Urologic Surgical Associates of Delaware
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Prostatitis and Pelvic Pain
Prostatitis and Pelvic Pain
Prostatitis is an inflammation of the prostate that can result in pelvic pain and significant lower urinary tract symptoms.

Prostatitis is a poorly understood chronic pain syndrome occurring in men with some association with voiding dysfunction. There is no definitive test for prostatitis and it cannot be confirmed on any test. Rather, some other better understood pathologies of the bladder are generally excluded by performing certain studies. For example, cystoscopy is commonly performed when a patient presents for some of the common signs and symptoms of prostatitis. With cystoscopy one cannot confirm or refute the diagnosis of prostatitis but one can exclude some of the other better understood pathologies such as bladder cancer and neurogenic bladder. Generally, the diagnosis of prostatitis is arrived at gradually over time with continuing interaction between the patient and the treating urologist.

Common presenting signs and symptoms of prostatitis include recurrent urinary tract infections, pelvic pain, burning with urination, frequency of urination, night time frequency of urination, pain with ejaculation, and a sense of incomplete bladder emptying. A very common clinical scenario for a patient who ultimately arrives at a diagnosis of prostatitis is that they have been treated with mixed results for recurrent prostate infections and that the urinary cultures are almost always negative. Commonly, in such a situation the patient may have some pelvic pain or pain with urination. Another common presenting scenario for prostatitis is that a patient has unexplained, chronic pelvic or periniel pain and urinary frequency. Commonly, prostatitis patients also experience significant bladder pressure.

Another common pathway for arriving at a diagnosis of prostatitis is to elect to treat for a presumptive diagnosis of prostatitis and if the patient responds to a certain treatment protocol his response to the treatment may be highly suggestive of prostatitis. There are multiple possible treatment plans or methods for prostatitis. There is no treatment or management plan that can eliminate prostatitis. The management options for prostatitis, at best, can make the problem more manageable. For example, if a patient is presumed to have prostatitis and the patient suffers from bladder pain associated with urinary frequency, then decreasing the urinary frequency may reduce the overall amount of pain the patient is experiencing but it will not eliminate the pain. Some of the management plans available for prostatitis include treating urinary frequency with anticholergenic medications such as Ditropan, Detrol, Vesicare, Sanctura, or Oxytrol patch.

Prostatitis is often associated with difficulty emptying the bladder and perhaps an enlarged prostate. Treatment for prostate enlargement and difficulty emptying the bladder may help improve prostatitis. Medications to shrink the prostate (5 Alpha Reductase agents) such as Avodart (Dutestaride) and Proscar (Finasteride) can be helpful. Also, alpha blockers, which help relax the bladder opening can also be helpful such as Flomax (Tamzalosen), Uroxatrol, Rapoflow, Cardura, and Hytrin.

The most common prescription treatment for prostatitis is a prolonged (usually 30 days) of antibiotic therapy (usually a Flouroguinolone such as ciprofioxin, Levaquin, or Avolox). In some cases, alternative antibiotics may be used such as Septra (Trimethoprim Solfate). Many patients will have symptom relief while taking the antibiotics and then when the antibiotic dosing ends the symptoms reappear. Again, this occurs usually in the presence of a negative culture. It is not clear if this represents a subclinical infection.

Conservative measures may also be helpful with prostatitis. Such measures include long soaks in a warm bath or sauna, ibuprofen (Motrin or Advil), avoiding strenuous activity and avoiding spicy foods. Complementary therapies such as massage therapy, meditation, reike therapy, acupuncture and acupressure may also be considered. Some patients with a presumptive diagnosis of prostatitis may actually have interstitial cystitis. For more information, see our brief on interstitial cystitis.