Pain just above the genitals in men usually raises the concern about bladder or prostate problems. In young boys and male teens, prostate problems are usually not a consideration. However, prostate problems can arise in late teens with recent studies noting an increase in prostate cancer among teen males. In younger males, pain above the genitals is more likely associated with the bladder.
With older males, either prostate or bladder problems can be the cause of pain in this region. The bladder lies above the prostate. Therefore bladder pain is typically felt slightly higher than prostate pain. Most of the time this can be difficult to isolate and prostate problems can only be differentiated from bladder problems after conducting diagnostic investigations. Even other symptoms may also be similar in both bladder and prostate problems.
What is prostate pain?
Prostatodynia is the medical term for prostate pain. It may also include other sensations like prostate discomfort and is a sign of prostate problems. Pain and 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 exacerbation and a secondary prostate gland infection.
Type of Prostate Pain
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.
The description of the location of the pain may seem vague and sometimes be reported as :
- Bladder pain
- Rectal pain
- Groin pain
- Pelvic pain
- Coccyx pain (tail bone)
- Lower back pain
- Testicular pain
Other 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 urination (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 dysfunction, fever and unintentional weight loss may be seen in more severe prostate conditions and requires immediate medical investigation.
Causes of Prostate Pain
There are three main conditions that are responsible for prostate pain. This includes benign prostatitis hyperplasia (BPH), prostatitis or prostate cancer. Some are serious and potentially life threatening. However, the more common causes are not serious and can be easily treated and properly managed.
Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland. This is a non-cancerous (benign) enlargement that starts after the age of 40 years but is non-symptomatic in the early stages. Most of the time prostatitis is missed in the early stages. It affects almost half of all men in their fifties which is an age group where it tends to becomes symptomatic.
Prostatitis is inflammation of the prostate gland. It mainly occurs due to an infection of the prostate and most of the time these are sexually transmitted infections. However, prostatitis may also occur with other infections that are not sexually transmitted and may even be caused by non-infectious factors. Prostatitis is usually acute but can sometimes be chronic.
Prostate cancer is where a malignant tumor (cancer) develops in the prostate gland. It is the most serious prostate condition. Not only can it destroy the prostate gland but it can also spread to neighboring and distant sites. Prostate cancer can be fatal. Sometimes a cancer may develop elsewhere in the body and spread to the prostate (metastasis) and this can also cause prostate pain.
Prostate Pain Tests
Pain is a symptom which may be accompanied by other symptoms like difficulty urinating, groin pain and blood in the urine or urethral discharge. The exact cause of prostate pain needs to be diagnosed and treated in order for the pain to resolve. Various diagnostic investigations may be necessary to identify the exact cause. It is therefore important to consult with a medical professional like a specialist urologist about suspected prostate problems.
Apart from a digital rectal examination, other tests like a PSA (prostate-specific antigen) blood test and pelvic ultrasound are commonly performed for prostate pain. Depending on individual cases, a biopsy may be done to examine a tissue sample under a microscope. Scans like a MRI (magnetic resonance imaging( may also be considered for diagnosing prostate pain.