DEAR DR ROACH:
I am a 60-year-old man and suffer from chronic prostatitis/chronic pelvic pain syndrome. I have had bouts of prostatitis since childhood, but the last few years, it has been almost constant. My symptoms are burning, and I always get the feeling that I have to urinate. I have seen numerous urologists, but none who are familiar with treating this condition. I have been tested for infection. My prostate is not enlarged, and my PSA level is normal.
I have attempted biofeedback, acupuncture and Chinese herbs, all with no relief. I am at my wit’s end. Do you know of any treatments or specialists who deal with this issue? Also, do you have any other suggestions? Is there another type of doctor I should reach out to, such as a neurologist or pain specialist? — S.S.
ANSWER:
Your symptoms, although they are often attributed to the prostate, may not be caused by the prostate at all. Chronic pelvic pain in men is very common. It affects at least 2% of men, and some studies say as much as 10%.
For non-specialists like me, initial treatment is usually a combination of an alpha blocker like tamsulosin (Flomax) and an anti-inflammatory like ibuprofen, once infection is ruled out. A careful exam is usually enough to look for other common problems, but blood testing and even imaging studies may sometimes be done.
I have occasionally found men that are so worried about painful urination that they stop drinking, consciously or unconsciously, to minimize pain. However, concentrated urine often makes symptoms worse, and increasing hydration can make a world of difference.
It sounds like you have gone way past the kind of treatment a generalist can give, and although all adult urologists are certainly familiar with chronic pelvic pain in men, it doesn’t sound like you have found an expert in that condition. Many institutions have teams to treat male pelvic pain (just as there are teams for female chronic pelvic pain), usually consisting of a urologist, pain management…
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