Urology/Urinary tract problem-burning sensation extending to anus and footbottom
QUESTION: Dear Doctor,
I am giving a brief description of my Urinary Tract problem which I have been suffering since Feb 2013. Initially in Jan 13 i had a small problem of slight delay in urination in the night with no other connected problem.I consulted a Urologist in a reputed hospital in Calicut.Complete blood test including PSA values was taken as well as Ultra Sound scan since prostrate problem was suspected.Urine culture was also done.No abnormality was detected in the blood tests as well as Scan except that prostrate size was 39cc and Prostatomegali was recorded in the report. Infection was found in the urine.Urologist advised antibiotics and Dutas-T tablet for one month.Urine culture was done after the specified period and no infectionnwas found.After one month Dutas-T was replaced with Afdura. In Feb13 I stared feeling slight burning sensation and pain during urination andthe Dr.advised to continue Afdura.But it was observed that urine infection continued inbetween which disappeared on taking suitable antibiotics.The burning sensation and pain during urination continued to increase over the period.Again in July 13 whenthe problem became acute with the burning sensation feeling simultaneously felt in the testicle region, Anus and the bottom of the left foot, Urologist advised repeat blood tests including PSA values and Scan as well as TRUSS scan.The prostrate size was then reduced to 17cc and all test results were normalSince the Urologist could not identify the problen he advised CYSTCOPY AND TURP ( if required )which was done on 13 Aug 2013 with five days of hospitalisation.One month complete rest was advised.but after about four weeks the same problem of burning sensation reappeared and then urologist advised that it will take about 12 weeks tobe normal and get full advantage of the operation by which time the problem will disappear.But to my surprise the problem still continued without any relief.The urine flow is also not normal as shown in the Uriflow test which should have been improved after the procedure.i have been given some medicines by a different Urologist of the same hospital but without any relief.He is now suggesting another CYSTOSCOPY/TURP Which Iam hesitant to undergo now.In this connection I would like to mention that I had undergone HERNIA CORRECTION LAPROSCOPIC operation in Feb 2012. I am not not sure whether Hernia corerecton operation can lead to such aproblem siince burning sensation is felt simultaneously in the urinary tract, anus region and the foot region.I seek your valuable an expert advice.
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ANSWER: Sivadasan, I suspect that initially you had an infection of the prostate gland, so called prostatitis. The moderately enlarged prostate at that time ((39 cc) was no doubt due swelling of the prostate due to the inflammation. A later ultrasound showed that the gland had shrunken to only 17 cc (normal). However, you were still having symptoms even though your doctor could find no infection. I must tell you up front that all of your symptoms are compatible with prostatitis except for the burning on the bottom of the left foot. I must conclude that the later is due to a different cause unrelated to the field of urology.
TUR of the prostate is not often done for prostatitis. TURP is generally reserved for an obstructing prostate gland from natural growth of that organ (so call benign prostatic hypertrophy or hyperplasia - BPH that impairs normal voiding. Rarely a TURP is done when all other treatments for prostatitis have failed as it sometimes makes the inflammation worse. I would not recommend another TURP. I will attach my "macro" on prostatitis that will explain the disease, the various types of prostatitis and the treatment options available. Incidentally, I do not believe the hernia repair is a related issue. If you have occasion to write me again, please enclose your age, other medical problems and medications you are presently taking.
PROSTATITIS:This is a disorder that I have commented on extensively on this web site. In case you have not read it before, to follow is a "macro" I have written on this problem that will explain the various types of prostatitis and their treatment to you.
Symptoms that might occur with prostatitis include frequency of urination, slowing of the urinary stream, burning with voiding or ejaculation, burning in the penile tip unrelated to voiding, urethral discharge, sexual dysfunction (such as difficulty with erection), aching in the penis, testicles, and discomfort in the lower abdomen, low back, groin, rectum or perineum (the area between the scrotum and rectum – between the “wind and the rain”) and constipation. The passage of blood at the initiation or termination of urination or in the semen can also be noted. During sexual arousal the prostate gland & seminal vesicles manufacture fluid that account for the majority of the semen. The seminal vesicles are paired structures located behind the prostate gland that are also sensitive to sexual excitement. Sperm from the testicles (which account for only 1-2 % of the semen) travel up a series of tubes (epididymis and vas deferens) on each side to join the seminal vesicles forming the paired ejaculatory ducts. These structures empty into the prostatic portion of the urethra. At the time of ejaculation, fluid is discharged from the prostate gland and ejaculatory ducts into the urethra (urinary canal) forming the semen. The average semen volume is 2-6 cc. With the inception of ejaculation, the bladder neck closes and the semen is forced forward out the urethra by contraction of the pelvic muscles.
It is not uncommon for inflammation and/or infection to spread in a retrograde manner into the vas and epididymis. Even without such spread, prostatic discomfort is often referred into the testicle. Too frequent or too infrequent ejaculation, sexual arousal without ejaculation, withdraw at the time of ejaculation, aggressive bike or horse back riding, and excessive spicy foods, alcohol, and caffeine in the diet can predispose you to this. Sitting for long periods of time, especially in an automotive vehicle, can put undo pressure on the prostate and aggravate the condition. For the latter, it is best not to sit more than 2-3 hours at a time. Stop the vehicle periodically, take a short walk and go to the bathroom to urinate. A thick pad or piece of sponge rubber on your seat will also help to cushion the prostate. One should avoid any of the above that apply. Eliminating all of these factors that apply to you are just as important, if not more so, than taking medication! Ejaculation beyond the tolerance of the prostate to fill and empty may also cause discomfort. Likewise if one does so infrequently, fluid still builds up from thoughts, dreams, fantasies, etc. and has to be released periodically to decompress the gland and relieve the symptoms. For most men, ejaculation in moderation, perhaps 1-2 times a week, is reasonable. A daily warm bath for 10-15 minutes 1-2 times daily also lessens the discomfort. Attention to sexual activity and warm bathes should be utilized regardless of the type of prostatitis and whether or not medications are prescribed.
There are several types of prostatitis. Sometimes prostatitis can be due to an infection of the gland with bacteria. Typically, pus cells and bacteria are found in the prostatic fluid. The infection usually requires an initial 4 week course of an appropriate antibiotic (the commonest prescribed are the fluoroquinolones, but tetracyclines, sulfas and other agents can also work).
Abacterial prostatitis has several varieties. In one, the prostatic fluid demonstrates pus cells but no bacteria. In the other, there are neither pus cells nor bacteria in the fluid, just the symptoms. In all types of prostatitis, the urinalysis generally is normal unless the infection spreads into the bladder. Abacterial prostatitis is an elusive entity that has been called by a variety of names including nonbacterial prostatitis, prostadynia, pelvic congestion syndrome and most recently pelvic myoneuropathy. The latter name was coined by Dr. David Wise of Stanford. He believes that this may represent up to 95% of all cases of prostatitis. This variant may be an expression of interstitial cystitis and possibly is due to autoimmune or neurogenic factors. Dr. Wise suggests that the primary cause of the symptoms involves pelvic muscle spasm, nerve trigger points and some degree of anxiety (either the cause or result of the symptoms). His therapy involves the use of anti-depressents (we have used Elavil for years in refractory patients), relaxation techniques, trigger point physiotherapy, and biofeedback. Some others recommend Yoga & meditation as being useful. Although he may well prove to be correct, I generally recommend an initial course of antibacterial therapy for patients who clinically have symptomatic prostatitis of any variety. The majority of patients (even those with nonbacterial prostatitis) seem to respond favorably. It has been know for decades that many patients with the abacterial variety of prostatitis do well with antibiotics but the reason has been vague. Some theorized that they may harbor bacteria in the tissues of the prostate that are not being picked up in cultures (possibly walled off loci of infection). For more information on Dr. Wise's studies check out:
In my experience, symptoms usually responds to the general measures mentioned in the initial paragraph. Medications that sometimes help include the over-the-counter natural supplement saw palmetto 320 mgm daily and alpha-blockers (such as Flomax, Hytrin, Cardura & Uroxatral). The latter require a prescription from you physician if he thinks it is indicated. More recently, a naturally occurring flavinoid with anti-oxidant and anti-inflammatory properties (such as quercetin) has been used in prostatitis. It's success is yet to be confirmed.
Prostatitis may also be classified as acute (severe), subacute (mild), or asymptomatic. It may also occur as a single episode, be recurrent or chronic. In chronic bacterial prostatitis, long term low dose antibacterial therapy often works well in suppressing symptoms. In refractory cases, culture of the prostatic fluid or semen often will disclose the offending bacteria. If found, sensitivity studies can identify which antibiotics are most likely to eliminate that particular germ. One should be off of all antibiotics for 7-10 days before the culture is taken. Otherwise, if there is residual antibiotics in your system, this may prevent bacteria from growing in culture.
In other cases refractory to treatment, there is another condition that can produce similar symptoms. This disorder is ejaculatory duct obstruction. Usually the doctor will find the seminal vesicles to be very swollen on rectal examination. The patient will notice either absence or a markedly diminished semen volume. The diagnosis is made by doing a transrectal ultrasound of the prostate and seminal vesicles.
Therefore, if symptoms persist, consultation with a urologist should be scheduled. In cases with recurrent prostatitis or hematuria, it often is necessary to study the urinary tract more completely. Predisposing factors to prostatitis such as a urethral stricture (narrowing) and other disorders can then be evaluated. A man should learn to listen to his body. Good luck.
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QUESTION: Dear Doctor.
As desired i am giving some information .I am 71 years old and a retired Scietist from the Ministry Of Defence.I had undergone Coronary Byepass Surgery( CABG ) in Aug 2005 for one block of 95%, but had no heart attack symptoms.Since then I am taking m=essential medicines regularly to control cholesterol and Blood pressure.I am not taking any other medicines as a regular practice. I have already mentioned that I had undergone Hernia Correction laproscopic surgery in Feb 2012.Physically Iam quite normal having brisk walking for about 45 minutes daily in the morning and Iam doing all other household duties and also car and scooter driving including long drives.So I do not have any physical problems as on today.Only problem troubling me for the last one year is the urinary tract problem written to you which even after Cystoscopy/TURP did not give me any relief.
Sivadasan, thank you so much for providing the additional information. However, none of what you have added changes my opinion. From a urologic standpoint, I think it would be reasonable to undergo a cystoscopy (but not the TUR) to see if there is residual prostatic tissue or perhaps a stricture developed that is obstructing the urethra.
I would also see if your urologist can obtain a sample of prostatic fluid for culture. This can be done by prostatic massage, obtaining the first few drops of urine after prostatic massage or collecting a semen sample in a sterile container.
I have one further thought. Sometimes problem in the back (such as a herniated disc) can cause urinary problems, and pain or numbness in the foot and anal areas. Although your symptoms are not typical, it would be reasonable to seek consultation for this. In the USA, this would be done by either a neurologist, neurosurgeon or an orthopedic surgeon who specializes in back disorders.