What does male pelvic pain syndrome (prostatitis) feel like?

Written by: Mr Keng Jin Ng
Published: | Updated: 28/03/2019
Edited by: Laura Burgess

Prostatitis is inflammation of the prostate gland. It is also termed male pelvic pain syndrome. It usually affects younger men in their 20s up to those who are in their ‘middle age’. Leading urologist Mr Keng Jin Ng explains how to recognise the symptoms of prostatitis, and what you should do about the pain.

What causes male pelvic pain syndrome?

The mechanism for causing prostatitis is due to the abnormal tightness of a ring of muscle called the ‘bladder neck’. This ring of bladder neck muscle sits on top of the prostate gland and forms the top part of the water passage (urethra). During normal voiding, this ring of bladder neck muscle should automatically relax to allow the opening up of the urethra.

However, in patients who suffer prostatitis, this ring of bladder neck muscle is too powerful, tight, and fails to relax open properly, causing turbulent flow of urine downstream at the prostate gland. Such turbulent flow will cause the urine to shoot into the prostate gland, causing chemical inflammation. When the patient is emotionally stressed, the bladder neck muscle will automatically tighten even more, aggravating the symptoms of prostatitis. 


What are the symptoms of male pelvic pain syndrome and what does it feel like?

Patients typically describe severe pain deep in the pelvis especially in the perineum (the part of the body between the scrotum and the anus). Any physical activity such as cycling, where the perineum is in contact with the saddle of the bicycle seat, would significantly aggravate the pain.

The pelvic pain is usually deep-seated and may be vague.  Patients often also experience scrotal ache and lower backache together with groin pain. Occasionally, the pain may spread down to the thigh. The back pain may be so severe that the patient often will end up going to A&E, thinking that they may be suffering from kidney stones.  In addition, the patient often notices urinary symptoms - having to wait a while to start a flow of urine, needing to go very often during the day and they may also suffer discomfort in the penis at the end of passing urine.  


Severe symptoms of prostatitis 

In severe cases of prostatitis, there may be associated symptoms of irritable bowels with patients describing bloating, constipation and even intermittent loose motions. This is due to the nerve endings in the prostate affecting the nerve that controls the bowels – medically termed “neuronal crosstalk”.  It is a bit like “short-circuiting” of the nerve endings in the different branches of nerves in the pelvis. The big bundle of nerves in the pelvis is called pudendal nerve. So when there is short-circuiting effect in the pelvis, we call it pudendal neuropathy.

Read more about the treatment process, such as PTNS

If you are concerned about suffering from prostatitis, book an appointment to see Mr Keng Ng

By Mr Keng Jin Ng

Mr Keng Jin Ng is a leading consultant urological surgeon in London who specialises in female urology and minimally invasive surgery. He received his training at the Institute of Urology, London as a clinical research fellow where he focused his research on bladder dysfunction and urodynamics.

Mr Ng is the current chair of the specialist interest group International Urogynaecological Association on the subject of chronic pelvic pain and interstitial cystitis. He regularly holds surgical master classes for consultant colleagues and offers certificates of attendance.

Mr Ng is also a national and international trainer for Bulkamid bladder neck injection for urinary stress incontinence. He is a regular speaker at The London Bladder Forum to an audience of consultant colleagues speaking on topics such as cystitis, urinary incontinence and the treatment of bladder pain syndrome. 

He has been invited to present two lectures at the forthcoming annual conference of the International Urogynaecological Association (IUGA) from 2nd - 5th September 2020. The lectures are titled, "Urethral pain - from phenotyping to the concept of urethral colonisation/female prostatitis" and "Bulking agents in stress incontinence - a credible alternative".

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