Chronic Prostatitis: Symptoms, Diagnosis, and Treatment Options

Prostatitis

Hello Doctor,
I have been treating my prostatitis for nearly three months now, but I have not seen much improvement.
Initially, I was treated at a small clinic, and during that time, I went to National Taiwan University Hospital in Yunlin for an examination.
However, they stated that it was not inflammation.
At that time, my urine test showed white blood cells at the upper limit of the normal range, and I was prescribed antibiotics, muscle relaxants, and pain relievers.
After finishing the medication, I did not experience any improvement, so I returned to the small clinic for treatment.
I have been receiving prostate massage during my visits to the clinic.
I also soak in hot water at least two to three times a day, but my symptoms persist.
The location of the pain varies; it comes and goes, sometimes strong and sometimes weak.
I am very concerned that there might be another underlying condition or a more severe bacterial infection.
The pain is more pronounced on the right side.
Recently, the areas of pain include:
A.
The right side at the base of the penis, extending through the scrotum to the groin, as if a certain "duct or gland" is hurting (this pain started in the last two weeks; it was not painful at first).
B.
A specific point at the junction of the groin and right thigh that is noticeably painful when pressed at certain angles.
C.
The area where the right thigh meets the body, and the junction of the right thigh and groin.
D.
Occasional sharp pain on the inner side of the right thigh.
E.
The area of pain in the lower right abdomen has slightly expanded over the past two days.
F.
Occasionally, there is itching in the urethra or inside the penis, but I am unsure if the itching originates from the urethra.
These points of pain have been alternating over the past month, and the areas that hurt are different from earlier.
Initially, there was also pain in a certain section of the left side of the penis, but at that time, I had not yet been diagnosed with prostatitis; I only reported pain in the penis.
I would like to ask:
1.
Do my symptoms still lean towards prostatitis, or could there be another condition?
2.
I want to undergo thorough examinations, such as a prostate ultrasound and bacterial testing of prostate fluid.
Which hospitals offer these services? Could you please let me know, particularly in Yunlin (or any hospitals in central and southern Taiwan)?
I am concerned that the inflammation might be due to a bacterial infection, as I delayed seeking medical attention for many days.
Before seeking treatment, I also experienced unexplained fevers and severe nocturia and frequency.
I worry that it might have transitioned from acute to chronic.
Thank you for your help.

yo, 30~39 year old female. Ask Date: 2011/10/31

Dr. Xu Weikai reply Urology

Hello, it seems that you may have prostatitis.
Whether it is chronic or acute requires professional evaluation.
In addition to the current treatment you are receiving, I recommend a type of pelvic floor magnetic therapy, which involves sitting on a chair that uses electromagnetic waves for treatment.
Our hospital has seen excellent results with this method.
You can consult nearby facilities or look it up online.
It is also advisable to perform bacterial cultures of the prostatic fluid and urine to confirm the diagnosis.
Additionally, a transrectal ultrasound examination is necessary.
If you have any further questions or need clarification, feel free to ask, and we can discuss and research together.
This message is from Dr.
Hsu Wei-Kai, Chief of Urology, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2011/10/31

More Info

Chronic prostatitis, particularly non-bacterial prostatitis, can be a challenging condition to manage due to its complex nature and the variability of symptoms. Based on your detailed description, it appears that you are experiencing a range of symptoms that could indeed be associated with chronic prostatitis or potentially other underlying conditions.

Symptoms and Diagnosis
1. Symptoms: The symptoms you describe, including pain in the perineum, groin, and lower abdomen, as well as urinary discomfort, are consistent with chronic prostatitis. The pain that radiates from the base of the penis to the groin and thigh, along with the sensation of itching or discomfort in the urethra, further supports this diagnosis. It is important to note that chronic prostatitis can present with fluctuating symptoms, which can make it difficult to pinpoint the exact cause or to achieve consistent relief.

2. Diagnosis: Diagnosing chronic prostatitis often involves a combination of patient history, physical examination, and laboratory tests. While prostate-specific antigen (PSA) levels can provide some insight, they are not definitive for diagnosing prostatitis. A prostate exam (digital rectal exam) and possibly a prostate massage to obtain prostatic secretions for analysis can be useful. However, as you mentioned, some healthcare providers may not perform these tests, which can lead to frustration in obtaining a clear diagnosis.

Treatment Options
1. Antibiotics: Since you have already undergone a course of antibiotics without significant improvement, it may be worthwhile to discuss with your healthcare provider the possibility of a longer course or a different class of antibiotics. Chronic prostatitis can sometimes be resistant to standard treatments, and some patients benefit from prolonged antibiotic therapy.

2. Pain Management: Given that you have been using pain medications and muscle relaxants, it may be beneficial to explore additional pain management strategies. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help alleviate pain and inflammation, but they should be used judiciously to avoid gastrointestinal or renal side effects. Additionally, physical therapy focused on pelvic floor relaxation techniques may provide relief.

3. Lifestyle Modifications: You mentioned that you have been soaking in warm baths, which can be soothing. Continuing this practice, along with regular gentle exercise, can help manage symptoms. Avoiding irritants such as caffeine, alcohol, and spicy foods may also reduce discomfort.

4. Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture, biofeedback, or cognitive behavioral therapy, which can help manage chronic pain and anxiety associated with the condition.

Further Investigations
If your symptoms persist and you are concerned about other underlying conditions, it may be appropriate to seek further evaluation. Here are some steps you can take:
1. Referral to a Specialist: Consider asking for a referral to a urologist who specializes in chronic pelvic pain or prostatitis. They may have more experience with complex cases and can offer advanced diagnostic options.

2. Advanced Imaging: If you suspect there may be other issues at play, such as nerve entrapment or musculoskeletal problems, imaging studies like an MRI or ultrasound may be warranted to assess the pelvic region more thoroughly.

3. Laboratory Tests: Requesting a comprehensive evaluation of your prostate secretions, if possible, can help identify any bacterial infections that may not have been detected previously.

Conclusion
Chronic prostatitis can be a frustrating condition, and it is understandable to seek thorough evaluation and treatment options. It is crucial to maintain open communication with your healthcare provider about your symptoms and concerns. If necessary, seeking a second opinion or consulting with a specialist may provide you with the answers and relief you are looking for. Remember, managing chronic prostatitis often requires a multifaceted approach, including medical treatment, lifestyle adjustments, and possibly alternative therapies.

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