Prostate pain (prostatodynia) or discomfort may be seen in all three of the main conditions affecting the prostate gland – prostatitis, benign prostatic hyperplasia (BPH) and prostate cancer. The pain may vary in severity and nature radiating to surrounding structures and extending to the lower back or even the tip of the penis.
At times, prostate pain may involve a large area of the lower abdomen or the entire pelvis. It is not uncommon for no pain to be present, especially in mild BPH and chronic prostatitis, with discomfort or pain only being reported during acute exacerbations and a secondary prostate gland infection.
Prostate pain can be non-specific and often associated with chronic unexplained pelvic pain in men (chronic pelvic pain syndrome). The presence of urinary symptoms, microorganisms and inflammatory cells in the urine and semen are the only conclusive indication that the pain is associated with the prostate gland.
Prostate pain is often described as discomfort or pain that lies deep to (behind) the penis and scrotum although most patients will report that it is not extending to the rectum. The character of the pain can vary significantly with some patients reporting a mild discomfort like the bladder (or even rectum) is not completely empty – pressure or fullness but not actual pain.
At other times, it may be described as a dull ache or pain that is mild, moderate or severe. The pain may be burning, attacks of sharp or stabbing pain, or a bursting pain similar to an extremely distended bladder. Identifying a prostate condition solely on the location and nature of the pain is difficult and therefore other symptoms have to be noted.
Prostate Pain Location
While pain may be felt throughout the pelvis and perineum, the close relationship to surrounding structures may help to identify the pain.
The prostate gland lies :
- Below the bladder
- Above the levator ani muscles
- Behind the pubic symphysis of the pelvic girdle
- Front of the rectum
Picture from CDC.gov
The description of the location of the pain may seem vague and sometimes be reported as :
- Bladder pain
- Rectal pain
- Groin pain
- Pelvic pain
- Coccygeal pain (coccyx ~ tail bone)
- Lower back pain
- Testicular pain
Prostate Symptoms with Prostate Pain
Pain is not always present with every prostate problem and at times the condition may be silent (asymptomatic). The most common symptoms reported along with prostate pain are urinary pain and a number of urinary problems. The presence of the following signs or symptoms may be a better indication of prostate pathology.
- Pain upon urination, including burning (dysuria)
- Difficulty urinating
- Frequent urination and even awaking at night to urination (nocturia)
- Straining to urinate
- Sensation that bladder is not empty/urination incomplete (vesical tenesmus)
- Urgency to urinate
- Painful ejaculation
- Post micturition dribble
- Blood in the urine (hematuria)
- Blood in the semen (hematospermia)
Erectile dyfunction, fever, unintentional weight loss and swelling of the legs with decreased urine output may be seen in more severe prostate conditions and requires immediate medical investigation.