Differential diagnosis for CPPS?

Male pelvic pain, prostatitis, IC
Hacksquat
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Differential diagnosis for CPPS?

Post by Hacksquat »

Hi!

Before I make the step of going abroad (Scotland/Bill Taylor and possibly in the future Sebastopol) for diagnosis of chronic prostatitis / chronic pelvic pain syndrome (and trigger points), I have decided to give the MD´s one more shot...

1. What specialists should I see for proper differential diagnosis?

I´ve only been to a urologist (ruled out prostatitis, no inflammation. Also did cysoscopy) and a general practitioner. Next week I´m going to see my gp again, and I plan on having him send me to a neurologist as well as an endocrinologist (see my post in this thread: viewtopic.php?t=551). Maybe even a psychiatrist, to see if we can diagnose my anxiety issues.

2. What are the common disorders typically mistaken for CPPS?

3. What tests should I request from the neurologist?

4. Is it common for symptoms to take turn?

I have had most of the typical chronic prostatitis / chronic pelvic pain syndrome symptoms since last december, but they are not all present at the same time. The frequency and penile/pubic/urethral discomfort/burning is most common, but some weeks this symptom is almost gone and instead I have incomplete bowel movements and what seem to be a tight levator ani. Then all of a sudden this is gone again and my original symptoms are back... I´ve had some pain in one of my testicles as well, only for a couple of weeks though.

5. What type of wand do you use for internal massage? I have kind of short fingers and only reach a couple of centimetres inside. I don´t know what I´m doing inside there anyway, but hey, at least I´m trying... :)

Thanks for any answers!
Age: 41 Onset Age: 27 (dec 2006)Symptoms: Urethral burning, muscular pain and soreness around the base of my penis, perineum and muscles around my sitbones. Frequency, urgency, dribbling, general discomfort in the pelvis, decreased libido, tight levator ani (according to PT) and occasional levator- and sphincter spasms. Sometimes ache in penis, especially when erected. Latest addition is testicular pain (and epididymis). Also excretions of clear (prostatic?) fluid throughout the day as well as secretion in my urine. Varying power of urine stream. Redness on tip of penis and ballsack.Helped By: Positive thinking and controlling anxiety Worsened By: Stress, lack of sleep, heavy training (especially abs and legs), catastrophizing over this condition
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Hacksquat
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Post by Hacksquat »

Found an answer to question nr 5:
viewtopic.php?t=5002
Age: 41 Onset Age: 27 (dec 2006)Symptoms: Urethral burning, muscular pain and soreness around the base of my penis, perineum and muscles around my sitbones. Frequency, urgency, dribbling, general discomfort in the pelvis, decreased libido, tight levator ani (according to PT) and occasional levator- and sphincter spasms. Sometimes ache in penis, especially when erected. Latest addition is testicular pain (and epididymis). Also excretions of clear (prostatic?) fluid throughout the day as well as secretion in my urine. Varying power of urine stream. Redness on tip of penis and ballsack.Helped By: Positive thinking and controlling anxiety Worsened By: Stress, lack of sleep, heavy training (especially abs and legs), catastrophizing over this condition
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rider fan
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Post by rider fan »

Before you spend any amount of money on a trip you should spend $30 and read AHIP. It has the answers to most of your questions.
Age: 32 | Symptoms: Twingy pain/muscle spasms in groin area (gone), tingling sensation at tip of penis (has resolved as of now), urinary frequency (resolved as of now), thicker/decreased amount of semen (resolved as of now). Makes better: Stretching, Relaxing pelvic muscles, moment to moment relaxation, not sitting with legs crossed, Elavil, quercetin. Makes worse: Sitting, stress, more than one orgasm/day, constipation, manual labour
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webslave
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Post by webslave »

Hacksquat, your symptoms are so typical that seeing a lot of specialists is just a waste of money. If a urologist has diagnosed you with CPPS, move on to the next stages.
Last edited by webslave on Sun Nov 11, 2007 5:49 am, edited 1 time in total.
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kevin
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Post by kevin »

Differential diagnosis depends on your exact symptoms. If you had voiding dysfunction/LUTS, I would recommend that you get worked up by a urodynamics expert, but your symptoms sound like they're related to the pelvic floor.

I don't think it will be that helpful to see a neurologist/endocrinologist if you don't have clear indications for doing so (e.g. you have tingling or twitching sensations in your body, or some known endocrine issue).
Started: Spring 2003; high urinary frequency and pain associated with bladder filling; urinary hesitancy; pubic/prostate/perineal discomfort; Helped by: trigger point therapy, Afrin nasal spray, Cymbalta, hydrocodone (small doses), distraction. Makes worse: sex.

Not medical advice. Consult your doctor.
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Hacksquat
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Post by Hacksquat »

rider fan: I have read HITP, I´m doing all the stretches and also trying relaxation. The trigger point part is harder though, as I don´t have any skilled PT nearby. Trying to press around myself, but I don´t seem to find anything... except for some tender spots in my lower abdomen that helped me get the testicular pain away.

webslave: I haven´t been diagnosed with chronic prostatitis / chronic pelvic pain syndrome by anyone but myself... the urologist kind of just dismissed me and said there´s not much more he could do :-( I then went to an MD specializing in pain, who did mention the term myoneuropathy for me, which had me on the internet searching. That´s what lead me to HITP and this site. I would like to have some sort of proof that intrarectal trigger points actually are part of the problem before I spend lots of money going to Scotland. Haven´t been able to find any tender spots yet. Going just for the day to see Bill for a 2-hour session would cost me like $700 . Damn those expensive flights!

kevin: I actually have had some tingling/burning and discomfort in my inner thighs and feet as well, but these symptoms seem to coincide with my bad days of pelvic pain, so I thought it was the pelvic nerves causing this as well.
Age: 41 Onset Age: 27 (dec 2006)Symptoms: Urethral burning, muscular pain and soreness around the base of my penis, perineum and muscles around my sitbones. Frequency, urgency, dribbling, general discomfort in the pelvis, decreased libido, tight levator ani (according to PT) and occasional levator- and sphincter spasms. Sometimes ache in penis, especially when erected. Latest addition is testicular pain (and epididymis). Also excretions of clear (prostatic?) fluid throughout the day as well as secretion in my urine. Varying power of urine stream. Redness on tip of penis and ballsack.Helped By: Positive thinking and controlling anxiety Worsened By: Stress, lack of sleep, heavy training (especially abs and legs), catastrophizing over this condition
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Post by carld »

Do you have anxiety or panic attacks? Do you have above normal amounts of stress prior to onset? If yes to any of these questions, then I believe you are dealing with classic CP/CPPS. Go from there and go see Bill Taylor and have him check your pelvic floor. I bet He finds tight muscles and some TP's as well.
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Age, 44 onset age 37 Feb 2006 Freq. need to urinate. Sensation of having to urinate soon after going. Perineum discomfort/burning/tightness, pubic area discomfort @ times,poor urine stream, post urine dripping/spray. All symptoms have improved with my protocol. At the worst I give it a 1 to 2 on irritation and discomfort and frequency. Helps: Elavil 5mg for anxiety and mast cell protection, (will only take it as needed) self internal PT as needed, stretching, walking, stairmaster cardio workout and light weights, reducing stress, moment to moment relaxation, deep breathing relaxation and using a Theracane. Makes worse: sitting for long periods, stress, over focusing on it. Currently 95%-98% recovered. Stay positive, relaxed and control your anxiety.
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Hacksquat
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Post by Hacksquat »

I do have anxiety issues, not panic, but more like gnawing anxiety that can last for hours at a time, sometimes a whole day. Mostly I have these anxiety issues in the morning and by the evening I am more relaxed, especially after a workout. I often feel this anxiety immediately when I wake up, then it vanishes sometimes midday. I am also very prone to stress :-( Weird thing is I don´t have a hard time falling asleep in the evening, by that time I´m almost always relaxed.

I went to my gp yesterday, and he thought testosterone supplementation could be a solution, given I have a bad libido as well as these anxiety problems. I will have to see an endocrinologist to get this prescription though.
Age: 41 Onset Age: 27 (dec 2006)Symptoms: Urethral burning, muscular pain and soreness around the base of my penis, perineum and muscles around my sitbones. Frequency, urgency, dribbling, general discomfort in the pelvis, decreased libido, tight levator ani (according to PT) and occasional levator- and sphincter spasms. Sometimes ache in penis, especially when erected. Latest addition is testicular pain (and epididymis). Also excretions of clear (prostatic?) fluid throughout the day as well as secretion in my urine. Varying power of urine stream. Redness on tip of penis and ballsack.Helped By: Positive thinking and controlling anxiety Worsened By: Stress, lack of sleep, heavy training (especially abs and legs), catastrophizing over this condition
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