Lower urinary tract symptoms – obstructive and irritative
Pelvic, groin, perineal pain, rectal and low back pain. Pain after ejaculation.
Exposure to sexually transmitted disease, eg Chlamydia and gonorrhoea.
MSU urine test and possible testing for chlamydia and gonorrhoea
Be wary of PSA levels taken during inflammatory flares as artefactual elevation may occur.
Post prostatic massage urine collection for microscopy and culture, looking for pus cells and organisms.
Unfortunately it is usually only of limited usefulness.
Ultrasound urinary tract and post void residuals.
Targeted at symptomatic relief.
Education, reassurance and lifestyle modification.
Stress relief, dietary modification – avoidance of alcohol, caffeine, spicy food, carbonated drinks and acidic drinks.
trial for 2 to 4 weeks Keflex 500mg four times daily
Trimethoprim 300mg daily
Ciprofloxacin 500mg bd
Norfloxacin 400mg bd
Doxycycline 100 mg daily for 3 weeks.
Doxyclycline is used less often. Ciprofloxacin has been associated with skin reactions and tendonitis and very rare neurological side effects.
Other agents such as metronidazole, which may be trialled to target rare and controversial infective aetiologies ( i.e. they are not easily able to be cultured ) such as trichomonas vaginalis and urealasma urealyticum.
Tamsulosin ( Flomaxtra 1 mane after food ) or 1-2 Prazosin daily ( starting at 0.5mg bd and titrated to minimize effects on blood pressure.)
Non steroidal anti-inflammatories such as nurofen and voltaren
After warning of GI side effects.
Saw palmetto, extract of the berry of the American Dwarf palm.
Ejaculation or prostatic massage.
Mucolytic agents such as Bisolvon.
Chronic pain team referral
Pelvic floor physio for investigation of trigger point treatment
For patients with debilitating symptoms which fail all above interventions.