AboutArthur Goldstein, M.D. Expertise Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations American Medical Association, American Urological Association, American College of Surgeons
Question Dr. Goldstein, no man ever thinks this will happen to them.
I'm 40 and have been blessed to be extremely healthy my whole life except for chronic prostate discomfort, pain and post-ejaculation bleeding for about 12 years.
That usually clears up with antibiotics but in the last year, that's not so foolproof anymore. And my frustration is growing to great heights with that issue.
Besides that mystery, in the last month, I notice after urination, I get leaking in my underwear. No matter how long I wait to truly finish in the bathroom, it gets me.
Besides the personal embarrassment, I am greatly concerned.
Post-ejaculate bleeding that won't go away for long periods of time and now post-urination drip -- Dr. Goldstein, what can this guy do to kick those two things to the curb for good. Sick and tired of it. I'm lean, good shape, eat right, don't sleep, emotionally a wreck over my ex-wife not leaving me alone (I filed three years ago), but other than that, great.
Help?
Blessings your way.
Would be happy to offer a testimonial or do anything to repay you for help. So frustrated.
Answer Mike, bleeding from the prostate gland. It is due to a tear in one of the fragile veins of the prostate. The prostate is the organ that produces the majority of the seminal fluid in response to sexual stimulation. When the prostate contracts at the time of ejaculation, a vein may tear and blood mixes with the semen (hematospermia). Red blood indicates new and dark (brownish) discoloration indicates previous bleeding. Prostatic bleeding often is associated with gross blood during urination. This typically will occur with initiation or at the end of urination (as opposed to being throughout the entire stream). With the latter, it is often manifest as spots of blood on the underwear, pajamas or bed sheets. Irritation of the gland (prostatitis) can also cause it to become inflamed and predisposed to bleed. Some factors leading to inflammation include too frequent or too infrequent ejaculation, sexual arousal without ejaculation, withdraw at the time of ejaculation, excessive alcohol or spicy foods, prolonged sitting or bike riding, etc. The prostate may then become secondarily infected and require antibiotic therapy for cure. Sometimes as the prostate gradually enlarges with age, friable veins called varices develop on its surface. These are also prone to tearing. In such cases, Proscar is sometimes prescribed to shrink both the prostate and the veins. Although hematospermia is not a typical sign of prostate cancer, its presence may indicate an increased risk of prostate cancer. Therefore, it is advisable to seek consultation with a urologist to evaluate this condition.
Post voiding dribbling is a very common problem. It is due to trapping of some urine in the urethra which then leaks out after one has finished urinating. It is usually due to an obstruction such as from a swollen prostate, a narrowing of the urethra (stricture) or a narrowing at the penile opening (meatus). The most common cause of a swollen prostate is an inflammation, so called prostatitis. In my experience, another common cause is in those men who remove their penis through the unzippered fly, void and then put the penis back. Often, the space is not adequate for total free flow as the lower (bottom) edge of the fly can actually push on the urethra causing urine to be trapped. This phenomenon can be totally avoided by dropping your trousers and then urinating in the standing or sitting position. Try the latter and if you are cured, no further evaluation is necessary. If the dribbling persists but is mild, get in the habit of "stripping" or milking the urethra from just behind the scrotum forward a couple times after voiding and then pat dry. Again if the problem persists or is more severe, you need to see a urologist in consultation.
To follow is some information I have written on the various types of prostatitis that you may find informative. Some is repetitvie with what I have sent you above on hematospermia so forgive me for not editing it. The best of luck 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, 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”). 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 manufactures fluid that accounts for about 2/3 of the volume of ejaculate. The seminal vesicles are paired structures located behind the prostate gland that also manufacture fluid. 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 into the urethra (urinary canal) from the prostate gland and ejaculatory ducts forming the semen. The semen volume is in the 2-6 cc range. 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. This 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). Typically, pus cells and bacteria are found in the prostatic fluid.
Abacterial prostatitis has several varieties. In one, the prostatic fluid demonstrates pus cells but no bacteria. In the other, called prostadynia, 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 usually responds to the general measures mentioned above. 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. 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 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 sometimes is necessary to study the urinary tract more completely. A man should learn to listen to his body.
