From the Guidelines
Prostatitis-related pain is characterized by pain in the perineum, suprapubic region, testicles, or tip of the penis, often exacerbated by urination or ejaculation, and is the primary defining characteristic of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) 1. The symptoms of prostatitis-related pain can vary, but common characteristics include:
- Pain in the perineum, suprapubic region, testicles, or tip of the penis
- Pain exacerbated by urination or ejaculation
- Voiding symptoms such as sense of incomplete bladder emptying and urinary frequency The diagnosis of CP/CPPS should be considered in men with pain perceived to be related to the bladder, and treatment approaches can include established IC/BPS therapies as well as other therapies specific to CP/CPPS 1. It is essential to note that the clinical characteristics of CP/CPPS are similar to those of interstitial cystitis/bladder pain syndrome (IC/BPS), and some men may have symptoms that meet criteria for both conditions 1. In terms of management, a combination of medications and lifestyle changes can be effective in alleviating prostatitis-related pain, but the most recent and highest quality study 1 does not provide specific treatment recommendations, emphasizing the importance of individualized treatment approaches.
From the Research
Symptoms of Prostatitis-Related Pain
The symptoms of prostatitis-related pain can vary depending on the type of prostatitis. Some common symptoms include:
- Pelvic pain, which may be constant or intermittent 2, 3, 4, 5, 6
- Pain during or after ejaculation 3, 5, 6
- Urinary symptoms, such as frequency, urgency, or difficulty starting to urinate 2, 3, 5, 6
- Systemic symptoms, such as fever and chills, in cases of acute bacterial prostatitis 2, 5, 6
- Painful urination or haematuria (blood in the urine) 5
Classification of Prostatitis
Prostatitis can be classified into several types, including:
- Acute bacterial prostatitis: characterized by acute onset of pelvic pain, urinary symptoms, and systemic symptoms 2, 5, 6
- Chronic bacterial prostatitis: characterized by recurrent episodes of documented urinary tract infections with the same uropathogen 2, 5, 6
- Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): characterized by pelvic pain, urinary symptoms, and painful ejaculation, without documented urinary tract infections 3, 4, 5, 6
- Asymptomatic inflammatory prostatitis: characterized by inflammation of the prostate without symptoms 6
Diagnosis and Treatment
Diagnosis of prostatitis-related pain typically involves a thorough history and examination, including a digital rectal examination and laboratory tests such as urine culture and microscopy 5. Treatment options may include:
- Antibiotics, such as fluoroquinolones, for bacterial prostatitis 2, 3, 5, 6
- Alpha-blockers and anti-inflammatory agents for symptomatic relief 2, 3, 6
- Pelvic floor training and biofeedback for chronic pelvic pain syndrome 4, 6
- Surgical interventions, such as transurethral microwave therapy, for treatment-refractory patients 6