Chronic Prostatitis and Related Urological Issues

Q: Chronic Prostatitis and Related Urological Issues

Hello： The best approach remains a healthy diet, exercise, and regular sleep. <br>Health supplements are merely food and mostly serve as adjuncts; they cannot effectively improve symptoms. <br>If symptoms are related to ejaculation, it is advisable to seek medical attention. <br>

Chronic prostatitis, inguinal hernia, urinary issues, varicocele, erectile dysfunction?

Hello Dr.
Du,
I hope you are doing well every day.
Below are my symptoms:
1.
Decreased rigidity of the genitalia: I can achieve an erection, but it feels soft.
Even when fully erect, it can become soft during intercourse.
I notice that nighttime and morning erections occur infrequently, and without stimulation, it easily becomes soft.

2.
Burning sensation at the urethral opening: There is less stabbing pain.
3.
Frequent urination and sometimes difficulty urinating: I constantly feel the urge to urinate; sometimes I genuinely need to, while other times I have to close my eyes and meditate for a while before I can urinate.
4.
Difficulty urinating: Sometimes I have to wait a long time to urinate, or I feel the urge but cannot urinate, and I have a sensation of incomplete emptying.
After masturbation or sexual intercourse, the difficulty and frequency of urination are particularly pronounced.
When I cannot urinate, I squat down, close my eyes, and meditate, and I also run hot water over myself.
5.
Intermittent urination: After urinating, I need to pull on my genitalia to expel residual urine.
6.
Pain in the scrotum: There is pain after ejaculation.
7.
A feeling of swelling and pain in the perineum: It feels like a whole area is numb, hot, and inflamed.
8.
Pain in the lower right abdomen (from the lumbar bone imagining the right triangle of underwear) feels like muscle soreness in a tube, very fatigued, and pain in the groin area (which I personally feel is near the pubic bone).
I have felt a stabbing pain during ejaculation, especially in the glans, where the sperm is forcefully expelled, causing a sharp sensation, but it feels like there is some relief.
I am unsure if it is prostatic fluid or semen blocking the ducts.
9.
Lower abdominal pain: About 6-8 fingerbreadths below the navel, it feels dull and intermittently painful, especially when there is desire without release.
It feels like a blockage in the urinary tract, and I am concerned it may lead to calcification.
10.
Pain in the right testicle: The testicle feels like it has moved up to the pubic hair area.
I suspect this is due to a history of varicocele on the right side, which I consulted a urologist about in high school.
11.
Back pain corresponding to the bladder (on both sides of the tailbone).
12.
Urine stream splitting: There are issues after ejaculation, and there are also problems when ejaculation does not occur.
I have tried abstinence, but it leads to issues 7, 8, and 9.
For the past three days, I have not engaged in masturbation, but I feel discomfort in the lower abdomen and right lower abdomen, including the groin area, with the right lower abdomen and groin being the most pronounced.
These issues have existed for about seven years, starting from high school.
During middle and high school, I would masturbate about 3-4 times a day, sometimes even 6 times.
Since university, it has been about 1-2 times a day for the past five years.
I usually exercise, playing basketball twice a week, and I drink over 2000cc of water daily.
I do not consume alcohol, betel nut, or smoke, but I tend to stay up late, often sleeping after 3 AM.
I suspect chronic prostatitis and a right inguinal hernia.
Thank you for taking the time to read my concerns.
I would like to know the possible conditions and how to improve these issues, as my sexual function has declined significantly.
I can achieve an erection during intercourse, but I lose rigidity when distracted, affecting my sex life.
How can I take care of myself? Should I supplement with maca, L-arginine, lycopene, or pumpkin seed oil?
I have seen a urologist two or three times in high school, and the urinalysis results were normal.
The physician at that time believed that, being in high school, I should not have any issues and advised me not to worry.
However, several years have passed, and these problems persist, prompting me to seek advice.
I will also visit the hospital for a consultation and discuss openly with the physician, but I still want to consider different doctors' opinions.
Thank you once again, Dr.
Du, for taking the time to respond to me.
I truly appreciate it!

Niming, 20~29 year old female. Ask Date: 2024/05/21

Dr. Du Shixi reply Urology

Hello: The best approach remains a healthy diet, exercise, and regular sleep.
Health supplements are merely food and mostly serve as adjuncts; they cannot effectively improve symptoms.
If symptoms are related to ejaculation, it is advisable to seek medical attention.
If there has been any unsafe sexual behavior, it is important to inform your physician.
Wishing you good health.

Reply Date: 2024/05/21

More Info

Chronic prostatitis, particularly nonbacterial prostatitis or chronic pelvic pain syndrome (CPPS), can be a challenging condition to manage. Your symptoms, which include decreased erectile hardness, burning sensations in the urethra, urinary frequency, difficulty urinating, and pelvic pain, are indeed indicative of this complex syndrome.
Firstly, it’s important to understand that chronic prostatitis can manifest in various ways, and its etiology is often multifactorial. The symptoms you describe, such as the sensation of incomplete bladder emptying, pain during ejaculation, and discomfort in the pelvic region, are common among individuals suffering from CPPS. The condition can significantly impact quality of life, leading to anxiety and frustration, particularly when conventional treatments have not provided relief.

Potential Causes and Considerations
1. Pelvic Floor Dysfunction: The pelvic floor muscles can become tense or dysfunctional, leading to pain and urinary issues. Physical therapy focusing on pelvic floor relaxation may be beneficial.

2. Nerve Sensitization: Chronic pain can lead to changes in how nerves respond to stimuli, resulting in heightened sensitivity and pain perception. This can explain the discomfort you feel in various areas, including the lower abdomen and groin.

3. Inflammation: Even in the absence of bacterial infection, inflammation can persist in the prostate and surrounding tissues, contributing to pain and urinary symptoms.

4. Psychological Factors: Stress and anxiety can exacerbate symptoms of chronic prostatitis. Techniques such as mindfulness, meditation, and cognitive behavioral therapy may help manage these aspects.

Management Strategies
1. Lifestyle Modifications:
- Diet: Avoid irritants such as caffeine, alcohol, and spicy foods. A diet rich in anti-inflammatory foods may help.

- Hydration: Continue to drink plenty of water, but consider timing your fluid intake to manage urinary frequency.

- Sleep Hygiene: Prioritize good sleep habits to help manage stress and fatigue.

2. Physical Therapy: Engaging in pelvic floor physical therapy can help alleviate muscle tension and improve pelvic floor function. A trained therapist can provide exercises tailored to your needs.

3. Medications:
- Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain. However, be cautious with long-term use and consult with a healthcare provider regarding any potential side effects.

- Alpha-blockers: These can help relax the bladder neck and prostate, potentially easing urinary symptoms.

- Antidepressants: Low-dose antidepressants can sometimes help with chronic pain management.

4. Alternative Therapies: Some patients find relief through acupuncture, biofeedback, or herbal supplements such as saw palmetto or pygeum. However, always discuss these options with your healthcare provider to ensure safety and efficacy.

5. Regular Follow-ups: Given the chronic nature of your symptoms, regular follow-ups with a urologist are essential. They can monitor your condition and adjust treatment plans as necessary.

When to Seek Further Evaluation
If your symptoms persist or worsen, or if you experience new symptoms such as fever, chills, or significant changes in urinary habits, it is crucial to seek medical attention. Additional evaluations, including imaging studies or cystoscopy, may be warranted to rule out other conditions.

Conclusion
Chronic prostatitis can be a complex and frustrating condition, but with a comprehensive approach that includes lifestyle changes, physical therapy, and appropriate medical management, many individuals find significant relief. It’s commendable that you are seeking further evaluation and considering various treatment options. Open communication with your healthcare provider will be key in navigating this condition effectively. Remember, you are not alone in this journey, and there are resources and support available to help you manage your symptoms.

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