Is prostatitis PNE or vice versa?

[garyholc]

Just been laid in the bath reading my HITP book again, particularly the rear of the book with peoples accounts and read a few who were diagnosed with possible PNE. I just read a few sites about PNE and the symptoms and it is exactly the same as prostatitis. I just wondered if there are any significant signs that PNE is different to prostatits or if indeed PNE is prostatitis. There seems to be little difference between the two.

I am assuming if you have PNE then the pain would not be alleviated by TP release, but then reading an article written by Dr Wise, it would appear that perhaps TP can actually help. It also says that PNE is something that gets worse with time and may come on gradually or suddenly, again, the same as PNE. Infact, given everything I know about chronic prostatitis / chronic pelvic pain syndrome etc. I wonder if PNE actually exists......

This is one of the articles I found particularly interesting :

http://www.jmweissmd.com/PDF/Pudendal%2 ... staken.pdf

[webslave]

You won't find PNE in any mainstream medical textbook. It still belongs in journals like "Medical Hypotheses". Only one study on PNE has made it into the top journal Urology, so I'll quote it in full (with emphasis added to key phrases by me):

Urology. 2005 Nov;66(5):949-52.
Anatomy of pudendal nerve at urogenital diaphragm--new critical site for nerve entrapment.
Hruby S, Ebmer J, Dellon AL, Aszmann OC.
Department of Surgery, Danube Hospital, Vienna, Austria.

OBJECTIVES: To investigate the relations of the pudendal nerve in this complex anatomic region and determine possible entrapment sites that are accessible for surgical decompression. Entrapment neuropathies of the pudendal nerve are an uncommon and, therefore, often overlooked or misdiagnosed clinical entity. The detailed relations of this nerve as it exits the pelvis through the urogenital diaphragm and enters the mobile part of the penis have not yet been studied. METHODS: Detailed anatomic dissections were performed in 10 formalin preserved hemipelves under 3.5x loupe magnification. The pudendal nerve was dissected from the entrance into the Alcock canal to the dorsum of the penis. The branching pattern of the nerve and its topographic relationship were recorded and photographs taken. RESULTS: The anatomic dissections revealed that the pudendal nerve passes through a tight osteofibrotic canal just distal to the urogenital diaphragm at the entrance to the base of the penis. This canal is, in part, formed by the inferior ramus of the pubic bone, the suspensory ligament of the penis, and the ischiocavernous body. In two specimens, a fusiform pseudoneuromatous thickening was found. CONCLUSIONS: The pudendal nerve is susceptible to compression at the passage from the Alcock canal to the dorsum of the penis. Individuals exposed to repetitive mechanical irritation in this region are especially endangered. Diabetic patients with peripheral neuropathy can have additional compression neuropathy with decreased penile sensibility and will benefit from decompression of the pudendal nerve.

PMID: 16286101 [PubMed - indexed for MEDLINE]

This study only looks at pudendal compression in the Alcock's canal in the perineum, whereas the promoters of PNE surgery claim the nerve is compressed here, and even more frequently at another site, viz. where the pudendal nerve passes under the sacrospinal ligament where it attaches to the ischial spine (higher up than the pudendal canal).

PNE is too often confused with chronic prostatitis / chronic pelvic pain syndrome by patients desperate for a quick surgical fix. It's disturbing and disappointing that the PNE forums on the internet are as busy or busier than this forum. Men have moved from "I have an infection" to "I have a compressed nerve". What's the common thread here? You got it — a quick fix is promised in both scenarios.

PNE surgery is a financially rewarding surgical solution to the difficult problem of chronic pelvic pain and has attracted a small following of surgeons.

Do you have increased pain after ejaculation? Then you cannot have "PNE". Do you have any symptoms outside the exact area of the pudendal nerve? Then you cannot have "PNE".

In every study on PNE that I read, symptoms are defined a bit differently. Take this one:

Perineodynia (vulvodynia, perineal pain, proctalgia), anal and urinary incontinence are the main symptoms of the pudendal canal syndrome (PCS) or entrapment of the pudendal nerve.

"Anal and urinary incontinence?" Nobody here has that.

Here's another list of symptoms:

pain along nerve distribution (100% of patients), pain aggravated by sitting (97%), pain relieved by standing or lying (89%)

Very few men have an immediate increase of pain when sitting, or go from painless to painful when going from standing to sitting.

This study has a very vague approach:

Clinical signs and symptoms of the pudendal neuralgia are very rich, with a great individual variability. The clinical diagnosis is difficult. It is confirmed or invalidated by the electrophysiologicals tests.

Many pro-PNE studies, none of which are published in the big, respected journals, make big claims for PNE, claiming that almost everyone with pelvic pain has PNE (clearly nonsense). Other studies, like this one below, make more modest claims:

Am J Phys Med Rehabil. 2003 Jun;82(6):479-84.
Pudendal nerve entrapment as source of intractable perineal pain.
Ramsden CE, McDaniel MC, Harmon RL, Renney KM, Faure A.
School of Medicine, Medical College of Georgia, Augusta, Georgia, USA.

Perineal pain caused by pudendal nerve entrapment is a rarely reported entity, with only a handful of cases in the modern literature. A 25-yr-old male medical student had refractory unilateral orchialgia for 32 mo and concomitant proctalgia for 14 mo. Pain was positional in nature, exacerbated by sitting and partially relieved when standing or recumbent. Pudendal nerve entrapment was diagnosed clinically, with computed tomography-guided nerve blocks providing temporary relief. A prolonged left pudendal nerve distal motor latency on electrodiagnostic testing later confirmed the diagnosis. At surgery, the left pudendal nerve was found flattened in the pudendal canal of Alcock and in contact with the sharp inferior border of the sacrospinous ligament. After surgical decompression and rehabilitation, the patient experienced significant relief of pain and returned to medical school. This case suggests pudendal nerve entrapment should be considered in the differential diagnosis of chronic urogenital or anorectal pain, particularly if the pain is aggravated by sitting or if there is a history of bicycle riding.

The best studies are careful to claim that PNE causes chronic PERINEAL pain, not chronic PELVIC pain. The perineum is the area between the anus and the testicles. There are no studies that claim more than a 50-60% success rate, and "success" seems to be loosely defined, all the way from a 50% improvement in symptoms to complete cure.

I think that if you are a professional or long-time cyclist, or have had surgery in the anorectal area, or (if female) have had a traumatic childbirth, or experienced a big impact or trauma to the area (car accident, for instance), then PNE is a possibility. But even in the rare cases of true PNE, the highly invasive and painful surgery should be the last thing you do. Remember that the pudendal canal is quite deep in the buttock, and the surgeon has to cut through a lot of tissue to get to it (therefore long recovery time, very painful). Here's how it should work:

1. Do everything we discuss on this forum, including some form of the Stanford/Wise-Anderson Protocol
2. if failing all that (and that will take you at least a year of experimentation), have nerve blocks to the pudendal nerve to see if you respond. One study found that "complete disappearance of pain for at least two weeks after a nerve block repeated twice before surgery may be the best criterion to predict success".
3. If you respond to these blocks, you can explore PNE

Below, see the pudendal nerve (the yellow one in the diagram):

[garyholc]

Thanks webslave for a comprehensive reply. I was asking mainly because I was surprised just how the PNE symptoms listed on websites seem to be an exact copy of the chronic prostatitis / chronic pelvic pain syndrome symptoms and I was wondering if PNE actually exists, or if in its early stages it is chronic prostatitis / chronic pelvic pain syndrome and if left with no treatment it goes to become PNE. While I dont get any pain after ejaculation, I do suffer from ED at the moment as do others here. Sitting can make my condition feel worse but standing or walking can also make my symptoms worse. Rather than all out pain, I usually just ache - I guess in a similar way muscles ache, and I dont think PNE would case lower back ache.

I'm not saying I am now thinking I have PNE, but was interested reading all the different articles about just how similar the two conditions are. However I am sure that with dysfunctional muscles in that region, then it would be possible for the nerve to be pinched eventually if left untreated.

Its amazing when I think back years before having this, I would never for one moment have thought the pelvic region is so complex!! You take these things for granted !!

[webslave]

Actually, the symptoms are different and you need to grasp that idea firmly.

• If sitting does not exacerbate your symptoms, you CANNOT have PNE.
• If you have back pain, that is NOT a symptom of PNE.
• However, if your pelvic pain is not ever exacerbated by orgasm/ejaculation, you probably do not have CPPS

For more on chronic prostatitis / chronic pelvic pain syndrome symptoms:
https://ucpps.men/what-is-chronic-prostatitis-CPPS

[garyholc]

Hmm, but are there not some people on here who get pain sitting? Such as the more recent post titled sitting on an airplane for 6 hours and others which use donut cushions to take pressure off the pelvis.

As for ejaculation issues, personally I dont find it makes symptoms worse, in some cases, it makes them better whilst other times, I may ache for a while afterwards, but generally its an ache, not a pain. But then i'm sure I have read other people on here who have no pains with ejaculation either.

Its a pity the chronic prostatitis / chronic pelvic pain syndrome symptoms are so variable in different people and dont tend to be consistent over time (moving around), no one seems get this condition the same, some get urinary symptoms, some get ED, some get pain sitting etc etc. For instance, I started only with urinary symptoms, then progressed to ED, urinary symptoms went and have been replaced by aches and pains on occasion which can be relieved by TP massage.

[graeme]

Gary Bill was chatting to me about this and he assured me if it was PN giving you grief you are highly likely to have a sudden pain when sitting that could make you jump,with chronic prostatitis / chronic pelvic pain syndrome it can just slowly add and increase your pain the longer you sit .

[garyholc]

Hi G

Yeah he mentioned it to me as well saying it was unlikely this was my cause. I'm not thinking I have it, but was just curious how one would differentiate between the two. What you describe about a gradual increase in aches and pains upon sitting is exactly what I get, mainly in the buttocks like they are bruised. No sharp stabbing pain.

Going back to the ejaculation issue, I've read through quite a few profile signatures now and and there are a few people who make no mention of pain afterwards but who have other chronic prostatitis / chronic pelvic pain syndrome symptoms.

Have rebooked to see Bill for the 11th June for my 3rd PT session, and have ordered a wand now as well.

At the moment, the majority of my pain seems to be around my coccyx or however you spell it lol and in my bum cheeks, I am sure that long ride on my motorbike caused this - grrrrr. Have put it up for sale now, gutted because I love her to bits, but think I will have to get one with a more comfy seat and more upright riding position now. Anyone want to buy a nice sports motorbike???

[webslave]

Let me be clearer about ejaculation.

If you have CPPS, it is a signature of the condition that the symptoms are affected by ejaculation, usually for the worse — temporarily. BUT, as you say, the opposite is also possible if there is congestion, and symptoms can improve instead. The key thing is the change in symptoms.

PNE is not affected by ejaculation.

[graeme]

Gary you say you do have an ache after ejaculation but not pain? An ache is a type of pain, a normal pelvic floor should not even have an ache.

Mine does not so much now, but if left for a long time without ejaculation: burning, stabbing pain around prostate during contraction and, if bladder not empty, can lead to a flare, but most time leaves a low grade dull burning ache for hours at best after

Don't undo your good work stressing again

[garyholc]

Gary you say you do have an ache after ejaculation but not pain? An ache is a type of pain, a normal pelvic floor should not even have an ache.

Yes its like a kind of dull ache between the legs and surrounding area (not painful), not always present, but I tend to take a hot bath afterwards and it goes. Other times, like you said, having a release from going for too long can bring relief to some symptoms.

Thanks for clarification on the ejaculation issue Webslave.

Will stop thinking about it now! Will have a chat will Bill about things when I see him on the 11th

[Clay]

I don't think PNE is a good fit for me either, if it even exists, but my case is pretty different in a couple of ways and I don't think it is classic chronic prostatitis / chronic pelvic pain syndrome either.

I've never had any reaction to ejaculation. My urinary symptoms have all long since passed. Sitting is bad, but only in a gradual and delayed sort of way. My pain is all rectal right now. At my peak I was on 8 vicodin, Xanax and 40mg of morphine/day and still hurting to the point of suicidal thoughts. I'm still on 3 vicodin, Lyrica, Elavil, Xanax and 15 morphine, but that keeps it down to a dull ache usually. (I can't take NSAIDs). My sense is that after 2 years it is slowly improving.

My condition came on in my 60s after 40 pounds lost to diarrhea, undiagnosed illness, and a trapped kidney stone.

Did I ever mention my new Uro, Karny Jacoby, said she'd heard of another case of chronic prostatitis / chronic pelvic pain syndrome symptoms brought on by a kidney stone trapped in a ureter? She thought it was the extraction procedure that did it, but in mine chronic prostatitis / chronic pelvic pain syndrome started a month or two after the stone pain. It took 6 months to get the stone properly diagnosed and removed. Jacoby is very up to date with chronic prostatitis / chronic pelvic pain syndrome research if you are in the Seattle area.

I've had over 100 PT treatments, and I seldom had a direct good reaction.

I'm not sure that I think PNE/CPPS is either/or. I suspect they both share too much in common, and its a matter of degree. I lurk here because I pick up good tips, but I don't feel at home in either world.

And, no, I wouldn't let anyone come after me with a knife.

[Jay]

PNE is not affected by ejaculation.

Webslave,

Just curious, why is the above so? Not that I don't believe you, I'm honestly just curious. The pudendal nerve or its branches seem to link to or traverse areas involved in ejaculation.

[webslave]

The PNE school make no claims for ejaculation and symptoms, whereas doctors studying chronic prostatitis / chronic pelvic pain syndrome do. That's the main reason (I'm not doing original research). But underlying this is that ejaculation-induced pain increase is due to the paroxysmal muscle contractions of orgasm in the pelvis. We have proved that here on this forum by advising men with bad post-ejaculatory pain to deliberately relax their pelvic muscles during orgasm. Most (all?) report a drop in post-ejac pain.

[superuse]

A repost of my comment on PNE thread:


I had a guitar string like pain from my prostate down thru the sitbone to my left heel (funny how that side always has problems 3:1 vs right). Felt like my Achilles tendon was tearing in half. Have seen several other members mention the string plucking symptom. Mine seemed to originate from over aggressive hamstring stretches.

There should probably be a sticky for lurkers, browsers etc.. about PNE. One kid posting on a PNE board, Mr. J lets call him, was looking forward to his surgery trip like "a kid at Christmas" (his description). Once people get surgery, bacteria etc on their mind, it's hard to stop them. What's unusual is that many with symptoms less frightening than numerous men here (who have greatly recovered) are going from onset to surgery in less than 6-9 months.

Info on this (mostly PNE) is much more available now than years ago. The problem is that many have noticed a large decrease in symptoms (50-70% or more) within about 24 months or less of time regardless of what they did after onset, without surgery. This is about the same recovery reported 12 or 18 months after PNE surgery. There seems to be a large bias in success with women who have had hysterectomies. (I believe the ligaments in question are actually sutured and disturbed in a hysterectomy), and the number with problems (amongst the 10s of thousands of hysterectomies every year) seems small.

There have probably been less than 2000 of these surgeries worldwide in the last 9 years, done by less than 20 physicians. Most have been done by less than 8-10 it seems. This is probably in comparison to 1million? 5million? heart bypasses and operations done worldwide (perhaps one of the DR.s here could help with the #'s) and at least 100,000 (a quarter million? more?) surgeons who could qualify to perform the release surgery. For 2000 or so surgeries the documentation and publications are scarce (and they don't need to be).

A Sticky Post of the type "Yes we know about the PNE theory and these are some facts" in bold, standing out for all passers by to see would be very useful. This is all relevant because the availability of info now can have a determined boy (for the quick fix) in France, Houston etc in less than 3 months (similar to our bacterial folks with Dr Song). Especially when they start on the "better get it done early for successful results" stuff.

Webslave would have to evaluate this but I've heard numerous comments somewhat similar to Mr. J's on the other board and the "kid at Christmas" thing blew me away.

--jjf

[Ausie]

There seams to be a of grey area in these two conditions, they overlap dramatically. I believe webmaster you said Trauma can be a cause of PNE ? Or do we put in the chronic prostatitis / chronic pelvic pain syndrome basket ? So is there such a thing as PNE or not ?