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Could this be prostatitis

Posted 14 Sep 2020 at 14:23


Would really appreciate any views from those who may have experienced similar.

My problems started in January following an initial consultation with a gastroenterologist for repeated bouts of rectal bleeding. He performed a DRE and advised it was most likely piles but as I was very concerned I arranged a colonoscopy for a week later. A day or so following the DRE I experienced difficulty urinating with a much reduced stream. I took Ibruprofen and the problem improved somewhat but still was still experiencing some frequency. The colonoscopy revealed nothing untoward and he diagnosed piles as the cause of the bleeding.

A few weeks later I was still experiencing a reduced stream and some frequency issues so visited my GP. Bloods and urine sample revealed nothing unusual except that my PSA was 2.0 and slightly high for my age (42) GP performed a DRE and said it seems ok but referred me to a urologist as a precaution. The consultant performed another DRE and confirmed a benign feeling prostate and recommended a 2nd PSA test a few weeks later. 2nd test came back as 1.2 and I was discharged back to the GP with a recommendation that my PSA is checked annually.

I am however still experiencing intermittent frequency and a reduced stream. I also had supra pubic discomfort for a number of months. It felt like a dull ache or continual pressure in my lower abdomen but this has since improved quite a lot. My main concern is the reduced stream. Obviously I've considered the usual suspects but I understand problems associated with prostate size usually occur gradually, my symptoms appeared almost overnight and are intermittent- some days I seem normal.

I've never smoked, avoid alcohol, caffeine, and fizzy etc...as they are known irritants but it it doesn't seem to have helped. Not sure where I go from here. I'm due my next PSA test in Jan, is it advisable to have it checked sooner or maybe pay privately for a scan? My dad survived prostate cancer 10 years ago, aged 70, so naturally I 'm rather paranoid about it.

Any advice would be appreciated.


Posted 14 Sep 2020 at 15:43

You should go back to your doctor with your concerns, and he should refer you to urology, because it will need some tests and imaging your doctor can't do, such as a flow rate test, flexible cystoscopy, and maybe a scan. Given your genetic history, I would ask for an mpMRI scan. Not all prostate cancers generate raised PSA, but BPH and prostatitis could be causes too.

It might be that you need some treatment for outflow obstruction (narrowing somewhere along the path).

One thing to note is that men pee at different speeds at different times of day. You will pee slower at night and first thing in the morning because the part of your autonomous nervous system which opens the internal sphincter takes longer to wake up than your conscious nervous system and will still be half asleep. However, if you start getting an outflow obstruction, you are also more likely to notice it first at these times.

If you are peeing slowly, you might stop peeing before you emptied your bladder (peeing is timed, it doesn't run until the bladder is empty). However, it is important to empty your bladder each time to prevent UTI's. So I would suggest you try double voiding - wait 30-60 seconds after peeing and try peeing again (by relaxing, not forcing) to help make sure you have emptied your bladder.

The irritants you mention (caffeine, fizzy etc.) tend to cause bladder spasms in people who are sensitive to them (which is only some people), and that results in urgency, not the symptoms you describe.

Posted 14 Sep 2020 at 17:04

Hi Andy,

Thanks for your reply. The issue that confounds me is that I was absolutely fine before the first DRE with the gastroenterologist. 

I've definitely noticed flow can be slower upon waking and during the night, but not always in my case. One complication for me with regard to certain urology tests is the fact I've been a long term sufferer of paruresis or shy bladder and so am unable to urinate in the presence or perceived presence of others. I cannot use airplane toilets either. Tried many different treatments over the years, cbt, hynotherapy, even went on a weekend workshop organized by the UKPT (uk paruersis trust) but unfortunately all to no avail. In the unlikely event I did manage to produce something during a flow test it would not be a true reading as the autominous nervous system just takes over and have to force every drop. 

I guess my best hope is for a mpmri as any tests that involve voiding for a doctor would be impossible. My dad had a bladder snip procedure in his early 50's and later a turps so its quite possible these issues are my genetic legacy. 

The only other time I experienced urinary issues was over 20 years ago when I was interrupted mid-stream and unable to complete the job for some time after. Following this I felt like I needed the toilet every 30 mins. Suspecting an infection my GP prescribed many different courses of AB (despite cultures coming back clear)but nothing worked. It took at least 18 months for the symptoms to subside.

I will return to my GP and press for a mpmri but I suspect I will only be referred if my PSA rises to 2.0 or above.

Thanks again for taking the time to reply.

Posted 14 Sep 2020 at 21:47


It could be that  the DRE has irritated  the prostate and your obvious concern and stress about it isn't helping. I think the prostate  needs time to settle down.

I am in the middle of a flare up at the moment and my stress levels aren't good and are most likely not helping me. I also wonder if I have piles as rectum pain can get very bad with reduced urine flow.

As mentioned, best get a scan to check everything out good and proper. My GP won't  send me for one so I've arranged an appointment with a private specialist and will arrange one with him.

Hope you get it sorted out. It's  not good for mental health. By the way I'm 52.



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