Q. What is causing sensitive penis, rectal pressure and pain after ejaculation?
Hello doctor,
I am 35 years old male, with a long history of prostatitis, 3 to 4 years, no symptoms. Now a myriad of symptoms including all the following that come and go. Urgency, sensitive penis, rectal or prostate pressure, no pain but happens after ejaculation sometimes and from a bowel movement. Last urgent care said inflamed prostate on DRE and should take Flomax and antibiotics. Another doctor said maybe IC. The second opinion said he would treat for prostate within one month with Cipro. Not sure what to do. Please help.
Hi,
Welcome to icliniq.com.
From history and test report (attachment removed to protect patient identity), it appears as CPPS (chronic pelvic pain syndrome) and not to localize prostate as the source of the problem. I would like to add anticholinergic to your alpha-blocker (Flomax) and Psyllium Husk.
Probable diagnosis:
CPPS (chronic pelvic pain syndrome).
Treatment plan:Capsule Roliflo OD 2 mg (Tamsulosin with Tolterodine 2 mg), Psyllium husk 3 tablespoon HS with one glass water over it, perineal exercises.
Preventive measures:Bahy Pranayam, Moolbandh regular two times a day will relax the painful focus in the perineum.
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What is the differential diagnosis? Should I get a cystoscopy? How long should symptoms last?
Hi,
Welcome back to icliniq.com.
Differential diagnosis includes CPPS or prostatitis. Cystoscopy will not help. Instead first get a uroflowmetry done, if normal curve, no need of scopy. Urine has no pus cells, post prostatic massage prostatic secretion will rule out inflammatory or infective prostatitis. For CPPS, need to take treatment and perineal relaxation exercises. Duration: Initially take 10 days treatment, then follow-up.
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