1.i am 23 year old i have gone through right inguinal hernia surgery in right side 1.5 years ago 2.when full urgency of urine i need to exert force to complete urination 3.getting up 2 times in midnight during sleep to urination 4.dull aching pain in perinium especially after urination
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I now have comprehensive information from Campbell-Walsh Wein Urology to give you a detailed, evidence-based answer.
Your Symptoms - A Clinical Analysis
Disclaimer: This is educational information only, not a diagnosis or treatment plan. Please see a urologist for a proper evaluation.
Most Likely Diagnosis: Chronic Prostatitis / Chronic Pelvic Pain Syndrome (CP/CPPS)
Your four symptoms together form a classic picture of CP/CPPS (NIH Category III), which is actually the most common urologic diagnosis in men under 50.
| Your Symptom | Clinical Correlation |
|---|---|
| Need to strain/force during urination | Obstructive voiding symptoms - pelvic floor muscle tension compresses the urethra |
| Waking up twice at night to urinate (nocturia x2) | Bladder hypersensitivity / incomplete bladder emptying |
| Dull aching pain in the perineum after urination | Classic CP/CPPS - perineal pain is the most common pain site (63.3% of cases) |
| Age 23, prior right inguinal hernia repair | Pelvic/groin surgery can irritate pelvic floor muscles and nerves |
According to Campbell-Walsh Wein Urology (p. 1536), the most frequent site of pain in CP/CPPS is the perineum, and pain after urination is one of the hallmark features distinguishing this from conditions like BPH (which typically affects older men).
Why the Hernia Repair Is Relevant
Your right inguinal hernia surgery 1.5 years ago is worth mentioning to your urologist. The inguinal region shares nerve supply with the pelvic floor (ilioinguinal, genitofemoral nerves). Post-surgical nerve irritation or mesh effects can contribute to:
- Pelvic floor muscle guarding/tightness
- Referred perineal discomfort
- Voiding dysfunction via altered pelvic floor muscle coordination
This does not mean your surgery caused CP/CPPS - but the timing (symptoms appearing after surgery) is clinically relevant information.
What the Evaluation Should Include
Your urologist will likely order (per Campbell-Walsh Wein Urology evaluation guidelines, p. 1568):
Mandatory:
- Urinalysis and urine culture (to rule out infection/UTI)
- Full history of pelvic pain: location, timing, severity
- Neurologic review: any back pain, leg numbness
Recommended:
- NIH Chronic Prostatitis Symptom Index (NIH-CPSI) scoring
- Two-glass urine test (pre and post prostate massage)
- Urine flow rate test
- Post-void residual urine ultrasound (to check if bladder is emptying fully)
- STD screening (urine NAAT) given your age
Possibly:
- Transrectal ultrasound of the prostate
- Urodynamics if voiding symptoms don't respond to treatment
- PSA (though less relevant at 23)
Treatment Options
Treatment works best when multimodal - targeting your specific symptom cluster. The UPOINT system (Urinary, Psychosocial, Organ-specific, Infection, Neurologic, and Tenderness) guides therapy.
1. Alpha-blockers (best evidence for voiding symptoms)
Drugs like tamsulosin (0.4 mg/day) or silodosin relax the bladder neck and prostate smooth muscle - directly helping with the straining and incomplete emptying you describe. Meta-analyses show the combination of antibiotics + alpha-blockers gives the greatest symptom reduction (decrease of ~13.8 points on the NIH-CPSI scale vs placebo).
2. Short course of antibiotics (fluoroquinolones)
A 4-6 week course of levofloxacin or ciprofloxacin is often tried first, especially in men with shorter symptom duration (like you - 1.5 years or less since hernia surgery). Fluoroquinolones also have anti-inflammatory effects (reduce IL-6 and TNF-alpha in prostate tissue).
3. Pelvic floor physical therapy
This is particularly relevant given your prior pelvic/groin surgery. A physiotherapist trained in pelvic floor therapy can release muscle tension that contributes to both the voiding difficulty and perineal pain. Studies support myofascial release for CP/CPPS.
4. Anti-inflammatory drugs (NSAIDs)
Celecoxib and other NSAIDs have shown benefit in clinical trials for pain reduction in CP/CPPS.
5. Lifestyle modifications
- Avoid prolonged sitting (especially on hard surfaces)
- Avoid caffeine, alcohol, spicy food (bladder irritants)
- Warm sitz baths can relieve perineal pain
- Regular moderate exercise
Other Diagnoses to Rule Out
Your doctor will also consider:
- Interstitial cystitis (IC/PBS) - bladder hypersensitivity; 42% of CP/CPPS patients in the NIH MAPP study also met IC criteria
- Urethral stricture - can cause straining; relevant given prior pelvic surgery
- Bladder outlet obstruction - uncommon at 23 but checked via flow rate/post-void residual
- Sexually transmitted infection - chlamydia/gonorrhea can cause similar symptoms
Key Takeaway
At 23 years old, with perineal pain (especially after urination), obstructive voiding, and nocturia - this is almost certainly CP/CPPS (Category IIIb - non-inflammatory, or IIIa - inflammatory depending on urine findings). It is treatable, and most men improve significantly with the right combination of alpha-blockers, targeted physiotherapy, and anti-inflammatory treatment.
Please see a urologist soon. A recent 2025 AUA Practice Guideline (Lai et al., J Urol 2025) on Male Chronic Pelvic Pain now provides updated, evidence-based management steps your doctor can follow.
- Campbell-Walsh Wein Urology, pp. 1536-1572
- Lai HH et al. AUA Guideline: Male Chronic Pelvic Pain. J Urol. 2025 Aug. [PMID: 40243110]
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