Perinium Pain ?

[digital]

Hello,

I started about 3 weeks ago with a pain in the perinium area, well not exactly very painfull more of a discomfort or hot feeling, at first I thought it may something to do with the heat but when the cooler weather came it was still there. The feeling started to move around and now it feels more like its the anus, I am male 43 years. It seems to come for a few days then gone again, I do cycle but not huge amount maybe 20 minutes a day 5 days a week. I have had a lower strength of urine stream for a while, but I dont really get up in the night, maybe just once in the early morning but not every night, I can start to urinate no problem but sometimes the flow is weak at the end but not all the time, no blood or anything like that

I made an appointment to see the urologist, but actually on the day I went there was little pain at all, as I suspected he thought the prostate. Did a urine test and that came back all clear, his english was not the best but he was going more towards an injury from the cycling, to much weight on a small seat. I was expecting (and dreading) that he would now do a digital rectal exam, but he didn't. When pushed a bit more he sent me off for a lower abdomen ultrasound saying this would show up any problems. When I arrived for the scan they could not do it right away so I am now booked in for Tuesday.

When we went to pay the bill we found he had prescribed paracetamol, diclofenac and muscle relaxant the Dr did not tell us he had done that, we declined these as I already have them as I take sometimes for back pain. For the next 2 days I had no pain at all, but it has started up again now and it feels more like the anus area again, I have been taking the medicines but I did notice that the muscle relaxant I am using (pormus orphenadrine with paracetamol) says should not take with prostate problems so won't take any more of those for now. So I am not really sure what the problem is, if its the prostate or something else ?

[Sheryl]

Have you checked the skin to see if there is any rash, prickly heat or the like? Or a hemorrhoid? (which cycling would aggravate) (Use a mirror if necessary).

Doesn't sound to me like prostate issue.

[JHolmesJr]

If it's prostate (specially chronic prostatitis) there are other symptoms….weak, incomplete dribbling urine stream…urge to pee many times…..weak ejaculations etc. Also, believe it or not, the head of the penis tingles from time to time due to nerve endings being irritated. Usually caused by bacteria getting into the prostate via the urethra….can be caused by receiving fellatio or otherwise. Some other possibilities, too graphic for this thread.

Might be the bicycle….adjusting you seating position might help….push your butt as far back as it can go so the tip of the seat isn't digging into your perineum area….some seats have a hollow cavity so there is zero or minimal pressure.

In the mean time, chill on the coffee and alcohol…they do irritate a compromised prostate like hell.

[johnatong]

Your Dr.is wise in seeking possible causes of your pain---------- If prostatitis and other common causes are excluded you could have a condition known as "Levator Ani Syndrome"

http://www.ncbi.nlm.nih.gov/pubmed/21607003

You might want to try other forms of exercise and give the cycle riding a rest for a month or two.

[digital]

Have you checked the skin to see if there is any rash, prickly heat or the like? Or a hemorrhoid? (which cycling would aggravate) (Use a mirror if necessary).

Doesn't sound to me like prostate issue.

Thanks, At first it felt that could have been the problem as prickly heat is how it feels sometimes but I havent seen anything, it started when it was hot weather so some kind of rash or skin irritation is what I thought. I have had extenal hemorrhoids before just once or twice, this time there is nothing external to see, should I be abe to see something if its internal.

About the ultrasound scan... would this show up this kind of problem, the request from the Dr just says lower abdomen so not sure what is usually seen from this scan in addition to the prostate. I am considering to put the scan back a week to see what happens, he didnt suggest to have the scan done straight away untill I asked more questions

If it's prostate (specially chronic prostatitis) there are other symptoms….weak, incomplete dribbling urine stream…urge to pee many times…..weak ejaculations etc. Also, believe it or not, the head of the penis tingles from time to time due to nerve endings being irritated. Usually caused by bacteria getting into the prostate via the urethra….can be caused by receiving fellatio or otherwise. Some other possibilities, too graphic for this thread.

Might be the bicycle….adjusting you seating position might help….push your butt as far back as it can go so the tip of the seat isn't digging into your perineum area….some seats have a hollow cavity so there is zero or minimal pressure.

In the mean time, chill on the coffee and alcohol…they do irritate a compromised prostate like hell.

Thanks, as I said not much of a problem with urinating, my flow has not been as stong as it used to be for a long time but I didn't think much of it and thought it was just to do with getting a bit older. I dont get dribbling but the end is a lot lower flow than the start, think I've finished and a slow flow continues (but not always). I drink coffee only for breakfast and alcohol rarely.

Your Dr.is wise in seeking possible causes of your pain---------- If prostatitis and other common causes are excluded you could have a condition known as "Levator Ani Syndrome"

http://www.ncbi.nlm.nih.gov/pubmed/21607003

You might want to try other forms of exercise and give the cycle riding a rest for a month or two.

Thanks will take a look, I didn't really think the amount of cycling I do would be that much of an issue but its worth giving a rest for now.

[Jingthing]

May be related to earlier stage chronic non-bacterial prostatitis.

Bicycling is the absolutely worse exercise for people with that condition.

[Sheryl]

It doesn't sound like you have any signs of prostatitis.

As for the scan, I think that was ordered because he had not found a urologic cause for your pain and you pushed the issue he ordered the scan. Frankly doubt it is necessary and sounds like he also did not think it really necessary.

Quite likely the cause is not related to the prostate especially given your age and lack of other symptoms. There would usually be pain or burning on urination (and also sometimes ejaculation) in prostatitis.

While the need for a scan is debatable you do need a digital rectal exam. In addition to ruling out enlargement or tenderness of the prostate, this would identify if there is tenderness in the levator ani muscle and also if there are internal hemorrhoids. I am surprised the urologist did not do this and you might do well to consult a different one. Where doe you live?

Certainly a rectal exam makes more sense at this stage than a scan.

[digital]

It doesn't sound like you have any signs of prostatitis.

As for the scan, I think that was ordered because he had not found a urologic cause for your pain and you pushed the issue he ordered the scan. Frankly doubt it is necessary and sounds like he also did not think it really necessary.

Quite likely the cause is not related to the prostate especially given your age and lack of other symptoms. There would usually be pain or burning on urination (and also sometimes ejaculation) in prostatitis.

While the need for a scan is debatable you do need a digital rectal exam. In addition to ruling out enlargement or tenderness of the prostate, this would identify if there is tenderness in the levator ani muscle and also if there are internal hemorrhoids. I am surprised the urologist did not do this and you might do well to consult a different one. Where doe you live?

Certainly a rectal exam makes more sense at this stage than a scan.

Thanks, I was surprised the digital exam was not one of the first things he did, I'm in Phuket and the Dr was a surgeon at Mission Hospital.

[Jingthing]

Could also be physical internal damage from the cycling. Only way to look at that is with a scope up the urethra. I have a friend with that and the doc said it was caused by biking. Needed that test to see. Surgery only for serious cases.

[Sheryl]

Slim pickings in Phuket.

Could try Dr. Somchai Chitpenthom at Phuket International Hospital, have had some good feedback on him.

[tandor]

Have you checked the skin to see if there is any rash, prickly heat or the like? Or a hemorrhoid? (which cycling would aggravate) (Use a mirror if necessary).

Doesn't sound to me like prostate issue.

...maybe perineal abscess aggravated by the cycling.

[lostinisaan]

Have you checked the skin to see if there is any rash, prickly heat or the like? Or a hemorrhoid? (which cycling would aggravate) (Use a mirror if necessary).

Doesn't sound to me like prostate issue.

...maybe perineal abscess aggravated by the cycling.

OP, you might have a look here: http://blog.listentoyourgut.com/perianal-abscess-natural-treatment/

[johnatong]

Have you checked the skin to see if there is any rash, prickly heat or the like? Or a hemorrhoid? (which cycling would aggravate) (Use a mirror if necessary).

Doesn't sound to me like prostate issue.

...maybe perineal abscess aggravated by the cycling.

OP, you might have a look here: http:// just go to neighbouring country/perianal-abscess-natural-treatment/

Why the link to Quackery ?

[digital]

Thanks for the replies, I think I will consult with another Dr next week and cancel the ultrasound scan for now, I am not really sure whats going on and I keep thinking I may have some other symptoms but no pain/burning when urianting which sems to be the main one, it may be I have just been reading to much !

[Jingthing]

Burning when urinating if not an infection points to prostatitis. Of course keep in mind there can be more than one thing wrong.

[digital]

Burning when urinating if not an infection points to prostatitis. Of course keep in mind there can be more than one thing wrong

Thanks, NO I don't have burning when urinating, I've looked at the list of symptoms for prostatitis and put my answer next to them

• blood in the urine or semen. >NO
• pain or burning with urination. >NO
• pain with bowel movement. ? >Discomfort I have in this area with or without bowel movement
• pain with ejaculation. >NO
• pain in the low back, above the pubic bone, between the genitals and anus, the tip of the penis, and the urethra. >Had perenium pain, but now feels more towards anus but hard to pinpoint, possibly some penis irritation/sensations just started today
• difficulty or straining to urinate. >NO
• frequent or urgent need to urinate. ? >Urinating more than usual but have been drinking more water than usual, no urgency or waking to pee in the night.

The hospital said I had a slight fever, this I put down to having a mild sore throat. And also today I have had mild abdomen pain below my right rib, this maybe some irritation from the diclofenac I have been taking 3 x daily 25mg + 3 x paracetamol 500mg, I was originally prescribed a muscle relaxant also but I read you should not take orphenadrine with prostate problems so stopped that just in case.

Yes maybe its more than one thing, hopefully another Dr consultation will make things clearer.

[Jingthing]

Sorry! I obviously badly misread your post. My mistake. So never mind what I said.

[brewsterbudgen]

Herpes can also cause pain in this area, and doesn't always result in the more common blisters. However it should only occur intermittantly.

[digital]

An upddate...

I contacted a couple of other hospitals and in the end went to Vachira (govt Hosp), I got no response from Bangkok Phuket.

The Dr examined the area first, then asked some qestions then did the rectal exam, he said my prostate felt a little enlarged and recommended I make an appointment for today with the specialist.

My symptoms have improved over the last few days, but I have gained a small pain in my abdomen, right hand side, below ribs towards the side.

The Dr today (plus a group of students he was teaching) sent me off for another urine test and an xray of lower abdomen to rules out some other things. The urine test came back clear (as it did before) but on the xray there were 2-3 small dots in my lower abdomen area, he said these may be stones. I told him I had a little worry about cancer and he said dont need to worry about that, the symptoms sounded like a prostate issue but he want to check out these stones. I am not sure what/where the stones are exactly, I have questions now but did not think to ask at the time. My wife said he did say to the students that the kidneys were clear. He ordered a blood test for BUN and CRE and I will get the result next time.

Now I am booked in for next Thursay for another xray with colour contrast, (I think he may have wrote KUB xray but can't be sure) I can not eat meat for 2 days before the xray they recommended kongee and was given some liquid laxatives to take for 2 days, also no drink from midnight the night before (the cost will be 4,000THB). He has prescribed Coprofloxacin and Permixon to take twice daily.

My costs so far, first Dr visit 200B. Today was 1,335 for medicines, 180 for lab test, 170 for xray and 200 for Dr.

[digital]

My symptoms regarding the abdominal pain have been getting worse, lower abdomen, groin, under ribs moving around to the back, but seems to vary in position and intensity. The original pains in the perinium and surrounding areas are very small now, zero at times.

The xray I am now waiting for is an intravenous pyelogram (IVP), I was looking around at the cost of this and could not find much except for one saying it was about $80 in the US, so 4,000THB in a Thai Gov't hospital maybe seems a bit high?

[Sheryl]

An IVP in the US costs much more than that, don't know where you get $80 from.

https://healthcarebluebook.com/page_ProcedureDetails.aspx?id=373&dataset=MD

At a government hospital, the main cost is from the contrast media that they have to use which is an expensive imported drug.

[Jingthing]

80 bucks in U S. might buy an aspirin in the hospital. On a good day.

[digital]

Thanks, I couldn't find a lot about the price, the $80 was found on some random heath forum so not an accurate figure. It just seemed a lot compared to a normal xray, didn't realise the contrast dye was an expensive imported drug, no problem.

The pains are quite weird now, as well as around the abdomen/groin have had aches pains is many random places calf muscles, thigh, top of hip bone, neck, chest a few inches to left of armpit etc etc. Maybe its a cipro side effect so have stopped it for a day starting today.

[digital]

Well I had the IVP done 23 June and the results were ok, (they noted my left kidney was realively enlarge compare to the right but there were no problem, also noted a problem with my back which I was aware of as I had a discectomy fusion long time ago and my back it quite crooked) the Dr said it looked like I had passed the stones already. I still has some pain but did not feel it was anyhting to worry about.

But.... I am still in pain 2 weeks on from the IVP, a couple of days after I had strong pain in my right side under the ribs, this mostly passed after about 3 days then I got some perinium pain for a day then it was ok. But what is more of a problem are the bodily aches and pains, mostly around abdomen, stomach, sides, groin, back but I also had pains near breast bone and the most severe pain right on the tip of the left hip which I think is the iliolumbar ligament? this is sore to touch and feels like there is a little lump there, yesterday i developed a burning and pain in my right front ankle and today I have it in the left also, these pains / burning heat feelings seem to be happening in random places all over my body. I was prescribed Ciprofloxacin on 16 June and shortly after this the body aches started especially my legs and calfs, we called the hospital pharmacist to report the problems on 21st and they said it was not problem and not related to the Cipro maybe I had caught a old (this seemed ok as I had sore throat also).

Now just a day or two ago when trying to work out what was hurting so much on my left hip bone and reading about the iliolumbar ligament i started to discover many others complaining of damage caused by cipro to tendons, ligaments, muscles among other things, some of the problems reported were very severe and long lasting . This has got me worried especially as I was taking twice a day for 15 days and it seems to possibly fit with the problems I have been having, but not sure what I should do now, I read about taking magnesium supplements and there are all kinds of other supplements. I could go and see the Dr again but not sure what he can do?

[JHolmesJr]

Why don't you read the leaflet that the cipro tablets came in? They would list possible side effects…or google them.

[digital]

Why don't you read the leaflet that the cipro tablets came in? They would list possible side effects…or google them.

Thanks, No leaflet supplied with the tablet from the hospital, just strips in a plastic bag, the only warning given was dont take with dairy calcium, and confirmed when we called the pharmacy to check before being told it was ok, oly mild symptoms at first so trusted the Dr and was told its ok by hosp pharm.

Googling is exactly what I've been doing to find out about this, found out there is a FDA warning given alongside this type of antibiotic in the US.

[Sheryl]

The cipro side effect you refer to (which is infrequent, much less than 1%) is inflammation or injury of one or more tendon? usually the Achilles tendon. This does not match the diffuse aches and pains all over that you report. If as it sounds like, all this began after the IVP then an autoimmune reaction to the contrast media is more likely.

Going back to your original doctor, a kidney specialist, is not likely to help. There is a rhematologist at Bumrungrad named Dr. Virat who is very good and diagnosed a similiar problem in my sister.

[digital]

The cipro side effect you refer to (which is infrequent, much less than 1%) is inflammation or injury of one or more tendon? usually the Achilles tendon. This does not match the diffuse aches and pains all over that you report. If as it sounds like, all this began after the IVP then an autoimmune reaction to the contrast media is more likely.

Going back to your original doctor, a kidney specialist, is not likely to help. There is a rhematologist at Bumrungrad named Dr. Virat who is very good and diagnosed a similiar problem in my sister.

Thanks Sheryl,

Achilles tendon is back of the lower leg right? no I don't have pain there other than a general achiness in the legs. Still the left hip is most painful and most occuring, sometimes in the same side but lower toward groin, pain in front of both ankles and now pain in side of right ankle near the bone, at the moment also have some pain in right side maybe 2 inch below armpit. Other pains seem to come and go in random places, earlier this afternoon started a pain in upper right arm then right wrist.

It began before the IVP but milder, started the cipro evening of 16 June, pains started day or two after so stopped it on 20 June, 21 June called Pharmacy to check and they said its ok to continue so did until 2 July (IVP was 23 June).

I'm in Phuket, this afternnon have bought Chelated Magnesium (magnesium amino acid chelate 18% 556mg equiv to magnesium 100mg) to take 3 times a day with meal., i also read it was reommended to take calcium but wit the kidney stones thought it was better not to take this.

[Sheryl]

The pain you describe is definitely not tendinitis. Nor is the location of the pains you mention consistent with any type of arthritis (there are reactive types of arthritis that are set off by meds one is allergy to etc). From what you describe the pain seems to often be in soft tissue, away form joints and tendons.

Pain that migrates all over the body may be suggestive of an autoimmune condition such as fibromylagia. It is possible you never had kidney stones and that this is just a continuation of whatever caused the perineal pain.

I had forgotten you are in Phuket. Suggest you consult a rheumatologiost there e.g.

http://www.phuketinternationalhospital.com/pages/19?locale=en

[digital]

The pain you describe is definitely not tendinitis. Nor is the location of the pains you mention consistent with any type of arthritis (there are reactive types of arthritis that are set off by meds one is allergy to etc). From what you describe the pain seems to often be in soft tissue, away form joints and tendons.

Pain that migrates all over the body may be suggestive of an autoimmune condition such as fibromylagia. It is possible you never had kidney stones and that this is just a continuation of whatever caused the perineal pain.

I had forgotten you are in Phuket. Suggest you consult a rheumatologiost there e.g.

http://www.phuketinternationalhospital.com/pages/19?locale=en

Thanks again.

Yes possible I never had the stones at all. I did see some reports of people blaming Cipro for their Fibromyalgia but people seem to blaming Cipro for all kinds of things if you look for it.

I was told once a long time ago I had very mild early arthritis in one of my ankles, also I have the back problem I mentioned in an earlier post, the report from the IVP said "mild scoliosis with spondylosis of the lumbar spine is noted".

I'll give it a few days and then maybe see another Dr, Vachira is more in my price bracket than PIH, a bit of a longer wait but from past experience most of the docs seem to work also in PIH BPH and there own clinic. I noticed there is a german doctor with a clinic who also works at Vachira, hes an orthopedic surgeon so not sure if he would be good for this or not.