Tag: UTI

Andrologist, Urologist

Painful ejaculation or painful orgasm- causes, diagnosis and treatment

Dr Varinder Attri

What is painful ejaculation or painful orgasm ?

Pain before onset of ejaculation or during ejaculation is termed as painful ejaculation. It can be dull or sharp pain and can involve the scrotum, penis root or shaft or perineal region. Pain can persist for few minutes to hours and person can have pain with urination also.

What are the causes of painful ejaculation ?

Various reason for painful ejaculation include – Prostatitis (infection/inflammation of the prostate), urinary tract infection, history of prostate surgery, sexually transmitted infections (STDs), use of medications such as antidepressants, prostate cancer, ejaculatory duct calculi etc. are the most common causes of painful ejaculation.

How to diagnose this condition and its causes ?

Painful ejaculation diagnosis is based on history provided by the patient. Causes leading to painful ejaculation can be assessed with the physical examination including digital rectal examination to palpate the prostate for any infection, urine examination with microscopy and culture, urethral discharge (if any), Trans rectal ultrasound (TRUS), serum PSA test. Additional tests are usually advised based on these initial tests.

What is the treatment for painful ejaculation ?

Treatment depends on the underlying cause. When it is caused by infection with either prostatitis or sexually transmitted infection, treatment is prescribing antibiotics to the patient along with analgesics. When its secondary to prostate surgery, it usually subside with time. Treatment for prostatic duct or ejaculatory duct calculi need endoscopic surgery for ejaculatory duct resection. Change of medicines for antidepressant induced painful ejaculation may be necessary. When painful ejaculation occurs due to prostate cancer, its treatment is done after more elaborate investigations and depending upon stage, type, patients age etc.

Whom to consult if you are having symptoms of painful ejaculation ?

Meet your local Urologist or Andrologist for best treatment.

Andrologist, Urologist

Guide to chronic prostatitis: symptoms, diagnosis and treatment

Dr Varinder Attri

What is prostate gland ?

Prostate is a walnut sized reproductive gland present below the bladder in all men. Urethra (urinary passage) passes through it. Its function is to provide nutrition to the sperms.

What is prostatitis ?

Prostatitis means that you have inflammation of your prostate gland. Prostatitis can present in short time duration with fever/chills (acute prostatitis) or can have persistent course (chronic prostatitis) and can have either infective or non-infective etiology.

What is meant by chronic prostatitis ?

Chronic prostatitis is the persistence of inflammation in the prostate for more than three months. It can be either infectious or non – infectious. Majority of patients have non infectious cause of chronic prostatitis and only 1 in 10 diagnosed having bacterial cause of infection. Read more about urinary tract infection at Urinary tract infection (UTI)

What are the symptoms of chronic prostatitis ?

Symptoms of chronic prostatitis are variable and include – Burning micturition (painful urination), pain in the penis, scrotum or suprapubic region, difficulty in initiating urinary stream, frequent urge of passing urine, poor urinary stream, sensation of having residual urine in bladder after passing urine, dribbling at the end of passing urine, pain while ejaculation or during orgasm etc. These symptoms may be very subtle in few patients but can be very annoying and bothersome in others, interfering in daily activities, work and sexual life. (Know the symptoms of enlarged prostate at BPH (Enlarged prostate) Symptoms)

How to make a diagnose of chronic prostatitis ?

Diagnosis of chronic prostatitis is made after detailed history and work up of the patient. Workup includes physical examination with digital rectal examination (DRE) to palpate the prostate and rule out any acute infection and laboratory tests such as urine examination and imaging with ultrasound to look for source of infection. EPS (Expressed prostatic secretions) which are drops of urethral discharge obtained after DRE and initial urine sample after DRE helps in ruling out any bacterial infection within prostate. Occasionally doctor may advice cystoscopy to look at urethra, prostate and bladder for any pathology. Read how to diagnose BPH at Prostate enlargement diagnosis

What is the treatment of chronic prostatitis ?

Lifestyle changes

Use of heating pad or sitz bath (soaking lower body half in warm water), limiting caffeinated products such as cold drinks, tea, coffee, cutting down alcohol intake, avoid spicy and acidic food, avoiding large amount of fluid intake at a time, avoid prolonged sitting, daily brisk walk for atleast 15 minutes, pelvic relaxation exercises etc helps in improving symptoms.

Medical treatment

  1. Alpha blocker – This medicine relax the bladder neck and prostate muscle fibers and helps in easing pain or voiding symptoms associated with chronic prostatitis.
  2. Antibiotics – Role of antibiotics are controversial when urine examination tests are normal, but use of antibiotics for 2-3 weeks (Doxycycline, fluoroquinolones) are often prescribed for any subclinical infection harboring in the prostate.
  3. Analgesics and Anti-inflammatory drugs – Painkillers and anti-inflammatory drugs (NSAIDs) helps reducing inflammation and reduces pain. Other neuropathic painkillers such as pregabalin helps in few patients.
  4. Muscle relaxants – These drugs helps in relaxing spasm of pelvic floor muscles.
  5. Prostatic massage – Prostatic massage helps reducing inflammation and reduces the symptoms of chronic prostatitis.

What is the prognosis of chronic prostatitis ?

Chronic prostatitis is poorly understood entity and its association with infection is subtle. Hence, this disease is very difficult to cure with many men do not respond to the therapy . Nonetheless, several potentially effective treatments are available. Your urologist may be able to help out in alleviation of symptoms associated with this disease.

Does chronic prostatitis increase the risk of prostate cancer ?

There is no evidence that chronic prostatitis increases the risk of developing prostate cancer. Read more about prostate cancer and its diagnosis at Prostate cancer

Urologist

8 tips to prevent recurrent kidney stone formation

Dr Varinder Attri
  1. Adequate fluid intake – Drinking plenty of oral liquids helps in reducing the chances of stone formation. It is estimated that nearly 50% of stone formations is due to less liquid intake. More concentrated urine leads to less dissolution of salts in it and thus leading to high chances of urinary stone formation. One should drink at least 2.5-3.0 litres of liquids per day so that the urine output remains nearly 2.0 litre/day. Citrate containing fluids such as orange and other citrus fruits decreases risks of stone formation.
  2. Calcium intake – Vitamin D deficiency often leads to excessive secretion of calcium in urine. Vitamin D supplementation along with calcium rich diet helps preventing renal stone formation. Calcium containing supplements should be taken along with the meals.
  3. Low salt intake – Avoiding excessive salt in the diet is beneficial and reduces the risk of calcium stone formation. Low salt in diet leads to less excretion of calcium in urine and hence less chances of calcium stone formation.
  4. Reduce body weight – Obesity with metabolic syndrome persons are prone to develop uric acid stones. Reducing body weight decreases the chances of uric acid stone formation.
  5. Avoid oxalate rich diet – Diet such as nuts, cashew, cocoa, chocolates, spinach, coffee, beet, rhubarb etc is rich in oxalate. Oxalate present in the food bind with the calcium in gut and does not get absorbed. Excessive oxalate gets reabsorbed in gut and get excreted in urine and increases chances of calcium oxalate stone formation. Avoiding such diet helps reducing the risk of these stone formation.
  6. Avoid excessive vitamin C intake – Excessive of vitamin C or its supplement increases the risk of stone formation. Other micronutrients such vitamin B6 helps reducing formation of stone.
  7. Get stone analysis – If someone has recently passed a stone or operated for stone disease, he/she should get the stone analysis done. It helps in knowing the composition of stone and hence doctor takes appropriate measures either with changes in food habits or starting some medicine, so as to decrease the chances of formation of stone disease.
  8. Prevent recurrent urinary tract infection – Recurrent urinary tract infection also leads to the formation of certain types of renal such as struvite stones. Preventing recurrent UTI helps decreasing the episodes of such types stone formation.
Andrologist, Uro-oncology, Urologist

Ten tips to improve urological health

Dr Varinder Attri
  1. Consume fluid intake of 2.5-3.0 litre/day in regular interval to maintain constant hydration.
  2. Drink cranberry juice to help prevent UTIs.
  3. Maintain weight in healthy range.
  4. Avoid smoking.
  5. Limit the intake of salt and caffeinated products.
  6. Empty your bladder before going to bed.
  7. Limit fluid intake 2-3 hours prior to sleep at night.
  8. Avoid prolonged holding of urine.
  9. Regular Kegal exercises to strengthen the pelvic floor muscles.
  10. Front -to- back direction cleaning of genitals in women to prevent UTIs.

Urologist

Urinary tract infection (UTI)

Dr Varinder Attri
  • A urinary tract infection (UTI) is an infection in any part of the urinary system — kidneys, ureters, bladder and urethra.
  • Most commonly it involves the bladder and urethra.
  • Kidney infections are more serious.
  • Women are affected more commonly than men. These infections are typically treated with antibiotics along with other surgical intervention if required.

Symptoms

  • Burning micturition
  • Frequent urination
  • Lower abdominal pain
  • Passing cloudy foul smelling urine
  • Persistent urge to pass urine
  • Passing blood in urine

UTI types

Organ involvedSymptoms
Kidney (acute pyelonephritis/renal abscess/pyonephrosis/emphysematous pyelonephritis)Flank pain on involved side
Fever with chills
Nausea
Vomiting
Tenderness on palpation
Bladder (cystitis)Lower abdominal pain
Frequent small volume urination
Burning micturition
Blood in urine
Prostate (Prostatitis/abscess)Fever with chills
Burning micturition
Pus in urine
Urethra (Urethritis)Pus discharge
Burning micturition

Causes of UTI

  • Main portal of microbial entry causing UTI is through the urethra.
  • Kidney infections sometimes occur secondary to bloodstream infections.
  • Women are more prone to infections due to close proximity of urethra to anus and short urethra length.

Risk factors leading to UTI

  • Chronic indwelling catheter
  • Poorly controlled diabetes mellitus
  • Women gender
  • Urinary tract abnormality
  • Any recent urological surgery
  • Stone disease

Prevention

  • Daily fluid intake of 2.5-3.0 litre.
  • Drinking cranberry juice prevents UTI.
  • After passing urine or bowel movement, women should clean from front to back.
  • Empty the bladder after intercourse.
  • Person developing infection after sexual intercourse should use barrier method.

Diagnosis

  • Urine routine test
  • Urine culture and sensitivity test- this test tells us which bacteria is causing the infection and which medicine will be most appropriate for that bacterial infection.
  • Imaging test in form of Ultrasound/CT scan as per need.
  • Cystoscopy – in case of recurrent UTI of lower tract (bladder, urethra), to look for the source of infection. 

Treatment

  • Antibiotics are mainstay of treatment for urinary tract infections.
  • Simple uncomplicated infections such as urethritis, cystitis are usually treated with oral antibiotics such as fosfomycin, cephalexin trimethoprim/sulfamethoxazole etc. Other supportive medicines for burning and frequent urination are often prescribed.
  • For complicated infections such as acute pyelonephritis, renal abscess, emphysematous pyelonephritis, hospitalisation intravenous antibiotics are often required. 
  • Surgical intervention such as pus drainage with pigtail, DJ stent placement in kidneys etc may be required. 

Recurrent infections

  • Low dose long term oral antibiotic may be required.
  • Single dose oral antibiotic after sexual intercourse, if your infections seems to related to sexual activity.
  • Vaginal estrogens in postmenopausal women.