Prostatodynia is a discomfort similar to chronic prostatitis caused by spasmodic pain in the urethral muscles, prostate muscles, or muscles in the perineum and pelvic floor. Patients with prostatodynia have abnormal urine flow, including delayed urine flow and dribbling; dentate waves on the urogram and reduced urine flow, characterized by a mildly impaired or normal maximum urine flow rate and a markedly reduced uniform urine flow rate, or a uniform urine flow rate that is still at the low end of normal, but with prolonged voiding and, in some cases, significant residual urine.
Increased urinary frequency, urgency and nocturia. Pain and discomfort are predominant in the perineum, abdominal muscular groove, testes, lumbosacral and pubic arch of the lower abdomen, and are more prominent in the penis and urethra. Typically, the pain may be significantly aggravated by seminal emission, urination and defecation, or even with ejaculation pain.
Etiology
Prostate congestion is one of the most important causes of prostate pain. This is the most important cause of prostatitis, which is the pressure on the urethra, the pressure on the bladder outlet, and the irritation of the pelvic muscles; the resulting discomfort is the same as chronic prostatitis, which we call prostate pain. The actual fact is that the actual people who have regular congestion of the prostate are most likely to get prostate pain.
1, biological factors
（The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things.
(2) Biological factors also include the body’s immunity status, the body’s immunity is normal, even if there are pathogens in the urethra, it will not be infected with disease; on the contrary, if the body’s immunity is reduced, the normal presence of non-pathogenic bacteria in the urinary system, will also make people sick.
2.Psychological factors
Due to various factors, such as anxiety, impatience, depression and other unhealthy psychological activities, these psychological activities can make the human body immune level of decline, such as experimental evidence, a person with long-term depression, his blood immunoglobulin level is lower than normal, the possibility of colds, stomach ulcers, prostatitis, and even cancer is much greater than normal people.
3.Social factors
It is mainly bad habits, or bad lifestyle. The main ones are: alcohol abuse; eating irritating foods such as chili peppers; being sedentary; not being a water drinker; long-term habitual constipation; and catching cold.
Clinical manifestations
Prostate pain is mainly seen in young and middle-aged men, and its symptoms are also variable. Prostate pain symptoms are mainly
1, systemic symptoms
Weakness, weakness, anorexia, nausea, vomiting, high fever, chills, deficiency or septic manifestations. The systemic symptoms can mask the local symptoms when there is a sudden onset.
2.Local symptoms
Heavy pressure in the perineum or suprapubic area, aggravated by prolonged sitting or defecation, and dissipated to the waist, lower abdomen, back, thighs, etc.
3.Urinary tract symptoms
Burning pain during urination, urinary urgency, urinary frequency, urinary dripping and purulent urethral discharge. Bladder neck edema may lead to poor urination, thinning or interruption of urine flow, and in severe cases, urinary retention.
4.Rectal symptoms
Rectal distension, urgency and painful defecation, and white urethral discharge during stool.
Examination
1, rectal examination
There is no special abnormality in the prostate.
2.Prostate fluid microscopy
is normal and the culture is negative.
3.Cystoscopy
Mild or moderate bladder neck obstruction and varying degrees of bladder trabeculae formation can be seen.
4.Imaging urodynamic examination
The “rigid” dysfunction of the bladder neck and prostatic urethra, i.e. the internal sphincter, decreases the maximum and mean urinary flow rates, the bladder neck and the prostatic urethra near the external urethral sphincter do not relax completely, the maximum urethral closing pressure at rest is increased, and the external urethral sphincter is electrically silent (normally relaxed), which is a typical manifestation of prostatodynia. Typical presentation.
5. Cystourethrography
Obstruction of the bladder neck during voiding or the appearance of incomplete funneling and urethral stricture at the external urethral sphincter may be seen.
Diagnosis
Diagnosis can be made based on clinical manifestations. Objective examination has the following features.
1. normal prostatic pressures.
2. uroflowmetry examination reveals a ramped, hemivoltine wave with a significantly impaired mean uroflow rate and a mostly normal maximum uroflow rate.
3. cystoscopy usually suggests moderate or mild bladder neck obstruction and various bladder trabeculae formation.
4. Longer duration of disease with ultrasound suggesting significant residual urine but normal prostate.
Differential diagnosis
Both bacterial and non-bacterial prostatitis symptoms can present with perineal pain, urethral discharge, urinary tract symptoms such as urinary frequency, urinary urgency, and urinary pain, which can be difficult to differentiate purely from symptoms.
Bacterial prostatitis, you can find a large number of pathogens in the prostate, caused by staphylococci, you can find a large number of staphylococci; also more white blood cells, you can see more than 5 white blood cells.
Non-bacterial prostatitis actually has no bacterial infection, but you can also find a large number of leukocytes, and macrophages, where no pathogens can be found, but a large number of leukocytes are present.
The current diagnosis of prostatodynia is primarily an exclusionary diagnosis. In other words, if the patient has similar symptoms of prostatitis, but there are no inflammatory cells in the prostate fluid examination and no bacterial growth in the prostate fluid culture, and the patient has no urinary tract infection such as urinary frequency, urinary urgency, and urinary pain, the diagnosis of prostatodynia can be made.
Treatment
The treatment of prostate pain is difficult, and there is a lack of special treatment after diagnosis, but the measures that can be taken include
1. Sit less. A thicker cushion on the seat to reduce local pressure.
2, physical therapy and hot water sitz baths.
3.Anal lifting exercises.
4.Anal administration of drugs, anti-inflammatory and pain-relieving suppositories.
5.Avoid spicy food.
6.Sleep early and get up early to exercise.