Prostatitis

Can Prostatitis Cause Back Pain?

When you start to understand medicine, you realize that everything isn’t always what it seems. We always have patients with uncommon signs and symptoms.

Pain is sometimes reported in areas apparently far from the problem area. This is because nerve terminals are very long and receive signals from a large extent. Organs do not have the same sensitivity as the skin, and it is sometimes challenging to locate the pain. Long nerves can also cause referred pain to an unrelated area.

But is prostatitis like that? Can you feel prostatitis outside of the immediate prostate gland area?

In this article, we’re exploring the topic of prostatitis symptoms with a particular emphasis on back pain. Is prostatitis a cause of back pain, and why? What medical and natural therapies are there to recover from prostatitis?

What is prostatitis?

Prostatitis is the medical term to describe the inflammation of the prostate gland. In most cases, this inflammation is triggered by a bacterial infection. After bacteria enter the prostate, the immune system starts an inflammatory process. The prostate gland starts swelling and retains liquid. This stimulates nerve terminals and causes pain usually located near the groin. Another common symptom is urinary tract problems, mainly urinary retention.

Unlike benign prostatic hyperplasia, prostatitis is more common in younger males. The origin of the infection can be a repeated urinary tract infection or sexually transmitted diseases. In both cases, the bacteria reach the prostate tissue through small prostatic ducts connected to the urethra.

In some cases, prostatitis is not triggered by a bacterial infection. These cases are known as nonbacterial prostatitis. They can be difficult to handle and cause chronic pelvic pain syndrome.

In most cases, prostatitis is not severe, and it is treated with antibiotics. However, as the disease becomes more challenging to treat, it affects the patient’s quality of life. Complications sometimes arise, such as a prostatic abscess or recurrent prostatitis (1).

Who is at risk of developing prostatitis?

You are more likely to get prostatitis in these cases (2):

  • If you had recent or recurrent urinary tract infections, one of prostatitis mechanisms is urine reflux into the prostatic ducts. In urinary tract infections, this urine comes with bacteria and debris. This increases the chance of prostatitis in male patients.

  • If you suffer from benign prostatic hyperplasia (BPH): An enlarged prostate changes the gland’s configuration. Intraprostatic reflux is more likely, and there’s stasis in prostatic secretions. All of these factors contribute to prostate infections.

  • If you’ve been infected with sexually transmitted diseases: This is one of the most frequent causes of prostatitis in young males. Gonorrhea, chlamydia, and other microorganisms infect the urethra. They cause urethritis. But the urethra is next to the prostate, and they can migrate into the gland, causing prostatitis.

  • If you have frequent unprotected sex: Young males with an active sexual life and multiple sexual partners are at a higher risk. Primarily if they practice unprotected anal sex.

  • If you consume spicy food, alcohol, and other irritants: Spicy foods and irritants affect the urinary tract and prostate health. If you have an underlying or asymptomatic inflammation of the prostate, they may contribute to flare-ups.

  • If you undergo trauma in the pelvic area: Inflammation is also triggered by trauma. In this case, it is usually repeated trauma to the pelvic area. Cycling for very long hours without a prostate-friendly seat can be a risk factor.

Symptoms of prostatitis

There are different types of prostatitis, and each one has characteristic symptoms. We have acute bacterial prostatitis, which usually has sudden and more severe symptoms. Chronic bacterial prostatitis is prolonged and annoying, but symptoms are not as severe. Pelvic pain syndrome is another type of prostatitis, and it is challenging to treat.

Common symptoms in acute bacterial prostatitis include (3):

  • Fever and chills: Prostatitis is an acute bacterial infection, and this is a very likely sign-temperature increases as a part of the inflammatory process. Chills are experienced when the temperature reaches peak levels and starts to drop.

  • Muscle and joint pain: Patients often feel this type of pain. It is usually accompanied by muscle weakness and malaise.

  • Burning pain while urinating: This is also known as dysuria. It can be a sign of a urinary tract infection as well.

  • Urinary frequency: Patients feel the urge to void more often. The volume of urine may stay the same as the frequency increases.

  • Urinary urgency: This is very similar to urge urinary incontinence. When patients feel the need to void, it feels urgent and unavoidable.

  • Sensation of incomplete voiding: After urinating, the patient has the feeling that he’s not done yet. 

  • Weak urinary stream: This symptom is similar to BPH, especially if the gland is considerably swollen. When they’re about to finish voiding, they may also have a terminal dribble.

  • Nocturia: It is increased urinary frequency at night. This symptom is very uncomfortable and wakes up patients several times.

  • Abdominal pain: In most cases, pain is located in the suprapubic area. This is the low abdomen. However, some back pain cases have also been reported.

  • Urethral discharge: This symptom is particularly relevant in young males. In these cases, sexually-transmitted diseases should be ruled out.

Common symptoms in chronic bacterial prostatitis include (4):

  • Intermittent dysuria: Similar to the above, these patients feel a burning sensation when urinating. But this symptom is not continuous. It comes and goes.

  • Intermittent obstructive symptoms: The most common obstructive symptoms include nocturia, a sensation of incomplete voiding, increased urinary frequency, and a weak urinary flow. But they are not continuous. They often come and go.

  • Recurrent urinary tract infections: This is very common in chronic bacterial prostatitis. We have male patients with recurrent cases of urinary infection. This is uncommon in males and should be carefully evaluated.

Common symptoms in chronic prostatitis and pelvic pain syndrome include (5):

  • Pelvic pain: This is the most common symptom in these cases. Pain can be located in different parts of the body. It is usually reported in the low abdominal area or the perineum. Other patients report pain in the groin or scrotum. In some cases, it is located in the rectum, the coccygeal area, or the lower back.

  • Pain upon ejaculation: These patients often report pain during ejaculation. It is more severe as the prostate is more inflamed.

  • Dysuria and obstructive symptoms: Like other types of prostatitis, these patients often feel nocturia, increased urinary frequency, and a sensation of incomplete voiding. All of these urinary symptoms are not usually continuous. They come and go in flare-ups.

  • Erectile dysfunction: In chronic pelvic pain syndrome, there are also cases of erectile dysfunction. They can be found in other types of prostatitis as well. The difference is that erectile dysfunction in chronic pelvic pain syndrome appears to be directly related to the disease and not associated with psychological factors.

Can prostatitis cause back pain?

The short answer is yes. Prostatitis can cause back pain. It is listed in the symptoms of acute bacterial prostatitis and chronic pelvic pain syndrome. It is not prevalent in chronic bacterial prostatitis, or at least not severe and usually not reported.

There are different mechanisms for back pain in prostatitis.

In acute prostatitis, the inflammation of the gland is adjacent to the rectum. In some cases, it leads to inflammation of the rectal mucosa and neighboring areas. Local inflammation can lead to irritation of nerve terminals and referred pain in the lower back. This is often mistaken with spinal problems. However, a close examination would reveal fever, urinary symptoms, and other suggestive signs of prostate involvement.

In chronic prostatitis and chronic pelvic pain syndrome (CPPS), the association is also related to nerve terminals. There is a type of CPPS that is not associated with microbial infections. Instead, it is triggered by nerve dysfunction and ghost pain in the pelvic area. In these cases, back pain is also a possibility as referred pain. Other prostate symptoms may be reported as well.

Still, you want to remember that back pain is not the mainstream symptom of prostatitis. Thus, your doctor needs to rule out spinal involvement and other causes, even if you have prostatitis signs and symptoms.

How can you resolve prostatitis related back pain?

Prostatitis-related back pain can be difficult to solve, especially if you have chronic prostatitis and chronic pelvic pain syndrome. There is actually no consensus about what to do and when. So, doctors need to use a trial-and-error approach until they find the right treatment for you.

There is no cure for chronic pelvic pain syndrome. Some patients experience longer asymptomatic periods. But a flare-up may bring back the symptoms once again after a while. What doctors do in these cases is trying to manage pain symptoms as much as possible.

In acute prostatitis, the problem is easier to solve. The pain usually goes away with the right combination of antibiotics and anti-inflammatories. In most cases, it is enough with over-the-counter non-steroidal anti-inflammatories drugs-for example, ibuprofen and naproxen. Only a few cases may require more specialized pain-relieving therapies such as oral or injected steroids.

Unlike chronic pelvic pain syndrome, acute prostatitis resolves after a few weeks. However, you need to take your meds exactly as prescribed, or it may become a recurrent problem (3,4,6).

Prostatitis treatments

Prostatitis treatment depends on what type of prostatitis we have. However, most of them follow a similar approach.

Medical

Medical treatment of prostatitis and chronic pain syndrome may include these drugs (1, 4):

  • Antibiotics: They are essential in cases of acute and chronic bacterial prostatitis. They treat the infection and resolve the inflammatory problem.

  • Non-steroidal anti-inflammatory drugs: They are commonly used to counter the pain. In most cases, it is enough with over-the-counter pain relievers.

  • Alpha-blockers: These drugs are useful in patients with urinary symptoms. They relax the smooth muscle of the urethra and improve urine flow.

  • Stool softeners: They could be fundamental for patients with constipation. They reduce pressure upon the prostate and contribute to managing pain by promoting bowel movements.

Natural supplements

Besides medical treatment, we can also use prostate supplements to find some relief. Some of them work for prostatitis and BPH as well:

  • Turmeric: It is an excellent anti-inflammatory with added antibacterial function. Turmeric is an excellent spice to add to your foods if you have an inflammatory condition. It counters inflammation while contributing to fight the infection (7).

  • Saw Palmetto: This North American herb can contribute to treating prostatitis in two ways. It has beneficial substances called flavonoids. These are potent antioxidants and prevent free radical damage in the prostate and other tissues. Besides, it has an innate anti-inflammatory potential. Thus, it counters inflammation whenever it is located (8).

  • Quercetin: This is a natural treatment for benign prostatic hyperplasia and prostatitis. Similar to the above, it has potent anti-inflammatory potential. When administered along with the appropriate medical treatment, it could contribute to relieving the symptoms faster or extend the periods without flare-ups (9).

Keep in mind that these natural supplements do not replace medical therapy. They are useful as a complementary therapy or to prevent flare-ups in chronic pelvic pain.

Lifestyle

Treating prostatitis should be accompanied by proper lifestyle modifications. For example:

  • Avoid riding a bicycle unless you have a proper seat. And even if you have, try to avoid this type of activity when you have symptoms.

  • Stay away from spicy food and alcohol. They irritate your urinary tract and worsen your symptoms.

  • Practice safe sex and get treatment for any sexually-transmitted disease.

  • Take hot baths or use heating pads to contribute to relieving the pain

  • Reduce your sugar intake and eat more fresh foods instead of their processed counterparts

  • Exercise lightly and drink plenty of water

  • Engage in pelvic floor physical therapy exercises to strengthen your pelvic floor muscles.

Conclusion

Prostatitis can be divided into different types, and each has an array of signs and symptoms. There are even cases of asymptomatic inflammatory prostatitis. But prostatitis back pain is mainly found in non-bacterial prostatitis. This is also known as pelvic pain syndrome.

In most cases, prostatitis pain is located in the perineum or the lower abdomen. Other accompanying symptoms include sexual dysfunction, urinary urgency, painful urination, and obstructive signs also found in early prostate cancer.

Sources

  1. Ramakrishnan, K., & Salinas, R. C. (2010). Prostatitis: acute and chronic. Primary Care: Clinics in Office Practice, 37(3), 547-563.
  2. Ku, J. H., Kim, S. W., & PAICK, J. S. (2005). Epidemiologic risk factors for chronic prostatitis. International Journal of andrology, 28(6), 317-327.
  3. Davis, N. G., & Silberman, M. (2019). Bacterial Acute Prostatitis. StatPearls [Internet].
  4. Rees, J., Abrahams, M., Doble, A., & Cooper, A. (2015). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU international, 116(4), 509.
  5. Habermacher, G. M., Chason, J. T., & Schaeffer, A. J. (2006). Prostatitis/chronic pelvic pain syndrome. Annu. Rev. Med., 57, 195-206.
  6. Shoskes, D. A. (2001). Use of antibiotics in chronic prostatitis syndromes. Can J Urol, 8(Suppl 1), 24-28.
  7. James, M. I., Iwuji, C., Irving, G., Karmokar, A., Higgins, J. A., Griffin-Teal, N., … & Morgan, B. (2015). Curcumin inhibits cancer stem cell phenotypes in ex vivo models of colorectal liver metastases, and is clinically safe and tolerable in combination with FOLFOX chemotherapy. Cancer letters, 364(2), 135-141.
  8. Barry, M. J., Meleth, S., Lee, J. Y., Kreder, K. J., Avins, A. L., Nickel, J. C., … & McCullough, A. (2011). Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. Jama, 306(12), 1344-1351.
  9. Duclos, A. J., Lee, C. T., & Shoskes, D. A. (2007). Current treatment options in the management of chronic prostatitis. Therapeutics and clinical risk management, 3(4), 507.

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