Prostate infection with a negative urinalysis?


Q: Went to my doctor reporting symptoms of weakness, fatigue, and chills combined with difficulty urinating and emptying my bladder. One night I was fine, the next, I wasn't at all. He did some blood and urine tests and said everything looked good, so I must have an enlarged prostrate. He suggested I have BPH and prescribed Flomax to help with the urine flow. I'm only 38 years old and this was so sudden. I've had one prostate infection before and it resolved with antibiotics over 4 years ago. I've not had any sexual partners in 2 years, so not an STD. Could it be from something else other than an infection? Could it be an infection not detected? Help, I'm struggling here!

Symptoms:  Difficulty urinating, emptying bladder, "full" feeling rectum,

A:   Hello,
Thanks for the query to for an opinion.

Prostatitis refers to a loose assemblage of syndromes characterized by urinary problems such as burning or painful urination, the urgent need to urinate, trouble voiding, difficult or painful ejaculation, and pain in the area between the scrotum and rectum (known as the perineum) or lower back. Although it causes some of the same symptoms as BPH and can occur at the same time, prostatitis is a separate condition.

Some types of prostatitis are caused by bacterial infection. These cases are often accompanied by the classic symptoms of infection, such as fever, chills, and muscle pain along with urinary problems. As a result, they are relatively easy to diagnose and treat, and they usually respond well to antibiotics. Unfortunately, such straightforward forms of prostatitis are the minority. In your case its a sudden onset acute prostatic infection.

This sudden-onset infection is caused by bacteria that travel from the urethra, and perhaps from the rectum, to the prostate. It’s the least common but most dramatic form of prostatitis, beginning abruptly with high fever, chills, joint and muscle aches, and profound fatigue. In addition, you may have pain around the base of the penis and behind the scrotum, pain in the lower back, and the feeling of a full rectum. As the prostate becomes more swollen, you may find it more difficult to urinate, and the urine stream may become weak. (If you can’t urinate at all, it’s a medical emergency; this usually means the prostate is so swollen that it’s completely blocking urine flow. Depending on the severity of symptoms, hospitalization may be necessary.)

Antibiotics are the standard treatment and are highly effective for this form of prostatitis Typical choices include fluoroquinolones—such as ciprofloxacin (Cipro), levofloxacin (Levaquin), and ofloxacin (Floxin)—and trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim). It’s important to continue your medication for the entire prescribed course, even if you are feeling better. This will help prevent your infection from returning.

To help ease any discomfort, try sitting in a hot bath, take stool softeners, and use over-the-counter pain relievers, such as aspirin or ibuprofen. Drinking plenty of fluids can help flush the bacteria from your system, too. The diagnosis can however be confirmed and re-ascertained with an MRI pelvis to look for enlargement of prostrate and also for the size causing obstructive symptoms.
I hope i have answered your query in detail,
Wishing you good health,

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