PROSTATITIS

Prostatitis is not often talked about, but it is more common than most men realise. Studies estimate a lifetime prevalence of 1.8% to 8.2% globally. A Singapore-based clinical study (Singapore Med J. 2002 Apr;43(4):189-93) found that 2.8% of respondents reported prostatitis-like symptoms, including pain or discomfort in the perineum, testicles, tip of the penis, or bladder and suprapubic region. Many also reported lower urinary tract symptoms, such as pain during urination, along with erectile dysfunction that affected their quality of life.

Prostatitis is one of the more frustrating conditions to diagnose in urology, partly because its symptoms overlap with several other conditions. A broader, more structured approach to diagnosis helps doctors tell the different forms of prostatitis and pelvic pain apart, so treatment can be better targeted.

The National Institutes of Health groups prostatitis into four types:

The exact cause is often unclear. Known risk factors include anything that allows bacteria to enter the urethra and prostate, which can also raise the risk of urinary tract infections, as well as factors linked to chronic nerve-related pain. Men with a history of urethritis from a sexually transmitted infection may be at higher risk of developing chronic prostatitis later.

Because the symptoms overlap, chronic prostatitis needs to be distinguished from other causes of pelvic pain, such as interstitial cystitis or bladder pain syndrome, pelvic floor dysfunction, prostate or bladder cancer, benign prostatic hyperplasia, bladder or kidney stones, and other causes of painful or frequent urination.

Other possible contributors include irritating chemicals in the urine, an immune response following a past urinary tract infection, or nerve damage in the pelvic area.

The most common symptom of prostatitis is pain in the penis, testes or perineum, which may spread to the lower back.

Some men notice sexual symptoms, including erectile dysfunction, blood in semen, painful ejaculation, or pain during intercourse.

Doctors often focus first on chronic bacterial prostatitis when assessing long-term symptoms. This form involves symptoms lasting three months or longer, with the same bacteria found repeatedly on urine or prostate fluid cultures. Escherichia coli is the most common bacteria involved, followed by Enterococcus. Treatment typically involves 4 to 6 weeks of antibiotics.

However, chronic pelvic pain syndrome is far more common, accounting for more than 90% of chronic prostatitis cases. It involves pelvic pain lasting three months or more without a consistent bacterial cause, and antibiotics do not help relieve this type of pain.

If you notice ongoing pelvic, urinary or sexual symptoms, or pain in the perineum, it is worth speaking to a doctor rather than waiting for it to resolve on its own.

Because prostatitis shares symptoms with other urinary tract conditions, an accurate diagnosis takes a careful, experienced approach. At Singapore Paincare, our primary care doctors and pain specialists work alongside urologists to assess your medical history and carry out a physical examination. This may include a digital rectal exam, urinalysis, or blood test.

In many cases, non-surgical treatment can bring good relief. At Singapore Paincare, our approach is to identify the specific cause of your pain first, then treat it using the least invasive option suitable for your case. This may combine targeted injections and minimally invasive procedures with medication and rehabilitative therapy, with the goal of easing pain and helping you avoid recurrence.

Our specialists may recommend physical therapy such as Kegel exercises or myofascial release to help ease muscle tension and spasm in the pelvic floor.

Because chronic prostatitis can be a frustrating, ongoing condition, cognitive-based therapies may be offered alongside physical treatment. These are aimed at helping manage stress and reduce the overall experience of pain.

Beyond NSAIDs, medications may be used to improve urine flow. Alpha-blockers and antibiotics form a large part of treatment, particularly where a bacterial cause is likely.

For prostatitis pain that doesn’t respond to other treatment, Neurospan treatment uses pulsed radiofrequency to desensitise the nerves causing pain, without destroying the nerve itself. This targets the S2 to S4 nerves that supply the lower genital area, including the bladder, prostate, penis and testes, and is performed under caudal analgesia. It is similar in concept to root canal treatment for a sensitised tooth, and does not affect your ability to control urination or bowel movements.

In a small group of carefully selected patients with chronic prostatitis, spinal cord stimulation targeting the S2 to S4 nerves may achieve around a 50% reduction in pain. A small implanted device sends mild electrical currents to interrupt pain signals before they reach the brain.

Most cases of prostatitis are managed with medication and non-invasive treatment, so surgery is rarely needed. If other treatments have not worked, transurethral resection of the prostate may be considered. This procedure is generally not recommended for younger men, as it carries a risk of impotence, infertility and urinary incontinence.

Treating urinary tract infections promptly can help prevent the infection from spreading to the prostate. If you notice pain in your perineum when sitting, see a doctor early. Addressing the issue sooner may help you avoid it progressing into chronic pelvic pain.

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