Rectal Pain

[Greg]

I am a 49 year old male.  I annually see a urologist, (except for last year when my schedule didn't permit)

Occassionally after ejaculation, (and less often after a difficult bowel movement) I will experience profound dull rectal pain that seems to emmanate from the prostate area.  By occassionally, I mean once every 3 months or so.  But the pain is extreme and can last up to half an hour or 45 minutes, and lately seems to be just a bit more frequent... maybe monthly.

Once the pain starts, it is alleviated by walking or by rectal massage, or sometimes it just stops spontaneously.

My urologist did not seem too concerned and likened it to a muscular spasm.  But I am concerned that perhaps he wasn't really "listening".

The first time I remember having this pain was as a young teenager, although it was not then associated with ejaculation (the pain just "started" and then stopped pretty quickly) and it was even less frequent... maybe once a year once I became sexually active.

My grandfather and father had prostate cancer.

What could this be.... it seems to have gone on for so long that I doubt it's cancer, but could it be predictive?

Thanks

[HFHS M.D.-BL]

Dear Greg,

Prostatitis denotes a condition of inflammation of the prostate gland.  Prostatitis is typically separated into two categories: those with and those without bacterial infection.  This is a critical differentiation, because bacterial prostatitis is unlikely to spontaneously resolve and also has the potential to escalate into potentially lethal bacteremia.  The symptoms of bacterial and non-bacterial prostatitis are very similar.  Most patients complain of painful urination, increased frequency of urination, ill-defined pelvic or perineal discomfort, and pain with or after ejaculation.


After reviewing your symptoms, I feel that you would benefit greatly from a thorough history and physical exam from a physician.  A physical exam, including a rectal exam, would be useful to either localize your symptoms to the prostate or to possibly find other reasons for your symptoms.  Your physician would most likely perform a urinalysis to screen for bacterial infection.  It is very unlikely that your symptoms would be caused by prostate cancer, but a PSA should be performed because of your age.  This could be a "muscular spasm" as your urologist mentioned.  Prostatitis, however, can not be overlooked.  There is no substitute for a complete history and exam by a skilled physician.  


This information is provided for general medical educational purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.  More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).


Sincerely,
HFHS M.D.-BL

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