Why the word prostatitis alone is not enough
Acute bacterial prostatitis, chronic bacterial infection and chronic pelvic pain syndrome require different approaches. Pain may be maintained by pelvic floor muscles, nervous system function, urinary problems and other conditions. A normal test result does not make the pain imaginary.
Where and when it hurts matters: above the pubic bone, in the perineum, penis or scrotum; whether symptoms worsen as the bladder fills, after using the toilet, after sexual contact or after prolonged sitting. We also discuss sleep, physical activity and how the symptoms affect everyday life.
What should not be dismissed as a usual flare-up
Fever with chills, marked weakness, severe pain and difficulty urinating require urgent assessment. Complete urinary retention needs emergency care. Sudden severe testicular pain is itself a reason to go to hospital immediately, even if you were previously diagnosed with prostatitis.
Prostate massage is contraindicated if acute bacterial prostatitis is suspected. Waiting for a routine consultation or attempting the usual course of procedures in this situation is dangerous.
Assessment starts with the history of symptoms
The sequence of events needs to be reconstructed: when the pain began, whether there was an infection, which tests were done before treatment, and how the condition changed after each prescription. Bring the actual results, rather than only a diagnosis of chronic prostatitis.
The examination and tests are selected according to the clinical presentation. They may include urinalysis and urine culture, testing for sexually transmitted infections, and assessment of urination and pelvic floor muscles. If a chronic bacterial infection is suspected, the urologist will decide whether specialised tests are needed.
Ultrasound alone does not confirm bacterial prostatitis. Calcifications or heterogeneous prostate tissue do not automatically explain all pain. PSA is also not used to confirm prostatitis: testing is considered separately, based on age and indications.
With persistent pelvic pain, no single test explains every case. A neurologist, pain specialist or another doctor may sometimes need to be involved, depending on the findings.
How treatment is chosen
In bacterial prostatitis, antibiotics are selected according to the suspected or identified pathogen and the patient's condition. For chronic pain, endlessly changing antibiotics without reassessing the diagnosis does not solve the problem. An ineffective course is a reason to reassess the causes of symptoms.
The plan may include treating urinary problems, controlling pain, addressing overactive pelvic floor muscles and modifying activities that consistently trigger symptoms. Strengthening exercises are not suitable for everyone: excessive muscle tension calls for a different approach, often including relaxation training.
Sleep, anxiety and constantly anticipating pain can influence its course. Addressing these issues complements treatment and does not replace investigation. Needing a pain specialist or psychologist does not mean your symptoms are considered imaginary.
Outcomes are assessed through meaningful changes: pain intensity, ability to sit and work, urination, sleep and sexual life. It is best to agree on follow-up dates and the next steps in advance.
What to prepare for the appointment
Bring dated test results, reports and a list of treatments already tried. Note what helped and how long the benefit lasted. You can write down your three main symptoms and questions beforehand: this helps keep the consultation focused amid numerous previous prescriptions.
Consultation with urologist Artem Vladimirovich Ershov in Krasnoyarsk — RZD Medicine, 47 Lomonosova Street. To book, call +7 (391) 229-22-22 and specify the doctor. The contact centre will confirm his schedule and the fee.
Before your appointment
Frequently asked questions
I have pain, but the culture is negative. Does that mean there is nothing to treat?
No. A negative culture is assessed in light of how the sample was collected and any previous treatment. If infection is not confirmed, other causes of pain should be considered and an appropriate management plan chosen.
Does everyone need prostate massage?
No. It is not an obligatory treatment for every case of perineal pain. Massage is contraindicated in acute bacterial prostatitis.
Can I have sex with chronic pelvic pain?
There is no universal frequency. Guidance depends on tolerance and the cause of symptoms. Discuss pain during ejaculation with your doctor; a diagnosed sexually transmitted infection requires specific restrictions during treatment.