Adult Version: Perineal Discomfort from Prolonged Sitting, Urethral Discharge, and the Cure of Prostatitis

61. Why do I feel discomfort in my perineum after sitting for a long time?

Male office workers are the group most prone to prolonged sitting, spending long hours in the office with very little physical activity. Many in this group experience discomfort in the perineal area.

Prolonged sitting can cause poor ventilation in the lower body, affecting blood circulation and leading to blockage of the prostate ducts and impaired drainage of prostatic fluid. This results in chronic congestion of the prostate and prostatitis. Sitting in a soft car seat, in particular, causes the buttocks to sink deeply, compressing the scrotum and hindering venous return. This obstructs microcirculation of blood in the genital area, making prostatitis more likely. In severe cases, it can also cause varicocele, testicular descent, and dull pain in the lower abdomen. Furthermore, prostatitis is very prone to recurrence. Being in this state for a long time can cause neurasthenia, general weakness, frequent urination, and incomplete urination, seriously affecting quality of life.

Prolonged sitting and lack of exercise can lead to erectile dysfunction. Long-term discomfort in the lower back and perineum can cause psychological stress in men, leading to concerns about their sexual function. These psychological factors can decrease libido and cause sexual dysfunction. Furthermore, patients with prostatitis are prone to prostate infections, and prostate congestion during sexual arousal can worsen local pain, causing premature ejaculation and painful ejaculation, thus creating a fear of sexual activity.

Prolonged sitting can also hinder the excretion of harmful substances produced by testicular metabolism. The accumulation of these harmful substances reduces testosterone secretion, leading to sexual dysfunction, male infertility, and even testicular necrosis. It is understood that men who exercise regularly are only half as likely to experience erectile dysfunction as men who habitually sit for long periods.

**62. Does the discharge of mucus from the urethra during defecation require treatment?**

Some young men frequently experience a white or semi-transparent mucus discharge from their urethra during defecation, which often causes them great anxiety, wondering if they have contracted a sexually transmitted disease or are experiencing nocturnal emission. What exactly is going on?

This symptom is called "white discharge," which is a sign of chronic prostatitis. The white discharge is prostatic fluid.

In men, the urethra serves as the common passage for urination and ejaculation. During defecation, the rectum, which is directly connected to the anus, lies in front of the seminal vesicles and prostate. Strong peristalsis occurs during defecation, and the pressure and friction from the passing feces on the intestinal walls causes some of the secretions accumulated in the seminal vesicles and prostate to be squeezed into the urethra and drip out. During urination, increased abdominal pressure causes the muscles of the perineum and bladder sphincter to contract, compressing the prostate and causing prostatic fluid to drip from the urethra.

So, does "white discharge" require treatment?

Nearly 50% of men will experience symptoms of chronic prostatitis at some point in their lives. Of these, 90% of chronic prostatitis cases are not caused by pathogens but by chemical inflammation. In other words, most cases of chronic prostatitis are not caused by bacterial or viral infections. Therefore, the best treatment for these patients is lifestyle management, primarily including: ① Dietary considerations: Avoid alcohol and spicy foods. ② Regular lifestyle: Avoid prolonged sitting, exercise regularly, avoid staying up late, and maintain a regular lifestyle (including sexual activity). Of course, treatment can also be achieved through physical therapy (such as hot sitz baths to promote local blood circulation) and medication (to regulate prostatic fluid secretion). A small percentage of chronic prostatitis cases involving pathogen infection require antibiotic treatment.

Therefore, the discovery of "white discharge" should not be ignored, but there is no need to be overly nervous. It is necessary to go to a regular hospital for examination and targeted treatment.

**63. Can prostatitis be "cured completely"?**

With the popularization of medical and health knowledge, prostatitis has gradually become known to the public. However, prostatitis is currently perceived as an incurable chronic disease, much like diabetes and hypertension. Is this really the case?

Prostatitis is an inflammation of the prostate gland caused by a variety of complex factors and triggers. Clinically, it is mainly characterized by urethral irritation symptoms and chronic pelvic pain. The classification of prostatitis is very important, as the treatments for different types are completely different. The latest classification of prostatitis includes four types: Type I: Acute bacterial prostatitis; Type II: Chronic bacterial prostatitis; Type III: Chronic prostatitis and chronic pelvic pain syndrome, which is the most common type of prostatitis, accounting for more than 90% of chronic prostatitis cases; Type IV: Asymptomatic prostatitis, with no subjective symptoms, and evidence of inflammation is only found during examinations related to the prostate.

Antibiotic treatment for type I prostatitis is both necessary and urgent. Intravenous antibiotics should be administered initially, followed by oral medications once symptoms such as fever improve. The course of treatment should be at least 4 weeks.

Type II and Type III: (1) General treatment: Health education, psychological and behavioral counseling have a positive effect. Patients should abstain from alcohol and avoid spicy and irritating foods; avoid holding urine and sitting for long periods of time, pay attention to keeping warm, and strengthen physical exercise. (2) Drug treatment: The most commonly used drugs are antibiotics, alpha-receptor blockers, herbal preparations, and non-steroidal anti-inflammatory analgesics. Other drugs also have varying degrees of efficacy in relieving symptoms. (3) Other treatments: Prostate massage: Prostate massage can promote the emptying of prostate ducts and increase the local drug concentration, thereby relieving the symptoms of patients with chronic prostatitis. It must be pointed out that this method is contraindicated for patients with type I prostatitis. Heat therapy: It mainly utilizes the heat effect produced by various physical means to increase blood circulation in prostate tissue, accelerate metabolism, and is beneficial for anti-inflammatory and tissue edema elimination, relieving pelvic floor muscle spasms, etc. It has a certain symptom-relieving effect in the short term, but the long-term effect is unclear. It is not recommended for unmarried and childless individuals.

Type IV generally does not require treatment. However, if the patient also has elevated serum PSA levels or infertility, differential diagnosis should be considered and appropriate treatment should be administered.

The perception that prostatitis is incurable stems from the belief that inflammation can be cured simply by taking antibiotics, but this often fails to achieve a complete cure. In fact, the first step in treating prostatitis is to accurately identify its subtype. Only by clearly diagnosing and classifying prostatitis and taking appropriate measures can it be completely eradicated.