Possible UTI / Prostatitis Exam

I (33M) have been having some UTI like symptoms over the last few months, burning urethra, post-dribbling. I had an appointment with my DR. over the phone and he had me do a urine sample. This sample came back with blood, so he then sent me for a bladder and kidney ultrasound. The ultrasound technician tended to spend a lot of time on my right kidney and not so much on my other areas (not sure if thats a coincidence or not).

I got a call to come in to see him in person to go over my results and for an "exam". The receptionist or Dr didn't mention what would entail for this exam. This Dr has never been one to do thorough exams in the past, but hoping this time around is different. Any ideas on what would entail?

I'm sure Doctors hate when someone says “I googled…” but after reading lots of information on UTIs and my symptoms I have a feeling it might be prostatitis, should I ask him to check back there even if he isn't suspecting of it? I've never had a DRE before and my family does have a history of prostate cancer.

I have a feeling he's going to give me a prescription for antibiotics and be on my way, without any removal of clothing.

I have had prostatitis off and on since I was in my mid 20s. I have gone to several doctors both pcp and Specialist. It is very painful sometimes to get infection in prostate. They do the usual exam. Bend over table. Then they put finger up butt. It does hurt when you have a prostate infection. They take a urine sample. Doctor always says there is a sign of infection in urine. We will send it off to see what grows. I leave with prescription for an antibiotic. I'm in my forties and still deal with the prostatitis. It is not fun. Wish there was a way to slow down how often I get them.

A UTI is an infection, infections are caused by critters, so urine/blood tests should find them. If antibiotics are prescribed and clear up the problem, be thankful for modern medicine. Let the doctor do their job. But don't hesitate to ask questions if what you're told doesn't seem right or doesn't make sense to you.

Tell the doc of prostate cancer family history.

I have had two episodes of prostatitis, but neither presented with blood in the urine. Acute bacterial prostatitis would be most likely at your age, but the blood suggests a more likely kidney or bladder stone. Best guess is an exam would involve what @Rad1 said. If all you had in the urine was blood, they will likely not prescribe antibiotics, at least initially. I have not been overly impressed with the level of urological workups I've had in the past, but if your doc is concerned enough about blood in your urine, you might wind up with a cystoscopy (which, of course, might actually at least temporarily result in MORE blood in the urine.) Keep us posted on how the exam goes and what you find out.

The appointment is tomorrow, I'll keep everyone posted.

I feel a prostate check wouldn't hurt to rule out, but it would be nice for the Dr to offer it, and not me having to awkwardly request it. We'll see how the conversation goes, I might bring it up.

Obviously if the ultrasound showed a kidney issue that will be the focus.

Here's a list of my symptoms, they all tend to come and go for the last several months:

• A burning pain post urination
• Dribbling after urinating
• A feeling of not completely emptying my bladder
• A feeling of not completely emptying my bowels
• Dull pain/pressure in the perineum area
• Discomfort/itchy feeling in the tip of my penis

I've dealt with prostatitis several times since college. It is not fun.

They should do a standard GU exam as well as a prostate exam. If your doctor just gives you antibiotics and doesn't do an exam, I'd find a new doctor. Also, because of the nature of the prostate, it can be difficult for antibiotics to penetrate. So, often they will give antibiotics for 4-6 weeks. 7 days likely is not sufficient. Last time, I got six weeks of antibiotics along with oral Diclofenac (anti-inflammatory which penetrates the prostate well). I also got the reminder to stay really well hydrated and, once I was feeling better and was on the antibiotics for a few days, to ejaculate daily. (Again, to enhance the antibiotics getting into the prostate.)

I've only had blood in my urine one time. My urologist ordered a CT urogram then did a cystoscopy as he was concerned about the blood and the possibility of bladder cancer. He said that a cystoscopy was the only way to evaluate the urethra and interior of the bladder to rule out bladder cancer. A bladder ultrasound won't do that.

Personally, I'd ask for a referral to a urologist.

If they suggest cystoscopy, don't freak out. Its not as bad as it sounds. For me, it was more of a psychological mind-f$#k than anything. I was able to get a small amount of Valium to take the edge off. The only painful part (lasted 15-20 seconds) was when the scope passed through the prostate into the bladder. Other than that, it was only a “full” feeling.

Good luck!

Here's a list of my symptoms, they all tend to come and go for the last several months:

• A burning pain post urination
• Dribbling after urinating
• A feeling of not completely emptying my bladder
• A feeling of not completely emptying my bowels
• Dull pain/pressure in the perineum area
• Discomfort/itchy feeling in the tip of my penis

Could be more than one issue (i.e., prostatitis and STI).

I forgot to mention I did do STI tests and they were all negative. The only one they didn’t do was trich since it was a swab and not a urine/blood test and the lab doesn’t do swabs.

I might bring up the fact Trich was never tested and maybe he’ll do a swab. Not looking forward to that from what I’ve read on this forum.

As I mentioned he's very hands off, had him for 4 years and I’ve never even removed my shirt. I wouldn’t be surprised if I do get referred to a Urologist, which wouldn’t be a bad thing except will probably be months out.

I had some folliculitis issues and he didn’t even want to look at it, just referred me to a dermatologist - which took over 6 months.

I thought of switching to a NP in the area, and the way he handles this situation might make my decision easier.

Another thought just to confuse the issue more. 😣

Possible kidney stone(s). I'm no doc, so take this with a grain of salt. Or sugar if you don't have T2D. Or even a beer.

Well looks like it's most likely prostatitis.

The nurse brought me to the room, and just said have a seat. No removal of clothing or gown, just have a seat. Right away I was doubtful I'd be given a thorough look. Doctor walked in and right away we discussed the ultrasound on my kidneys and bladder. Nothing seemed wrong in the ultrasound.

We discussed my symptoms again, and I made sure he knew about the dull ache/pressure in the perineum area, as well as the other symptoms. He then had me jump up on the table. He had me raise my shirt while he did couple palpitations of the stomach/bladder, lasted maybe 10 seconds at the most. Then I sat back up and we discussed antibiotics for treatment. I figured the exam was pretty much over at that point

However he went back to asking questions about my prostate, and mention what we can do to check that would be a DRE and explained what it was and wasn't sure if I was ready for that today though. Seemed very reluctant to do it. I was like “well to be honest I don't really wanna make another trip back and rather get it done and out of the way now”. So he had me pull my pants down and jump up on the table again. I laid on my side and he asked me to raise my knees. I laughed in my head cause the next thing he said was “I'm sorry about this” and then put a finger in. It really wasn't that bad, wasn't sure what to expect being the first time anyones put anything up there. Once he hit the prostate, I was able to confirm that was the exact location of the ache/pressure. He said it felt fine and wasn't enlarged.

I have 4 weeks of antibiotics, we'll see how it goes.

I also got the reminder to stay really well hydrated and, once I was feeling better and was on the antibiotics for a few days, to ejaculate daily.

Didn't make any mention of this to me, but I'll definitely keep both up. Would have been nice if I got a note from the doctor about ejaculations to show my wife 😁

Another thought, @hawthorne – I have learned from my own experience that pelvic floor dysfunction (either tight or loose pelvic floor muscles/connective tissue) can also cause ALL of your symptoms and is a chronically under-diagnosed condition, and in fact an issue most PCP's and urologist either ignore or don't know anything about. If the antibiotics don't resolve your symptoms, you might see if you can get a referral to a pelvic floor physical therapist for an evaluation (likely a better exam than you've had yet too) and treatment. I have had very good results from my therapy (I am at 8 of 12 treatments) and also got a bunch of exercises to do at home to keep the condition at bay. Lots of YouTube videos on this subject, just enter pelvic floor physical therapy. Highly recommended!

@MedFan15

Yes! I did mention this but he kinda brushed it off. Figured working 12 hour days on a computer chair isn't good for my floor, probably tight if anything.

Did you have burning/discomfort in the urethra though?

I mentioned to the Dr I was suspicious of pelvic floor and mentioned when I looked it up they said stop your urine to identify it…I have no control over stopping my urine mid stream, even as a kid. Didn't even know people could do that. Curious if I'm alone on that one.

I can also get super bladder shy in public restrooms or for urinalysis and cant force myself to go unless I drink so much water.

Would love to hear stories of how your evaluation was. Do they spend a lot of time internally? The one that does it around here locally says on the website thats most likely going to happen in the what to expect.

@hawthorne--thanks for your response! I primarily went to PT for issues I have been having with urinary urgency, and, more concerning, mild ED and delayed ejaculation. All of those problems have gotten MUCH better with PT. I did not have urethral burning or penile pain myself, but those symptoms are common with tight pelvic floor muscles to the point of mimicking those of a UTI, like you have experienced. There are actually 14 overlapping muscles in your pelvis, and there is a considerable amount of crossover dysfunction that can happen when the muscles are tight, and a whole constellation of different symptoms that can present, though it is difficult to tell exactly which muscles are causing the symptoms, since all must act in concert for normal bowel/bladder/sexual function to take place. There is a physical therapist on YouTube (Susie Gronski) that has published a number of excellent videos that talk extensively about all of this, highly recommend you check them out.

As far as the internal exam, I did request this and my female therapist complied. She had me take off my pants and underpants and covered me with a sheet, and had me lay on my left side with a pillow between my legs. She gloved up and put a lot of lube on her index finger before inserting it into my rectum. The exam lasted a full 5 minutes, and as you might guess, since she was actually palpating the individual muscles and connective tissue, it got to be a bit uncomfortable and, although I was aroused by the idea of the exam and the situation, it was not a very erotic experience. She was actually able to feel both my tailbone and my pubic bone from the inside, which is an unusual experience. She determined I did indeed have tight pelvic floor muscles, particularly the left hip flexors. She spent all her time on the muscles, etc. and did not assess my prostate (not her area of expertise anyway) beyond obviously feeling it on the way in. My urologist has already told me I have mild BPH and urinary retention, but I believe between the PT, daily low-dose tadalafil, conscious double-voiding and home exercises, I can keep the problem from getting worse and from interfering with my sex life and urination.

Keep us posted on your progress and if you watch the videos (besides Susie there are lots of others) let me know what you think. Good luck!

@hawthorne …just a PS, the uroflow start/stop assessment you mentioned is something that urologists do to assess bladder capacity and function, and it is formally called urodynamics testing. Not sure what you would have to have in the way of symptoms to get them to actually order these tests, I have been disappointed by my urological evaluations to date for the most part. I may ask about this at my next uro appointment in a few months, since I am clearly not fully emptying my bladder every time (the uro's nurse DID do a bladder ultrasound at my last appt to confirm that, which is kind of a cool test.)The PT folks just take your history, but they are in my opinion MUCH better listeners than the urologists and very knowledgeable. Most of the PCP's and urologists either dismiss pelvic floor dysfunction or don't know anything about it.

The ultrasound said I had about 10% remaining, which my Dr seemed to think was normal or at least not a concern.

My symptoms seems to come and go throughout the weeks, I'm on 5 days of antibiotics and I do have some relief already, not sure if its working or just coincidence.

It's funny how the build up to the appointment can be somewhat exciting but once it actually happens there's nothing.

@hawthorne roger all of that. I know what you mean re: the anticipation of the appointment vs. the reality. I suppose that's why a good playdoc session might be better than a ‘legit’ appointment…Keep us posted with your progress.

UPDATE

Well after a couple months it all came back. Seemed like the antibiotics worked somewhat. My options are to do more antibiotics, which seems to be what the doctor would like to do OR I might request a referral to a PT like was suggested here. It seems like I can book an appointment without a referral so I think I will go that route anyways, but a referral would be nice for insurance purposes. Booked a phone appointment with me GP on Friday. I think I'd prefer a urologist or PT over more antibiotics.

I had situation like this were I had burning in urethra and it was most likely UTI but symptoms were also close to prostatitis. I booked visit to urologist and there was slight chance that he would want to check my prostate but to be honest if it was prostatitis I would probably be painful for me to sit. It ended up with getting antibiotics which worked.

@hawthorne I had good results with pelvic floor PT for my BPH and delayed ejaculation (now resolved.) Chronic non-bacterial prostatitis (CNBP) will not respond to antibiotics anyway and in fact prolonged use of them is bad for your overall health. Many times CNBP can be resolved with PT. Recommended!

I posted about this elsewhere, but when my boyfriend had similar symptoms, I went with him to his GP. The doctor examined his prostate, and then gave him a vigorous prostate massage and collecting the discharge from his penis on a slide for lab testing. Fun to watch.

What did they do for pelvic Floor PT

I ended up having a pelvic exam. Therapist was female probably in her 40s. Spent some time discussing symptoms and the pelvic floor muscles. Afterwards I was instructed to remove all clothing from the waist down, and lay down on a table with a sheet covering me. The therapist left the room. It was a little exciting, but no erection (was nervous I wouldn't be able to control myself). She then proceeded to feel all around externally (balls, perineum area mostly), and spent the majority of the time (probably roughly 10 minutes) feeling all around internally. I got a slight chub when her finger was first inserted but it went down pretty quickly. Definitely a weird thing having casual conversations while someone has a finger in your butt. I believe there was a purpose to this to see how my muscles were contracting/relaxing while I talked. Did a few squeeze/relax tests as well. When it was all done she left the room, I wiped up all the lube, and then we went over a few exercises when she came back in.

I have another appointment in 2 weeks.

My GP did another blood and urine test. PSA is normal but blood still in the urine so he will have me referred to a urologist as well.

Yes, @hawthorne --sounds like you had a good experience. Longest rectal exam I ever had, so not exactly erotic, but interesting. If your therapist does the same PT massage techniques mine did, each session will be 35-45 minutes and you will feel better afterwards. You should also notice an improvement in your symptoms, but it will be gradual. Keep us posted!