finger on the perineum (the point between the anus and the scrotum) to see if it alleviates the pain.
If it helps, you can apply pressure each time you urinate; this phenomenon may be related to neuropathic pain.

In addition to the above, inflammation of the prostate or seminal vesicles could also be a possibility.
Diagnostic methods include performing a prostate massage and examining the secretions, or analyzing the semen.
Furthermore, there may be lesions near the anus causing pain, such as hemorrhoids, fistulas, or abscesses, which can lead to discomfort around the glans.
Additionally, urinary tract stones can sometimes present with similar symptoms.
Recommendations:
1.
Obtain X-rays or a renal ultrasound for differential diagnosis.
2.
Consult a colorectal specialist for examination.
3.
Conduct a semen analysis.
4.
In the meantime, consider warm sitz baths to help alleviate symptoms.

Reply Date: 2003/07/22

More Info

Urological pain in men can be a complex issue, often stemming from various underlying conditions, not solely limited to prostate problems. Your inquiry about your teacher's persistent pain during urination, particularly in the glans (head of the penis) and anal area, raises several important considerations.

Firstly, while benign prostatic hyperplasia (BPH) is a common condition in older men that can lead to urinary symptoms, it is crucial to recognize that not all urological pain is attributable to prostate issues. The symptoms described—pain during urination and discomfort in the anal region—can also be associated with other conditions such as:
1. Chronic Pelvic Pain Syndrome (CPPS): This is a common condition that can affect men and is characterized by pelvic or perineal pain without evidence of urinary tract infection. It can manifest as pain during urination, discomfort in the genital area, and even pain during ejaculation. CPPS can be classified into inflammatory and non-inflammatory types, and its exact cause is often unclear.

2. Urethritis: Inflammation of the urethra, often due to infections (bacterial or viral), can cause pain during urination. Even if urine tests show no infection, it is possible for urethritis to be present.

3. Interstitial Cystitis (IC): This chronic condition affects the bladder and can lead to pelvic pain, urinary urgency, and frequency. It is often misdiagnosed and can coexist with other urological conditions.

4. Prostatitis: While your teacher has been diagnosed with BPH, it is also essential to consider prostatitis, which can cause significant pain and discomfort. Chronic prostatitis may not always present with typical symptoms, making it a challenge to diagnose.

5. Neurological Issues: Sometimes, nerve-related problems can lead to referred pain in the pelvic region. Conditions such as pudendal nerve entrapment can cause pain in the genital area and may not be directly related to the prostate.

6. Musculoskeletal Issues: Pain in the pelvic region can also arise from musculoskeletal problems, such as pelvic floor dysfunction or referred pain from the lower back.

Given the complexity of these symptoms and the fact that your teacher has not found relief through standard treatments, it may be beneficial for him to seek a comprehensive evaluation from a urologist who specializes in chronic pelvic pain. A thorough examination, including a detailed history, physical examination, and possibly imaging studies or cystoscopy, may be warranted to rule out other conditions.

Regarding the medication prescribed, particularly the antispasmodic, it can be helpful in managing muscle spasms in the pelvic area, which may contribute to discomfort. However, it is essential to monitor for side effects, especially considering your teacher's history of low blood pressure.

In conclusion, while prostate issues are a common cause of urological pain in older men, it is crucial to consider a broader differential diagnosis. A multidisciplinary approach involving urologists, pain specialists, and possibly physical therapists specializing in pelvic floor dysfunction may provide a more comprehensive treatment plan. Encouraging your teacher to advocate for further evaluation and not to settle for incomplete answers is vital in managing his ongoing discomfort.

Similar Q&A

Understanding Urinary Difficulties: Insights on Sensation Loss and Prostate Health

I am a male in my 30s with a job that requires prolonged sitting. I have a few questions for the doctor: 1. Last week, I suddenly experienced a lack of sensation in my urethra while urinating. I have the urge to urinate, but I cannot feel the urine flowing out; I wouldn't ...

Dr. Li Xinyi reply Urology
Urinary incontinence may suggest peripheral nerve issues, possibly due to viral infections or nerve inflammation. Generally, these are benign problems that require rest and observation. Regarding urination issues, there could be a possibility of prostate problems, but tests may n...

Understanding Frequent Urination and Penile Pain: Causes and Solutions

Hello doctor, I have been experiencing frequent urination and occasional sharp pain in the penis. I often feel discomfort in my right flank. I went to the hospital for a detailed examination, which included X-rays, urine culture, contrast-enhanced CT scan, cystoscopy, uroflowmetr...

Dr. Cai Zhuorong reply Urology
Your condition may warrant further evaluation through video urodynamics. Please consult the urology outpatient clinic.

Understanding Prostate Pain: Is It Related to Your Habits?

Recently, due to being stuck at home, I've been engaging in masturbation with frequent pauses, lasting for a long time. Sometimes I get a bit excited and then stop, but I always end up ejaculating. As a result, I've experienced some pain in my penis. Could this be relat...

Dr. Du Shixi reply Urology
Hello: I need to seek medical examination. It is difficult to determine the current symptoms. Wishing you good health.

Understanding Penile Pain and Lower Back Discomfort: Causes and Concerns

Hello Doctor, I started experiencing frequent urination on December 22 of last year and sought medical treatment. In January, the doctor diagnosed me with acute prostatitis. My main symptoms include pain at the base of the penis, a feeling of bladder fullness, and difficulty urin...

Dr. Li Xinyi reply Urology
If there is a history of urinary tract stones or suspicion of stone issues, it is advisable to consult a urologist for a thorough examination. Urinary stones typically do not cause prostatitis. Additionally, even if tests indicate that there is no inflammation, it does not mean t...