Hi
Here is the case:
Patient suffers from intense pain in the rectum lasting 3-4 months that does not seem to respond well to even to c/s determined targeted antibiotic treatment for weeks. All of a sudden, after a few months, the pain just goes away on its own. It returns exactly every two years roughly with the onset of summer! The sphincter becomes unusually tight and a little swollen - no external hemorrhoids, just skin tags but swollen. Slight pulling away on the buttocks causes the pain to increase further. Trans-rectal USG of the prostate was done with great difficulty after repeated attempts to enter through the sphincter and the patient was under great pain while this was being attempted. This was done during the last episode in 2008 after semen analysis confirmed profuse infection with Salmonella. The diagnosis made was that of prostatitis. The same diagnosis had also been made in 2006 when profuse E Coli was found in the semen. The patient had complained of acute pain in the rectal area that started with morning motions and remained during the day getting exceptionally worse if the 33 yr old young male patient had to resort to "standing" even for a minute or two. Sitting or lying down generally gave much needed relief to the patient. He generally woke up in the mornings with minimum pain - night's sleep did the trick until another day of pain resumed soon. It was the same pattern during both the 2006 and 2008 episodes. Itching in the penis and infection of the urethra also ocurred.
The pain has just started to return this year. Alcohol and performing a day long training session whilst standing seems to have triggered it (although long hours of standing was very well tolerated during the interim year and a half). The symptoms are similar except that dis-urea or other urogenital symptoms are not yet experienced.
What could be the root problem ? Could it be an anal fissure that gets worse and infects the prostate or chances are that it is just chronic prostatitis ? Why does it not respond to antibiotics and heals on its own after quite a few months of intense suffering ? Why could there be this bi-yearly pattern ? And what should be the best treatment ?
Thanks for your diagnosis and thoughts. The patient happens to be me !
Here is the case:
Patient suffers from intense pain in the rectum lasting 3-4 months that does not seem to respond well to even to c/s determined targeted antibiotic treatment for weeks. All of a sudden, after a few months, the pain just goes away on its own. It returns exactly every two years roughly with the onset of summer! The sphincter becomes unusually tight and a little swollen - no external hemorrhoids, just skin tags but swollen. Slight pulling away on the buttocks causes the pain to increase further. Trans-rectal USG of the prostate was done with great difficulty after repeated attempts to enter through the sphincter and the patient was under great pain while this was being attempted. This was done during the last episode in 2008 after semen analysis confirmed profuse infection with Salmonella. The diagnosis made was that of prostatitis. The same diagnosis had also been made in 2006 when profuse E Coli was found in the semen. The patient had complained of acute pain in the rectal area that started with morning motions and remained during the day getting exceptionally worse if the 33 yr old young male patient had to resort to "standing" even for a minute or two. Sitting or lying down generally gave much needed relief to the patient. He generally woke up in the mornings with minimum pain - night's sleep did the trick until another day of pain resumed soon. It was the same pattern during both the 2006 and 2008 episodes. Itching in the penis and infection of the urethra also ocurred.
The pain has just started to return this year. Alcohol and performing a day long training session whilst standing seems to have triggered it (although long hours of standing was very well tolerated during the interim year and a half). The symptoms are similar except that dis-urea or other urogenital symptoms are not yet experienced.
What could be the root problem ? Could it be an anal fissure that gets worse and infects the prostate or chances are that it is just chronic prostatitis ? Why does it not respond to antibiotics and heals on its own after quite a few months of intense suffering ? Why could there be this bi-yearly pattern ? And what should be the best treatment ?
Thanks for your diagnosis and thoughts. The patient happens to be me !
