HomeAnswersAndrologyprostatitisI have prostatitis, and its symptoms are worsening. Why?

Can prostatitis cause the veins in my urethra to get darker and inflated?


The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. K. Shobana

Published At April 27, 2017
Reviewed AtFebruary 19, 2024

Patient's Query

Hello doctor,

I am a 29 year old male, who has prostatitis. My prostatitis symptoms flared up four months ago, after eight months of partial remission. Last week, my pain got worse with cramping over my pubic bone. Now, the discomfort and cramping comes in multiple places simultaneously (perineum, penis, rectum, and over the pubic bone), they get me very tired and stressed, and I tend to feel cold. I also feel pressure at the base of the penis and some pressure and itching in the urethra and outside the penis. I had not experienced pain in so many places before. I am quite concerned about this and do not know what is causing this. What will be the next line of action? In the past four months, I also noticed that from time to time, the veins in my urethra get darker and inflate slightly, changing the color of my urethra especially, if I sit down for a long time on an uncomfortable seat, is this normal? What could cause this? Does my MRI of pelvis show any abnormalities? I have also attached two figures of the urethra, and the images may not show the true color of the veins.

Prostatitis symptoms like penile pain, pain during and after ejaculation, pain while starting urination, perineum pain, rectal pain, and lower back pain, started more than three years ago. Few months after a sexual encounter, I had a sharp feeling in the tip of the penis. The medications that I took are Cipro, Doxycycline, and Septrin. While taking these antibiotics, I only felt a slight improvement, and immediately symptoms returned after stopping the medication. I had to stop all antibiotics, due to adverse side effects (stomach related). Symptoms such as pain after ejaculation, pain in the perineum, and penile discomfort returned immediately after few days. But, after 3 to 4 weeks they became negligible. For next six months, my prostatitis related issues were minimal but it would flare up if I did any sports. During this time I had severe stomach issues (bloating, constipation, food sensitivities). As my stomach issues improved and as I got active, on one occasion while having sex I felt the same pinch in the tip of the penis, following this, in the course of two months all my symptoms were back.

After this, I went through the discomfort for four months, during this time I realized that my semen's color has changed to yellow. Following this, I managed to reduce my discomfort by diet and avoiding sitting on normal chairs. Four months ago, my symptoms started again after a day of sitting on a normal chair for an hour followed by a sexual encounter, this time the symptoms did not leave. At this time, I started having pain after walking and also the sensation of an unemptied bladder a lot. I started undergoing internal pelvic floor therapy, which reduced some of my lower back pain; however, my pelvic floor became very sensitive, on two occasions some physical activities started horrible spasms in my pelvis for days. Four weeks ago, I sensed a pain over my pubic bone. However, last week after trying some Magnesium supplements, this pain increased. The next day after an ejaculation, my urethra was very sore, and at night the pain over the pubic bone came about, and it was awful. The day after, I was in a lot of pain, I could not stand up from the pain. Since then I feel multiple places spasm at the same time in my pelvis, pubic bone, the base of the penis, and lower abdomen, which triggers horrible sensation in my body. Please help me.


Welcome to icliniq.com.

I am really sorry to know about your problems. I have gone through your MRI (magnetic resonance imaging) images and other reports (attachment removed to protect patient identity), and all reports are normal. Your clinical features and investigation results fit into chronic pelvic pain syndrome (CPPS). The most important thing is to understand that though the symptoms may be severe, this problem will not harm your body in any way. Any minor infection or even any stress can acutely precipitate these symptoms.I would advise you to take the following medications. Please consult your local physician before starting these. Take Tablet Levofloxacin 500 mg, once in the morning for four weeks and Tablet Tryptomer (Amitriptyline) 10 mg, once at night for two weeks, to be increased to 25 mg for another ten weeks. This drug can be again tapered to 10 mg for two weeks and stopped.

I hope I have answered your queries and guided you. Please get back to me in case you need any further clarifications.

Patient's Query

Hi doctor,

Thank you for the reply.

Is the angle at which my coccyx bone resides at looks fine? Should I follow up further with doctors with regards to this. My stomach is very sensitive to a lot of different foods, supplements and drugs. I have tried Ciprofloxacin before and it gave me a lot of psychological and physical symptoms. What other antibiotics can help? Will Levofloxacin would be beneficial here? In the past I had a lot of problems with antidepressants, it was very difficult for me to stop them and I feel much better psychologically after stopping them four years ago. I had taken Cymbalta many years ago, and it induced a lot of problems in me such as memory and concentration issues, high fatigue and even more depression. What are my alternatives suggested here compared to Tryptomer (something that will not affect my concentration, memory and energy levels)?


Welcome back to icliniq.com. Sorry for the delay in replying. I am not able to comment on any coccyx angulation based on the images provided. An orthopedician will be better suited to guide you regarding that. Levofloxacin is the current drug of choice since it has once a day dosing, less side effects and better sensitivity compared to other fluoroquinolones like Ciprofloxacin. The standard alternatives which have better prostate penetration are Co-trimoxazole and Doxycycline (both of which you had tried previously). The other drugs with minimal side effects include Cephalexin (500 mg twice or thrice daily) and Cefixime (200 mg twice daily).

Tryptomer at 10 mg dosage usually does not cause much side effects. Since your problem is related to neural sensitivity, most of the effective drugs will have some effects on mentation. Nortriptyline 25 mg has lower side effects than Amitriptyline. Capsule Pregabalin 75 mg or Gabapentin 300 mg are also effective in this condition. Weekly prostatic massages by a urologist is also an effective therapeutic measure for this condition. Wish you good health.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Raguram Ganesamoni
Dr. Raguram Ganesamoni


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