Pelvic pain, discomfort when urinating, or the feeling that your bladder is not completely empty can be frustrating—especially when these problems keep coming back.
For some men, these symptoms may be related to prostatitis. When pelvic pain and urinary problems continue without a clear bacterial infection, doctors may consider chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).
Treatment depends on the cause. For some men with long-lasting symptoms, extracorporeal shockwave therapy (ESWT) may be considered as a non-surgical treatment option.
What Does Prostatitis Feel Like?
Prostatitis can cause more than just trouble urinating. Some men mainly experience pelvic pain, while others notice changes in their urine flow. Common symptoms include:
- Pain or pressure in the lower abdomen or pelvis
- Pain between the scrotum and anus
- Burning or discomfort when urinating
- Frequent or urgent urination
- A weak urine stream
- Feeling that the bladder has not emptied completely
- Pain during or after ejaculation
These symptoms can also occur with a urinary tract infection (UTI), urinary stones, an enlarged prostate, or other urinary conditions.
How Is Prostatitis Checked?
The first step is usually to check whether an infection is present and understand how your symptoms affect urination.
A urine test can look for signs of infection, blood, or other abnormalities.
Depending on your symptoms, a doctor may also check the prostate, see whether urine remains in the bladder after you urinate, or measure how well your urine flows.
This helps distinguish bacterial prostatitis from chronic pelvic pain and other conditions that can cause similar symptoms. Pelvic pain or urinary discomfort that keeps coming back?
A urologic evaluation can help identify possible causes and determine which treatment may be appropriate for you.
How Is Chronic Prostatitis Treated?
There is no single treatment that works for everyone. Antibiotics may be used when a bacterial infection is found or strongly suspected. Other treatments may focus on pain, urinary problems, or tight pelvic floor muscles.
Warm sitz baths, taking breaks from long periods of sitting, and avoiding activities that clearly make the pain worse may also help some men. If pain and urinary problems continue after initial treatment, additional treatment options may be considered.
What Is ESWT for Chronic Prostatitis?
Extracorporeal shockwave therapy (ESWT) is a non-surgical treatment that sends low-energy shockwaves to the treatment area from outside the body.
For chronic prostatitis or CP/CPPS, low-intensity shockwaves may be applied around the perineum—the area between the scrotum and anus. Studies suggest that ESWT may help reduce pelvic pain and improve related symptoms in some men with CP/CPPS.
ESWT is not the same as shockwave treatment for urinary stones. Shockwave lithotripsy is designed to break stones, while low-intensity ESWT for chronic pelvic pain has a different purpose and treatment approach.
ESWT does not replace treatment for an active infection or another underlying urinary problem. It may be considered for selected patients whose pelvic pain continues despite initial treatment.
What About Shockwave Therapy for Erectile Dysfunction?
Low-intensity shockwave therapy has also been studied for erectile dysfunction (ED), especially when poor blood flow is thought to be one of the causes.
| Condition | Main Goal |
|---|---|
| Chronic prostatitis / CP/CPPS | Help reduce pelvic pain and related symptoms |
| Erectile dysfunction | Improve erectile function in selected patients |
ED can have many causes, so the underlying problem should be evaluated before deciding whether shockwave therapy is appropriate.
When Should You See a Urologist?
Consider seeing a urologist if pelvic pain keeps coming back or you also have painful urination, painful ejaculation, frequent urination, or a weak urine stream.
Seek medical care promptly if you have:
- Fever or chills
- Blood in your urine
- Severe pelvic, side, or back pain
- Difficulty urinating or an inability to urinate
These symptoms may point to an infection or another urinary problem that needs prompt evaluation.
Chronic Pelvic Pain Keeps Coming Back?
If previous treatment helped only for a short time, the next step is not necessarily a stronger treatment. It is important to check for infection, changes in urination, and other possible causes of pelvic pain first.
For some men with long-lasting symptoms, ESWT may then be discussed as one of several non-surgical treatment options.
Frequently Asked Questions
Q1. Do I always need antibiotics for prostatitis?
No. Antibiotics are used when a bacterial infection is found or strongly suspected. Chronic pelvic pain without a clear infection may require a different approach.
Q2. Can sitting make prostatitis symptoms worse?
Yes, for some men. Long periods of sitting can make pelvic or perineal discomfort worse. Taking regular breaks may help.
Q3. How many ESWT sessions will I need?
There is no single number for everyone. The treatment schedule depends on your symptoms and how you respond to treatment.
Q4. Is ESWT surgery?
No. ESWT is a non-surgical treatment that delivers shockwaves from outside the body.
Still Having Prostate or Pelvic Symptoms?
Gangnam St. Mary's Urology Clinic in Seoul provides evaluation and treatment for prostate, pelvic, and urinary problems. English medical communication is available for international patients.
Treatment recommendations depend on your individual symptoms, examination, and test results.