What is Prostatitis? (Male Pelvic Pain)

As any Pain Doctor will tell you: “Prostatitis is a common, often painful condition, that can affect men of all ages. Pelvic pain in & around the prostate may be from an infection caused by bacteria; inflammation from an injury or infection; or another issue. Many men experience pain in the pelvis at some point in their life” [1]

Common symptoms may include difficult, painful, or frequent urination; pain in the area of the bladder, groin, anus, & abdomen; inability to obtain an erection or pain during ejaculation; & fever and chills” [1]. So if you’re experiencing any of these symptoms, take immediate action & book an online or in-person appointment with a Pain Consultant

Did You Know?

Prostatitis is the most widespread urologic diagnosis in men who are in the under 50 year old bracket [1].

In a Nutshell

The prostate is a male gland that resembles the shape of a walnut. It is situated below the bladder, in front of the rectum. The urethra (a fibromuscular tube which functions as the terminal region of the male urinary system), passes through the prostate. The purpose of the latter, is to generate a great deal of the fluid which constitutes the male ejaculate, semen [1].

When Prostatitis Shows Up

The start of prostatitis can come on suddenly (in acute cases); or gradually (in chronic/long-term cases). Generally speaking, Pain Doctors and other medics, refer to this form of pain as ‘prostatitis,’ which literally means an inflamed prostate [1].

A Look at the Different Types of Pelvic Pain

The drivers of long-term pelvic pain are varied; possibilities include sexually transmitted or urinary tract infections

When a prostatitis patient visits a Pain Specialist, the latter usually explains that: although their prostate may be causing them pain; in many instances, it is likely that the pain they are experiencing “does not stem entirely (or in some cases at all), from issues with the prostate itself” [1]. So here is a list of some of the most common conditions that a Pain Doctor sees:

• Chronic Pelvic Pain Acute Bacterial Prostatitis: this can be described as sudden, acute pelvic pain. It It is normally linked to bacteria which is found in prostate secretions or urine; as well as fever and other indications of infection
• Chronic Bacterial Prostatitis: this can be defined as long-term, or recurring pelvic pain, which is linked to bacteria identified in urine or prostate secretions. Generally speaking, this is in the absence of fever and other signs of infection
• Non-Bacterial Prostatitis (which is sometimes referred to as prostatodynia), can be described as long-term, or recurring pelvic pain that is not linked to bacteria identified in prostate secretions or urine. Note: this form of non-bacterial prostatitis can be subdivided into two types: (1): when inflammatory cells are discovered in prostate or urine secretions. And (2): when inflammatory cells are not discovered in prostate or urine secretions
• The Existence of Inflammatory Cells in prostate or urine secretions in the absence of any symptoms [1]

The Signs & Symptoms of Prostatitis

These can be variable inline with the type of prostatitis a patient has. They include:
• Dysuria (experiencing a burning or painful sensation whilst urinating)
• Having trouble urinating (for example, being hesitant or dribbling)
• Feeling the need to pass wa ter as a matter of urgency
• Having to frequently pass water, especially at night (nocturia)
• Having blood in the urine
• Having cloudy urine
• Experiencing pain in the lower back, groin, or abdomen
• Feeling pain in the perineum (the area between your scrotum and rectum)
• Experiencing discomfort or pain in the testicles or penis
• Feeling pain when you ejaculate
• In the case of acute bacterial prostatitis: experiencing muscle ache, chills, fever, or other flu-like symptoms [2]

So What Are the Risk Factors For Prostatitis?

Although it has to be said that in a substantial number of cases there are no clear risk factors connected to prostatitis; in general, Pain Doctors are in agreement that certain risks include:

• Middle-aged or young adulthood
• Having suffered from prostatitis in the past
• Diagnostic sampling of tissue from the prostate (biopsy)
• Issues with, or tightness in, the musculature of the pelvic floor
• Urinary problems
• Abnormality of the congenital urinary tract
• Prostate enlargement
• Infection in the urinary system
• AIDS or HIV infection
• Immunosuppression
• Diabetes
• Having recently had a urinary catheter put in [1, 2]

Note: further risk factors regarding long-term prostatitis, or long-term pelvic pain, can include:
• Nerve damage within the pelvic region due to trauma or surgery, and
• Psychological stress [2]

Are There Any Complications I Should Know About?

There are a number of complications which are linked to both acute and long-term prostatitis. These will be explained to you when you have your consultation with a Pain Consultant. The main ones include:
• Bacteremia (meaning a bacterial infection in the blood)
• Epididymitis (which refers to inflammation of the coiled tube which is connected to the back of the testicle)
• Prostatic abscess (which is a pus-filled cavity within the prostate
• An infection which spreads to the lower spine or upper pelvic bone
• Depression or anxiety
• Sexual dysfunction, including erectile dysfunction, (the latter of which describes the inability to achieve and maintain an erection)
• Changes in semen and sperm which could result in infertility [2]

Note: As a Pain Doctor will tell you: “there is no direct evidence that prostatitis can lead to prostate cancer. [However], researchers are investigating whether chronic inflammation of the prostate is a risk factor for cancer” [2].

The Need For an Accurate Diagnosis

Be sure to make an appointment with a Pain Consultant if you have any of the conditions that can contribute to the symptoms and signs associated with prostatitis. It is crucial to receive an accurate diagnosis and a Personalised Treatment Plan as quickly as possible [2].

Arrange for immediate care if you experience any of the following:
• An inability to pass water
• Blood in your urine
• Difficult or painful urination accompanied by fever
• Severe pain or discomfort in your genitals or pelvic region [2]

So What Will Happen During a Physical Examination?

Getting an accurate diagnosis is synonymous with getting your life back on track as soon as possible. When you have an in-person appointment with a Pain Specialist (this could be after an initial online consultation), the Pain Doctor will review your medical history (if they haven’t already done so). They will also ask you a number of pertinent questions. After this, they will undertake a physical examination of your genitals. This will incorporate a digital rectal exam which will help them understand what’s going on with your prostate gland; and whether or not it is swollen or tender.

Your Pain Consultant will also arrange for you to provide a urine sample. This will be analysed to see if there are any markers which indicate inflammation or infection. Moreover, in the case of some patients, additional blood, urine, or radiology tests may be required. Furthermore, in some instances, the Pain Doctor may recommend a cystoscopy (which examines the inside of the prostate). Note: during a cystoscopy, a fiberoptic camera is inserted into the urethra [1].

References

[1]. University of California Urology Department (2024). “Prostatitis (Male Pelvic Pain).”
https://urology.ucsf.edu/patient-care/adult-non-cancer/male-sexual-and-reproductive-health/prostatitis

[2]. The Mayo Clinic (2022). “Prostatitis.”