Can’t urinate sitting down

Sit or Stand: How Should Men Pee?

In 2012, Viggo Hansen, a substitute member of the Sörmland County Council in central Sweden, made global headlines when he proposed a motion requiring men on the council to sit while urinating when using the office restrooms. Hansen argued that sitting would leave the toilets much cleaner, and also claimed that sitting reduces the risk of prostate cancer and endows men with a more robust sex life.

It’s difficult to dispute Hansen’s first point, but a new systematic review and meta-analysis published to PLoS ONE sheds a stream of light on his second.

Researchers in the Department of Urology at Leiden University Medical Center in the Netherlands pooled and analyzed eleven studies comparing the effects of sitting versus standing on three key “urodynamic parameters”: maximum flow rate, voiding time (the time that it takes to pee), and post-void residual volume (the amount of urine remaining in the bladder).

In healthy men, the team found no differences across any of the variables. Sitting was no better than standing for urinary health. However, the meta-analysis showed that men with lower urinary tract symptoms (LUTS) were able to empty their bladders more completely (see figure below), leaving 25 fewer milliliters of urine in their bladders. Men with LUTS also had a stronger flow and took 0.62 seconds shorter to urinate, but these two results were just shy of statistical significance.

LUTS affects approximately 40% of older men and encompasses symptoms like increased urinary frequency, painful urination, and incomplete emptying of the bladder. The most common cause is a benign increase in the size of the prostate.

In light of the evidence, the researchers recommend that men with LUTS consider peeing in the sitting position. Residual urine in the bladder is associated with increased prevalence of bladder stones and urinary tract infection, and men with LUTS are better able to empty their bladders.

But contrary to the arguments of Leftists in Sweden, a quick search of PubMed yields no evidence whatsoever that sitting is associated with reduced risk of prostate cancer or a better sex life. There doesn’t appear to be any direct health-related reason for healthy men to pee sitting down.

Source: de Jong Y, Pinckaers JHFM, ten Brinck RM, Lycklama à Nijeholt AAB, Dekkers OM (2014) Urinating Standing versus Sitting: Position Is of Influence in Men with Prostate Enlargement. A Systematic Review and Meta-Analysis. PLoS ONE 9(7): e101320. doi:10.1371/journal.pone.0101320

Yes, It Might Be Healthier for Some Men to Sit When They Pee, Urologists Say

Busy men might want to consider sitting down when they pee — not because it’s one of the few moments of the day they can rest but because it might be better for them. For older men with prostate problems, in particular, sitting down to urinate could help them empty their bladders more effectively and reduce the risks of cysts and other health complications.

“Men may start peeing sitting if their prostates are large and they need to help relax the pelvic muscles in an effort to help push the urine out,” Dr. Jamin Brahmbhatt, a urologist and professor at University of Central Florida College of Medicine, told Fatherly.


Scientists are not exactly sure what causes benign prostate hypertrophy, or an enlarged prostate gland, but the likelihood of having one increases with age. Hormones have something to do with it, as men who had their testicles removed at a young age due to cancer do not have these problems, research shows, and when men with enlarged prostates have their testicles removed, their prostates tend to shrink. The good news is that an enlarged prostate is thought to be a natural part of aging and not necessarily a precursor to prostate cancer. The bad news is that all that pressure from the prostate can increase the risk of bladder cysts, infections, and discomfort or difficulty while urinating. But when men with enlarged prostates pee sitting down, studies suggest they’re able to empty their bladders more quickly and effectively, which can reduce some of these problems.

Still, once your prostate is so troublesome that you’re sitting down just to pee effectively, you are probably overdue for an appointment with your urologist. “This is more something they become familiar with over time when they start having trouble urinating,” Brahmbhatt says. “It should be a reason to talk to your doctor or urologist about medical or surgical options.” This is especially the case if you’re under the age of 50 — young men shouldn’t be experiencing age-related prostate enlargement or trouble peeing. If you are noticing changes in stream, or blood in your urine, you should seek immediate medical attention.

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For younger, healthy men, sitting to pee probably won’t provide any benefit to their prostates one way or another. But it still might be a more hygienic option. Physicists have found that peeing standing up significantly increases the velocity of the stream and potential for backsplash, amounting to less hygienic, more bacteria-filled bathrooms. So if dads are not going to pee sitting down for their prostates, than they can do it for their partners. It will be good practice for their 50th birthdays.

“There are men that have bad aim and can soak the toilet with splatters of urine,” Brahmbhatt says. “Sitting and urinating on the toilet does increase your odds of making sure the urine is actually going down the drain.”

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HealthDay News — Prolonged sitting time and low physical activity levels are tied to higher incidence of lower urinary tract symptoms (LUTS) in men, according to a study published in BJU International.

Heung Jae Park, from Sungkyunkwan University in Seoul, South Korea, and colleagues assessed the association of sitting time and physical activity level with the incidence of LUTS in a cohort of 69,795 Korean men who were free of LUTS at baseline and followed annually or biennially for a mean of 2.6 years.

The researchers found that the incidence rate of significant LUTS was 39 per 1,000 person-years. Both low physical activity level and prolonged sitting time were independently associated with the incidence of LUTS after adjustment for multiple factors.

Comparing minimally active and health-enhancing physically active groups to the inactive group, the hazard ratios for incident LUTS were 0.94 (95 percent confidence interval, 0.89 to 0.99) and 0.93 (95 percent confidence interval, 0.87 to 0.99), respectively. Comparing five to nine hours/day of sitting time and ≥10 hours/day of sitting time to less than five hours/day, the hazard ratios for LUTS were 1.08 (95 percent confidence interval, 1 to 1.24) and 1.15 (95 percent confidence interval, 1.06 to 1.24), respectively.

“This result supports the importance of both reducing sitting time and promoting physical activity for preventing LUTS,” the authors write.

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This article was medically reviewed by Angela Chaudhari, MD, a gynecologic surgeon and member of the Prevention Medical Review Board, on May 8, 2019.

If you’ve ever had a urinary tract infection, you know the unique agony of a terrible burning feeling and relentless need to pee all wrapped up in one nightmare scenario.

Up to 60 percent of women will have a UTI at some point in their lifetime, and 1 in 4 will experience recurring infections, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). While men can get them, too, women are much more likely to contract one.

You can blame anatomy for this. (Thanks, anatomy!) Women have a shorter urethra (aka, the tube that urine flows out of) than men, which makes it all too easy for UTI-causing bacteria to pass through it and invade the bladder.

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“Our urinary tract system is designed to keep out bacteria; however, these defenses can fail,” says Kelly M. Kasper, MD, an ob-gyn at Indiana University Health. “When that happens, bacteria can grow, multiply, and cause infections.” Common symptoms of a UTI include painful urination, a strong urge to urinate with little relief, discolored or strong-smelling urine, pelvic pressure or pain, extreme fatigue, and sometimes even a fever if the infection has become more serious.

It’s important to emphasize that a urinary tract infection is common, so you shouldn’t be too embarrassed to seek care when symptoms strike (a prescribed course of antibiotics will get rid of symptoms quickly). In fact, delaying treatment can lead to serious complications, like a kidney infection.

Of course, the best thing you can do is prevent UTIs from forming in the first place—but to do that, you need to know what causes them. Here, the most common UTI causes in women, plus tips on what you can do to prevent them.

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Many women get UTIs after sexual intercourse because the motion can transfer bacteria from the bowel or vaginal cavity into the urethra. To lower your risk, pee within 30 minutes before and after being sexually active, says Lisa N. Hawes, MD, a spokesperson for the American Urological Association. Washing up after is never a bad thing, but avoid using lots of soap products. Research also shows that the use of diaphragms and spermicides can bump your chances of developing a UTI.

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UTIs are very common in women after menopause, Kavita Mishra, MD, a urogynecologist at Stanford University, recently told Prevention. That’s because your estrogen production to drops, resulting in vaginal pH changes. This disturbs the balance of bacteria and yeast in the vagina, increasing chances of infection. Some postmenopausal women with atrophy (aka thinning of the vaginal walls) can also develop small cuts near the urethra, which may predispose them to UTIs.

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Your poop (or lack thereof) is a UTI cause to be aware of. Being constipated makes it difficult to empty your bladder completely, which means trapped bacteria have lots of time to grow and cause infection, says Dr. Hawes. On the flip side, diarrhea or fecal incontinence can also increase your risk of getting a UTI, because bacteria from loose stool can easily make their way into your vagina and urethra. A tried-and-true tip: Wipe from front to back after you go to the bathroom to prevent bacteria transfer.

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Uncontrolled diabetes

“When blood sugar is high, the excess sugar is removed through the urine,” Dr. Hawes says. “This makes a favorable environment for bacterial overgrowth,” potentially leading to infection. What’s more, people with diabetes have a weaker immune system, which makes it difficult to fight off infection-causing bacteria. You may have heard that eating too much sugar causes UTIs, but Dr. Hawes confirms that unless you have diabetes, your sweet tooth isn’t the culprit.

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Holding in your urine

If you have to go, go! “Holding our urine for 6 hours or more may make UTIs more common, as bacteria that does get into the bladder has lots of time to overgrow between voids,” Dr. Hawes says. While traveling, for example, it may seem like a good idea to hold tight and keep driving until the next rest area, but do yourself a favor and stop—the extra miles aren’t worth the risk of a UTI.

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Drinking plenty of water not only quenches your thirst, but it also wards off UTIs, according to the NIDDK. When you pee regularly, your body is able to flush out any bacteria that could fester in your urinary tract, so aim to drink six to eight 8-ounce glasses of water daily to help prevent an infection, the NIDDK says.

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Feminine products

“Dirty pads and tampons are a place where bacteria can grow very easily,” says Ehsan Ali, MD, a primary care physician in Beverly Hills, California. To prevent urinary tract infections during your menstrual cycle, change your tampon at least every 4 hours, depending on your flow, and avoid wearing them overnight. Pads should also be changed every 4 to 6 hours.

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Uncomfortable underwear

Your underwear may also be a surprising UTI cause, according to Alyssa Dweck, MD, a practicing gynecologist in New York. She says wearing breathable, cotton underwear helps prevent excessive moisture that causes bacteria to grow down there. “Avoid thongs with a thin, chafing G-string, which can transfer bacteria,” she says.

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Kidney stones

Kidney stones are hard mineral deposits that form inside of your kidneys. Because they can block the urinary tract and back up urine, kidney stones can cause urinary tract infections by giving bacteria plenty of time to grow, says Dr. Ali. In turn, delaying treatment for your UTI can lead to potential kidney damage, so be sure to seek care ASAP if you feel any common UTI symptoms.

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Urinary incontinence

Common types of urinary incontinence

Most people with urinary incontinence have either stress incontinence or urge incontinence.

Stress incontinence

Stress incontinence is when you leak urine when your bladder is put under sudden extra pressure – for example, when you cough. It’s not related to feeling stressed.

Other activities that may cause urine to leak include:

  • sneezing
  • laughing
  • heavy lifting
  • exercise

The amount of urine passed is usually small, but stress incontinence can sometimes cause you to pass larger amounts, particularly if your bladder is very full.

Urge incontinence

Urge incontinence, or urgency incontinence, is when you feel a sudden and very intense need to pass urine and you’re unable to delay going to the toilet. There are often only a few seconds between the need to urinate and the release of urine.

Your need to pass urine may be triggered by a sudden change of position, or even by the sound of running water. You may also pass urine during sex, particularly when you reach orgasm.

This type of incontinence often occurs as part of a group of symptoms called overactive bladder syndrome, which is when the bladder muscle is more active than usual.

As well as sometimes causing urge incontinence, overactive bladder syndrome can mean you need to pass urine very frequently, including several times during the night.

Inability to Urinate

What Are Risk Factors and Causes of an Inability to Urinate?

There are a number of medical conditions and medications that may cause urinary retention. These medical conditions and medications may affect the function of the bladder itself, the function of the outlet of the bladder, and/or the urethra. Obstruction may be fixed (due to a mass blocking the bladder outlet) or dynamic (lack of coordination between the bladder and the muscles surrounding the bladder outlet and urethra). There are also infectious causes and surgical causes of urinary retention.

Common Causes/Risk Factors

  • Blockage (obstruction): The most common cause of blockage of the urethra in men is enlargement of the prostate. In males, the prostate gland surrounds the urethra. If the prostate becomes enlarged, which is common in older men, it may compress the urethra, causing resistance/blockage to the outflow of urine. The most common cause of prostate enlargement is benign prostatic hypertrophy (often called BPH). Other causes of prostate enlargement include prostate cancer. Acute infection of the prostate (prostatitis) may cause swelling of the prostate and lead to urinary retention. Less common obstructive causes in men include meatal stenosis (narrowing of the opening at the tip of the penis that urine passes through, which may be the result of chronic irritation or prior hypospadias surgery), paraphimosis (in which the foreskin in an uncircumcised male retracts and cannot be pulled back down, resulting in swelling and constriction), penile constricting bands, and penile cancer. Other causes of blockage of the urethra that can occur in both males and females include scar tissue in the urethra from prior trauma, surgery or infection (urethral stricture), injury to the bladder outlet or urethra (as in a car accident or bad fall), blood clots due to bladder infection or trauma, tumors in the bladder or pelvic region, severe constipation, and bladder or urethral stones or foreign bodies in the bladder or urethra. Blockage to the outflow of urine may also be due to lack of coordination between the bladder and the bladder outlet, bladder neck dysfunction, and/or lack of coordination between the bladder and the muscles surrounding the urethra, known as bladder-sphincter dysfunction. Bladder-sphincter dysfunction may be voluntary or involuntary. Voluntary bladder-sphincter dysfunction is seen in individuals who chronically hold their urine and tighten the pelvic floor muscles/sphincter when an urge to urinate occurs. Chronic tightening of these muscles leads to an inability to properly relax the muscles when urinating. Involuntary relaxation of the pelvic floor muscles/sphincter muscles occurs in individuals with neurologic conditions that can affect bladder and sphincter function. Lastly, in women, obstruction to the outflow of urine may be due to a large cystocele, or herniation of the bladder into the vagina, or may be the result of surgeries to treat urinary incontinence, such as sling procedures.
  • Nerve problems: Disruption of the nerves between the bladder and the brain can cause you to lose control of your bladder function. The problem may lie in the nerves that send messages back and forth or in the nerves that control the muscles used in urination, or both. Individuals who suffer from such conditions are referred to as having a “neurogenic bladder.” Occasionally, urinary retention is the first sign of spinal cord compression, a medical emergency that must be treated right away to prevent permanent, serious disability. The most common causes of this disruption include spinal cord injury, spinal cord tumor, strokes, diabetes mellitus, herniated or ruptured disk in the vertebral column of the back, or an infection or blood clot that places pressure on your spinal cord, and congenital spinal cord problems such as myelomeningocele (spina bifida) and tethered spinal cord. Nerve problems can also affect the ability of the muscles around the urethra to relax during urination, known as detrusor sphincter dyssynergia (DSD), which can lead to urinary retention.
  • Infection and inflammation: In males, inflammation of the head of the penis, the glans (balanitis), and infection of the prostate (prostatitis) or an abscess of the prostate may result in urinary retention. In women, infection of the vulva and vagina, vulvovaginitis, as well as chronic inflammation and resultant scarring, lichen sclerosus, may cause urinary retention. In both males and females, bladder infections, Guillain-Barré syndrome, Lyme disease, periurethral abscess, transverse myelitis, tuberculosis affecting the bladder, infection of the urethra (urethritis), and herpes zoster (shingles) can cause urinary retention. Herpes simplex virus can cause pain in the perineum and affect the nerves leading to urinary retention. Infections around the spinal cord can cause retention by placing pressure on the nerves of the spinal cord.
  • Trauma to the pelvis, penis, and perineum can cause urinary retention. Fractures of the pelvis can cause damage to the bladder outlet and urethra, and the healing of such injuries can lead to obstruction from scar tissue.
  • Surgery: Urinary retention is a relatively common problem after surgery. It can be a direct result of the anesthetic or the type of operation. Relative immobility after a surgery can also contribute to urinary retention. Previous bladder or prostate surgeries can sometimes cause urinary retention because of the formation of strictures (narrowing) due to scar tissue. This can occur after prostate cancer surgery (radical prostatectomy) as well as surgery for benign prostate enlargement (BPH) (transurethral prostatectomy, laser prostatectomy, and cryotherapy).
  • Chronic overdistention of the bladder (holding one’s urine for long periods of time) or excess alcohol intake can lead to urinary retention.
  • Immobility may result in urinary retention.
  • Other causes of transient urinary retention include immobility (especially post-operative), constipation, delirium, endocrine (hormone) problems, psychological problems, and prior instrumentation (medical procedures involving placing instruments in the urethra) of the urethra.

Medication-Related Causes

Certain medications can cause urinary retention, especially in men with prostate enlargement. Many of these medications are found in over-the-counter cold and allergy preparations. These drugs include the following:

  • Drugs that act to tighten the urinary channel and block the flow of urine include ephedrine (Kondon’s Nasal, Pretz-D), pseudoephedrine (Actifed, Afrin, Drixoral, Sudafed, Triaminic), phenylpropanolamine (Acutrim, Dexatrim, Phenoxine, Prolamine), phenyleprhine (neosynephrine), and amphetamines.
  • Antihistamines such as diphenhydramine (Benadryl, Compoz, Nytol, Sominex) and chlorpheniramine (Chlor-Trimeton, Allergy 8 Hr), as well as some older antidepressants, can relax the bladder too much and cause urination problems.
  • Anticholinergics, medications commonly used to treat overactive bladder, as well as other conditions such as oxybutynin (Ditropan, Ditropan XL, oxytrol), tolterodine (detrol, detrol LA), darifenacin (Enablex), solifenacin (VESIcare), trospium chloride (Sanctura, Sanctura XR), atropine, belladone and opioid, dicyclomine (Bentyl), flavoxate (Urispas), glycopyrrolate (Robinul), hyoscyamine (Levsin), propantheline (Pro-Banthine), and scopolamine (transdermal scopolamine)
  • Certain antidepressants may affect bladder/sphincter function, including amitriptyline (Elavil), amoxapine, doxepin, imipramine (Tofranil), and nortriptyline (Pamelor).
  • Cox-2 inhibitors, used for treating such conditions as sports injuries, arthritis, colorectal polyps, and menstrual cramps
  • Some medications used to treat heart arrhythmias may affect urination, including disopyramide (Norpace), procainamide (Pronestyl), and quinidine.
  • Certain antihypertensive medications, including hydralazine and nifedipine (Procardia)
  • Antiparkinsonian medications, including amantadine (Symmetrel), benztropine (Cogentin), bromocriptine (Parlodel), and levodopa
  • Antipsychotics, including chlorpromazine (Thorazine), fluphenazine, haloperidol (Haldol), prochlorperazine (Compazine), thioridazine (Mellaril), and thiothixene (Navane).
  • Muscle relaxants, including baclofen (Lioresal), cyclobenzaprine (Flexeril), and diazepam (valium)
  • Beta-adrenergic sympathomimetics, including isoproterenol (Isuprel), terbutaline (Brethine), and metaproterenol (Alupent)
  • Opioid-containing medications

Urinary Retention in Children

  • A child can have problems from birth that cause an inability to urinate properly. These problems may be identified prenatally. Such conditions include posterior and anterior urethral valves (areas of obstruction in the male urethra), ureterocele (a dilation of the part of the ureter that is within the bladder), and neurologic conditions such as myelomeningocele (spina bifida) and tethered cord. Children may develop urinary retention as a result of scarring from trauma to the urethra (straddle injury, pelvic trauma, or prior urethral instrumentation) and surgical procedures such as hypospadias procedures and continence procedures.
  • A child may suddenly become unwilling to urinate. This is generally due to a temporary condition that is causing pain with urination. Pain can be caused by a vaginal yeast infection in girls or an irritation from soap or shampoo used in bathing. Almost always, the child will eventually urinate without further help. Chronic holding of urine and failing to relax the pelvic floor muscles with voiding (dysfunctional voiding) may result in urinary retention.
  • Severe constipation may result in urinary retention.
  • A history of sexual abuse also is associated with urinary retention.

What to know about urethral syndrome

Doctors do not fully understand what causes urethral syndrome. However, certain health conditions and environmental factors can increase a person’s risk of developing urethral syndrome.

Some possible risk factors of urethral syndrome include the following:

Sexually transmitted infections

Sexually transmitted infections (STI) can increase the risk of developing urethral syndrome. STIs that may lead to urethral syndrome include gonorrhea, chlamydia, and mycoplasma genitalium.


Substances in certain foods can enter the urine and irritate the urethra. Foods that may increase the risk of urethral syndrome in some people include:

  • foods and beverages containing caffeine
  • hot or spicy foods
  • alcohol


Share on PinterestScented soap products can irritate the urethra.

Chemicals in soaps, personal hygiene products, and contraceptives can contain chemicals that irritate the urethra in some people. These can include:

  • scented soaps, body washes, and bubble baths
  • feminine hygiene sprays or douches
  • sanitary products
  • contraceptive gels
  • condoms

Urinary tract infection

People can sometimes develop urethral syndrome after recently having a UTI. This is because the urethra can be very sensitive while recovering from an infection.

Sexual intercourse

Rough sexual activity can damage the urethra, especially in females. In these instances, the inflammation that leads to urethral syndrome is part of the natural healing process.

Other risk factors

Other risk factors for urethral syndrome can include:

  • having sex without a condom
  • having a history of STIs
  • bacterial infections in the bladder or kidneys
  • taking medications that suppress the immune system
  • structural problems, such as a narrow urethra

Women who have given birth to several children may also be at greater risk of urethral syndrome. Having a delivery without an episiotomy, which is when a doctor makes an incision in the tissue between the vagina and the anus, can also increase a woman’s risk of developing urethral syndrome.

Why do I have a persistent pain in urethra?

Q: I am a 26 years old man suffering from pain and inflammation in the urethra region of penis and the pain gets worst after ejaculation. The doctor did the HIV, VDRL and urine culture test; HIV and VDRL test reports were negative and culture shows Escherichia coli (E. coli) infection. I was taking antibiotics for the last 3 months – ofloxacin (7 days), doxycycline (14 days), cefixime and Augmentin (7 days.), amikacin (3 days). These antibiotics increased the irritation and inflammation in the affected region. I have no symptoms of STD infection except the pain. There was no discharge of liquid from the shaft or any ulcer, clusters or blisters on genitals. I do not feel pain or inflammation while urinating but I feel some pain in prostate region and feel very tired and fatigue. Ultrasound report was normal except the calculi (6 to 7 mm) in cortex of both kidneys but I have no pain like a kidney stone patient. The urologist gave me Rolitren, Libotryp, capsule for mecobalamin and lipic acid and Neeri, but these too gave no relief. Then he gave me Fludac for 10 days but the problem still persists. This problem is affecting my sexual and married life. Do I have STD or prostatitis? Please advise.

A:The most common cause of the described complaints is inflammation of the prostate gland, called prostatitis. Symptoms that might occur with prostatitis include frequency of urination, slowing of the urinary stream, burning with voiding or ejaculation, burning in the penile tip, aching in the penis, testicles, and discomfort in the lower abdomen, low back or perineum. Prostatic discomfort is often referred into the testicles.
Too frequent or too infrequent ejaculation, sexual arousal without ejaculation, aggressive bike or horseback riding, and excessive spicy foods, alcohol, and caffeine in the diet may predispose to the discomfort. Sitting for long periods of time, as by computer professionals, or driving can aggravate the condition. It is best not to sit for more than 2-3 hours at a time, and take a short walk and empty the bladder intermittently. Eliminating all the factors that apply to you may help keep symptoms at bay, and are as important as medication. A daily warm bath for 10-15 minutes twice daily also lessens the discomfort.
Prostatitis may have a bacterial aetiology, or may be abacterial. A 4 to 6 weeks course of an antibiotic (fluoroquinolones, trimethoprim or tetracycline) would benefit bacterial prostatitis. Abacterial prostatitis has several varieties. In one, the prostatic fluid demonstrates pus cells but no bacteria. In the other, called prostadynia, there are neither pus cells nor bacteria in the fluid, just the symptoms.
Abacterial prostatitis usually responds to the general measures mentioned above. Medications that sometimes help include alpha-blockers and anticholinergics. Some ayurvedic and other herbal preparations available over the counter may help too. As mentioned earlier, changes in lifestyle are equally important to take care of symptoms. Your urologist would be able to guide you further, and investigate you to exclude other conditions that mimic this condition.

Prostatitis (male pelvic pain)

Many men experience pain in the pelvis at some point in their life. Common symptoms may include difficult, painful, or frequent urination; pain in the area of the bladder, groin, anus, and abdomen; inability to obtain an erection or pain during ejaculation; and fever and chills. The onset can be gradual (for chronic cases) or sudden (for acute cases).

In many cases this pain is referred to as “prostatitis”, that is to say inflammation of the prostate. The prostate is a walnut-sized gland in males that sits in front of the rectum and below the bladder. The urethra runs through the prostate. The role of the prostate is to produce much of the fluid that makes up semen, the male ejaculate.

Prostatitis is the most common urologic diagnosis in men younger than 50. While the prostate may indeed be a source of pelvic pain, it is likely that in many cases that pain in the male pelvis does not stem entirely (or in some cases at all) from issues with the prostate itself. A more accurate terminology has been promoted by the National Institute of Health; in this classification scheme for Chronic Pelvic Pain Syndrome (CPPS), men may be diagnosed with:

  • Chronic Pelvic Pain Syndrome I: formerly known as Acute Bacterial Prostatitis, defined as acute sudden pelvic pain, typically associated with fevers and other signs of infection as well as bacteria identified in urine or prostate secretions
  • Chronic Pelvic Pain Syndrome II: formerly known as Chronic Bacterial Prostatitis, defined as recurrent or chronic pelvic pain, associated with bacteria identified in urine or prostate secretions, usually in the absence of fevers or other signs of infection
  • Chronic Pelvic Pain Syndrome III: formerly known as Non-Bacterial Prostatitis or Prostatodynia, defined as recurrent or chronic pelvic pain that is not associated with bacteria identified in urine or prostate secretions. CPPS III may be subdivided into type A, when inflammatory cells are found in urine or prostate secretions and type B, when inflammatory cells are NOT found in urine or prostate secretions
  • Chronic Pelvic Pain Syndrome IV: presence of inflammatory cells in urine or prostate secretions in the absence of any symptoms.

CPPS III is by far the most common entity encountered in clinical practice.

The causes of chronic pelvic pain are varied; possibilities include urinary tract or sexually transmitted infections. Risk factors include diabetes, immunosuppression, prostate enlargement, congenital urinary tract abnormality, urinary issues, tightness or problems of the pelvic floor musculature, and having recent urethral instrumentation (e.g. having a catheter put in). In many cases there are no clear risk factors

A detailed history and physical exam of the genitals are essential. Examination should include a digital rectal exam, where the doctor inserts a gloved, lubricated finger into the rectum to examine the prostate and determine if it is tender or swollen. Urine samples are typically taken and analyzed for presence of infection or inflammation. In some cases additional urine, blood, or radiology tests may be indicated; some men may also be advised to have cystoscopy, in which a fiberoptic camera is inserted into the urethra to examine the prostate from the inside.

Treatment is geared towards eliminating and treatable causes. In the setting of bacterial infection, an extended course of oral antibiotics (selected based on test results or based on which drugs commonly work) is often used. For severe and acute infections, intravenous antibiotics and hospitalization may be required.

In many cases no specific infection is identified; while a single course of antibiotics may be sensible in these cases in order to treat occult (hidden) infections, it is not generally a good idea to give recurrent cycles of antibiotics unless bacteria are identified on future tests.

If pain is thought to be related to issues of pelvic floor muscle dysfunction, consultation with a pelvic floor physical therapist may be of benefit. Additional options in these cases may include muscle relaxants and other medications designed to decrease muscle tension.

Additional or adjunctive treatment strategies include over-the-counter nonsteroidal anti-inflammatory medicines, brisk fluid intake, avoidance of bladder irritants, maintaining regularity in terms of bowel movements, and soaking in hot baths.

Pain always has a strong psychological component. Strategies to manage pain are key in getting the best outcomes. In many cases chronic pelvic pain will resolve over time; management is geared primarily to minimizing symptoms and expediting recovery.

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