Is this actually consistent with Prostatitis? What should I do next?

September 12, 2018 4:16 AM

Hi all, I've been having some medical issues for a few years now and seen a number of doctors - but not sure where to go from here. Gross details below!

tl;dr - diagnosed with prostatitis -- I've seen a couple of doctors, but feel like I don't have clear steps on prognosis, or have any idea whether the diagnosis is even correct.

Also, you are not my doctor or other professional -- I know that. :)

Here's the longform version:
I'm in my early 30s and live in the US.

– In Spring-2015, I had a pain in my right testicle and was diagnosed with epididymitis (via ultrasound), without any known cause. No loss in sex drive, and it lasted for about 4-5 months before going away after a steady regimen of doxycycline (worked, then recurred about a week after completing the course), and cipro (for about a month). This exact epididymal pain subsided, and hasn't been felt since. (During all this, I saw a specialist and multiple general physicians. My concerns were almost always brushed off. Yuck.)

– (Maybe related?) About a year later, in mid-2016, I started having issues with a prolapsing internal hemorrhoid when having a bowel movement. I don't see any blood, but bowel movements take a while longer, and never quite feel complete. This hasn't changed after a regimen of fiber, exercise, and metamucil, but the immediate symptoms were/are not enough to get me to elect for surgery.

– In mid-2017, I noticed a severe drop in my sex drive (within about a week's time), followed about a month later by a recurring general pain in my lower back, generalised pain in my right testicle, and occasionally thigh. (Maybe a 2-3/10, so more persistent and annoying than anything else). This pain appears to lessen after a bowel movement. I was given a 10 day course of doxycycline tablets - which seemed to work. The intermittent dull pain was gone, and my sex drive came back after about four days. Of course, this only lasted for about five days after finishing the ten-day doxy course.

– I saw a urologist about this who gave me a 40 day supply of Doxy - except no effects were felt this time. I saw him again, and he recommended seeing an acupuncturist and coming back in six months. It was implied that if nothing changed, then epididymectomy would be on the table. I wasn't really pleased with this, so I saw a second urologist.

– This second urologist was definitely friendlier, but nothing was found after an ultrasound (apart from a small cyst), blood test (slightly lower than baseline free testosterone), and a CT scan (nothing) - but I was officially diagnosed with prostatitis. (No information as to kind). I've been given no other recommendations from this urologist other than, in this case, meditation and the prospect of flomax if issues persist. At no point was my prostate fluid checked, or my internal hemorrhoid asked about.

– Feeling discouraged from being given no clear solution by two different specialists (and feeling brushed off), I've spent the last 9 months working on myself to rule out the possibility of anxiety or other health issues - I exercise regularly, eat better, and generally feel (mentally and physically) better than when this debacle started -- except I still have my discomfort and general lack of sex drive.
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So, to sum, here are *all* of my symptoms together:
– Lessened sex drive
– Less semen and substantially less force when ejaculating.
– Generalized pain at my lower-right side of my back, and intermittent generalised vas-deferens(ish) pain. This is felt more before a bowel movement, or after ejaculation, but never fully goes away.
– Protruding item remains after most bowel movements; this can be pushed back in, but bowel movements take longer now. I think that my prostate *may* also be playing a part here - but it does take a good 20 minutes for me to have a full bowel movement. No issues with consistency, but definitely takes longer than normal.
– Slightly more fatigued, but I'm ascribing this to the ache itself, since it seems to occur most when my ache is at its worst.
– No immediately obvious issues noted with urination or itching.
– No nausea, vomiting, or other nasty stuff. Recent physical had good results.

Other items I've tried (to no avail):
– Metamucil
– Substantially more water intake
– 60 minutes exercise/day
– Standing up at work (40-50 minutes/hour)
– Moved wallet to front pocket

Miscellaneous notes:
– It's not a kidney stone - ruled out with CT scan.
– Had a blood draw recently; CBC/RBC/TSH levels/everything else are normal, save high Antigliadin IgG (standard gluten sensitivity is a-ok)
– No blood/tarry color observed in my stool.
– Free testosterone is ~8.2 pg/mL, and overall is ~420 ng/dL.
– Cortisol's in normal range
– I don't have chlamydia or any other known STI. (I've had this same urine test about five times)
– My stress levels are pretty low, on the whole.
– I still masturbate at a fairly regular basis, but I don't feel the urge as I normally do - and that lower back pain can be felt sometimes when I get closer to climaxing.
– I still get erections, but they're a bit harder to maintain. I can lose interest mid-way through while I normally wouldn't.

At this point, I'm planning to see a GI doctor about the likely hemorrhoid, but I'm not sure in what order I should tackle these issues, assuming they're at all related.
–––

So, my questions:
1. – I'm not entirely sure I agree that this is entirely prostate related yet, due to onset of low sex drive followed by pain only after a month. Are my symptoms actually consistent with prostatitis? If it is, does anyone have good first or second-hand experiences as to solutions, and/or prognosis?
2. What are some good questions for my urologist when I go back? Is there any benefit in asking for a prostate massage and fluid culture? Is it worth trying for a *third* opinion if no good solutions are presented? I'm feeling somewhat disheartened so far.
3. Is there anything I should be asking my doctors that I'm not? Is there anything I haven't thought of to try?

Since this is anonymous, I set up a throwaway email at:
[e-mail] for any followup questions.

Thank you all for your help!

posted by anonymous to Health & Fitness (1 answer total)

IANAD. The most obvious loose thread that you let dangle here is the first urologist's recommendation of an epididymectomy. Perhaps the second uro's testing ruled that out, but you don't say, and you went to the second uro because you didn't like the idea of the surgery. But epididymitis, orchitis and prostatis can all be related and together cause a lot of the symptoms you describe including loss of libido. They are not necessarily caused by chlamydia, they can be of unknown origin. This is probably unrelated to the hemorrhoid, but definitely give the GI doc the full yarn, and then follow their lead on further steps.
posted by beagle at 6:15 AM on September 12, 2018