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Is this non-bacterial prostatitis?

This is a bit complicated.  I'm 36, and work in a job that's fast-paced and high-volume, so for years I've been drinking a lot of caffeine--and then having to hold in urine for some time.  Over the years I've occasionally had spasms in the bladder after holding it in; I've mentioned this to doctors and they've said, "yeah, that can happen if you hold it in too long."  Didn't seem worried.  We're talking about a couple of hours of mild bladder aches, maybe every couple of months when I pushed it too far.

This past December (2019), it got worse, to the point where I could barely move for the pain extending from my testicles all the way up to my lower back.  I felt like I had to urinate, which offered partial relief but also hurt itself.  I asked a pharmacist, who said yep, that's a UTI.  It was not a burning-type pain, but I assumed it just manifested differently for men.  Azo offered middling relief.  I went to a walk-in clinic and got Bactrim DS, which had no discernible affect; however, symptoms did get better after I started abstaining from sex and caffeine.

Went to see a doctor, who confirmed prostatitis--not BPH--with digital probing, and gave me azithromycin, then levaquin, ten day courses of each.  Neither had any noticeable effect beyond making me constipated.  I did online research and found out that most prostatitis is not bacterial, a possibility the doc (who was elderly) did not even appear to consider.  Consulted a different doc over the phone (pandemic), who said it was unusual to get non-bacterial prostatitis at my age, but said that the courses of antibiotics were too short to make a difference anyway.  Suggested referral to urologist, because I refused more antibiotics.  This does not act like an infection at all.

I think it might be VERY slowly self-resolving, but it's hard to tell.  Haven't had a bit of caffeine since early January.  Prostate is fine--I feel nothing--unless I provoke it.  If I have sex once a week, I get mild and passing twinges I can ignore.  More than once a week is worse, and if I compound it by holding in urine, it's still worse.  Abdominal pressure from gas or bowel movements is likewise a stressor.  When flares get bad, I can dispel the pain with a single ibuprofen.  What I read of prostatitis sounds worse than this--but I rather miss tea, and regular sex.  I'm as sure as I can be that it's not VD; I haven't strayed and my wife, morals aside, wouldn't have time, since she watches the kids.

I'd be out of pocket, so a urologist might set me back $500.  I can afford it, but I'd rather not blow that kind of cash if he'll just say, "yeah, better leave it alone and it'll resolve itself."  What I read about treatments for NBP sounds dismal anyway; lots of people try alternative medicine stuff because mainstream treatments don't do much.  Anybody else have an experience like this?
1 Responses
207091 tn?1337709493
What kind of testing did you have done when you were first diagnosed with prostatitis? Any urine testing? Maybe blood tests?

My only concern would be is that if they didn't do that, then you don't know if it's bacterial or not. There can also be chronic bacterial prostatitis, as well as non-bacterial.

https://www.mayoclinic.org/diseases-conditions/prostatitis/diagnosis-treatment/drc-20355771

https://www.urologyhealth.org/urologic-conditions/prostatitis-(infection-of-the-prostate)

Prostatitis can be hard to treat, and I'm sorry you're going through this.

2 Comments
I had my urine tested by the doc twice.  At the first visit, it was positive, and he prescribed me the azithromycin.  I also got blood work done, showing nothing abnormal.  At the second visit, though I noticed no difference in symptoms, the urine test came back negative, leading the doc to conclude I was cured.  I assumed that my remaining symptoms were residual--but then it came back hard the next day, so with the doctor's permission I took a course of levaquin I had leftover from a bit of bronchitis (I got the med as a just-in-case but didn't take it).  If I didn't notice any difference at all after ten days of levaquin--which is a pretty powerful drug--this is one tough germ.  The constipation was serious and aggravated the flares because of intra-abdominal pressure, so I'm really reluctant to take a month of the stuff.

Also, I'm not an expert, but from what I've read, the bacterial kind is associated with frequent UTIs, and I've never really had UTI symptoms--my pain always felt obstructive, like I was trying to urinate through a pinhole, rather than burning.  Also, the Azo barely touched it.
Okay, since your urine was negative the second time, that makes me feel better about saying you should be okay to leave this, at least for now, especially with everything else going on.

Levaquin is a powerful drug with powerful side effects, for sure. It's a hard one to take.

Non-bacterial prostatitis is not easy to treat - if you haven't already landed on it in your research, google CPPS, or chronic pelvic pain syndrome. It probably won't offer much more in the causes, etc., but you may get something in home treatments. A lot of people call chronic non-bacterial prostatitis CPPS now.

Also, read through this forum, or our Urology forum. You aren't alone in this. https://www.medhelp.org/forums/Urology/show/52
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