Does Chronic Prostatitis Exist?

[garyholc]

Hi DimDem

I'm similar to you in some ways though have not suffered as long as you. I was diagnosed with this March 2007 (god nearly 2 years ago now). My uro felt my prostate which he said was boggy after I had a referral from my GP as I felt I could not stop going to the toilet, thought I have never had to get up at night. I was given Cipro etc. but didn't take them as I had already found this site by then.

The only thing I found that got rid of my frequency symptoms was alcohol, a glass of wine after work in the evenings, which indicated to me a muscular condition seeing as alcohol is one of the best muscle relaxants there is. I initially started with frequency, then the frequency went and was replaced by pain - though I never and still never have pain after ejaculation. However....... I may have an increase or re-occurrence of symptoms after an ejaculation but this doesnt happen for a day or two afterwards, if at all.

Since Sept last year I have been mostly pain free, however the frequency keeps coming back and forth which I find actually more of a problem mentally to deal with than the pain. At least with pain you pop a few pills and carry on. I havent really done anything to make the pain go away, it just has, and from others on here, it would seem this illness goes when it wants to, hides, then comes back when something sparks it off again.

The fact you had nothing for 15 years is excellent, and no doubt after this little flare you will have more years with nothing. Best of luck, Gary

[Dimdem]

Gary,

Thanks very much. I agree with you that some of the lingering frequency problem can be mental. Once you've had the experience of suddenly needing to go urgently, you don't forget. Frequency was the main symptom I had 15 years ago, and while I went for many years without any physical symptoms, I know that my earlier experience left its trace. I became more cautious about peeing when I had the chance, making sure I knew where bathrooms were, getting aisle seats, etc. Just, you know, in case. On the other hand, I think that part of the reason that frequency is bothering me less with this flare is that I know how to manage it better mentally. I remember that I used to get the sensation that I had a drop of urine at the tip of my penis, at the end of my urethra, and I would interpret that as needing to go immediately. I still have that sensation sometimes now, but I feel like maybe I process it differently and distinguish it from a real need to empty my bladder.

The more I think about it, the more I'm inclined to think that heat and even your alcohol may indeed be helping because of relaxing muscle tissue. Because the prostate itself contains muscle, though, for me it is still a little bit of an open question about whether this necessarily has to mean the muscles of the pelvic floor. Again, I'm not trying to deny that this is true for a lot of guys; I'm still just thinking about my own case, and wondering whether it is possible that I'm an exception to the rule. And I'm not trying to dispute what webslave said about the prostate being too deep for something like a sitz bath to reach it. I'm just confessing my own personal ignorance; I don't know one way or the other.

[garyholc]

Gary,
I remember that I used to get the sensation that I had a drop of urine at the tip of my penis, at the end of my urethra, and I would interpret that as needing to go immediately.

Yes thats the exact feeling. Its not in the bladder, but its in the urethra, the feeling there is a drop more to come out, its horrible!!! My PT was able to recreate this symptom exactly by pressing on a TP near the prostate. I'm still trying myself to locate it but its a tricky one to find as pressing on the prostate can also cause the feeling.

As for the prostate, I admit that I'm confused like you with regards its role in all of this. I don't think you are the exception to the rule, but I have found reading this site that so many people get this in so many different ways. Not one person has the same symptoms, which also unfortunately makes it difficult to treat. Perhaps its the muscles and nerves around the prostate, who knows, but there are stories of men who had their prostates removed and still had the same symptoms, so again, its role in all of this confuses me.

May I just ask, you say you didn't have any symptoms for 15 years, but still on occasion get the frequency feeling.... I find that mine comes for a fortnight or so, then goes for a while, then comes back, but hasn't lasted as long as my initial flare which I think lasted about 6 months. Looking back, how I put up with the urgency and frequency feeling for 6 months constant I don't know. Do you find when you get the frequency that if you hold off and ignore it, after an hour or so the feeling goes away? I do. Ignoring it is difficult, but the hours of being symptom free are worth it.

[timberdoodle]

The latter is the message that I've taken away from Dr. Shoskes, and to be honest his participation in the forum was the reason I joined.

Have you been evaluated by Dr. Shoskes? The reason I ask is that Cleveland Clinic (where he practices) does have a physical therapy department that could evaluate your pelvic floor. It might eliminate some of the guesswork as to why you have the pain you do.

[gmccormack]

DimDem,

I have suffered with chronic prostatitis / chronic pelvic pain syndrome for almost 4 months now, and I have never had post ejaculatory pain. While I'm sure it may be the most common/hallmark symptom not every man has it. My most painful symptoms have been mainly in the testicles, pelvis, and tip of penis.

I have experienced a significant improvement with internal/external PT, from this I conclude it is PFD but has been diagnosed as chronic prostatitis / chronic pelvic pain syndrome by 2 uro's. Regardless, I think that PT is worth a shot. After 1.5 months of PT and this board I no longer have pain even my ED is resolved, but there is a slight feeling that something isn't right, hopefully in time it will fade with more PT.

[carld]

This syndrome effects men differently...

In my case, at my onset, I had a boggy prostate as well and a WBC count of 10 and after a few months brought it down to 1 WBC...But still had the discomfort. BTW, I stopped having uros press on my prostate to get the fluid 2 years ago...I found that to be more painful and worse for my CP/CPPS...That being said....

I feel that my inflammation is in my prostate and was caused by years of anxiety and panic disorder, genetic disposition and the habitual clenching of my pelvic muscles, particularly my PC muscle. So I think I have dysfunction of my pelvic floor, (injury)...Which in turn effected my prostate. So by addressing the anxiety issues and learning to stretch and relax the pelvic floor and doing self internal PT and using low dose Elavil...I have managed my CP/CPPS...

Inflammation I believe does happen to the prostate for some men and is a form of the general term CP/CPPS...So prostatitis does exist in many forms tailored to the individual

Just my opinion

[Dimdem]

Just an update to say that I had a good first meeting with my uro today. (I had had a previous appointment with his nurse practitioner.) At my suggestion, he prescribed me Elavil 10mg. (My GP is also prescribing me Singulair, which is warranted because of my allergies chronic prostatitis / chronic pelvic pain syndrome aside.) He actually raised PT himself as a possibility for the future and said that they had had good luck with it when other modalities had failed; I'm not sure what form the PT would take. His basic attitude seemed to be the same as mine, which is that there are a variety of possible causes for this that are worth taking seriously, which includes but is not limited to pelvic floor issues.

Also, because I have had trace blood in two urine samples in the last 18 months---including one before I had chronic prostatitis / chronic pelvic pain syndrome symptoms, and along with several others that were negative---he is going to do a CAT scan to check for stones and possibly a cystoscopy.

Edit: He also mentioned that there was a Canadian doctor who seemed to be the leader in chronic prostatitis / chronic pelvic pain syndrome research, but he couldn't think of the name. Anyone know who he was thinking of?

[webslave]

Curtis Nickel.

[atma]

I showed trace blood in my urine samples also and according to my uro while it is not ideal, it has become relatively common. The next question is how much and where do you draw the line to have concern. Like most of us, I gave up on my uro.

ATMA

[Dimdem]

After three nights on Elavil (10 mg one night, then 5 mg the next two) and three days on Singulair I definitely feel better. Improvement was so quick that it may well be placebo effect. Still, I'll take it. If I seem consistently better after a few weeks I will drop one and see what happens and then maybe drop the other. I'll probably drop Elavil first because it seems to have the most side effects and also because for the next couple of months my allergies will be raging anyway.

[9999maverick88]

So should I take a hot bath? I've found that taking hot bathes helps my pelvic muscles relax, but if it's causing my prostate to become further inflamed, should I continue to do it? What would you recommend? Have you read anything pointing to the fact that maybe it isn't a good idea to be taking long hot bathes?

[webslave]

Well, I've already stated in this thread that a hot bath relaxes muscles and does not heat up or "further inflame" the prostate. So your question is based on a faulty premise.

[graeme]

A hot bath is proberly the only self help action that almost everyone get some relief from . To increase blood flow down there can only be good .

[Dimdem]

I thought you folks might find this interesting. I saw my uro again today, and since I'm still having some symptoms he recommended that I try PT. (He had mentioned this as a possibility at my last visit.) He said that he has had a good success rate with it, which he thought was partly due to the fact that he is pretty selective about who he sends, and that he'd consider me a good candidate. It is encouraging that someone else from my area was a member on here a few years ago, said that his uro sent him to PT which seemed to be helping, and then disappeared from the board. I haven't been able to make contact, even though webslave kindly sent him an email on my behalf, but I'm going to guess that we have the same doc or at least the same practice. When I asked him if the therapy would be trigger point release he said that the main focus was on pelvic floor relaxation, but that I could talk to them about trigger point stuff. (He also brought up acupuncture in that context.)

I'm certainly willing to try the therapy. I think that some of my comments on here may have given the impression that I'm hostile to the approach, which was never my intention. I've definitely been convinced that PT has the potential to help people. It seems to me that there are two plausible views that a person can have... that a good percentage of chronic prostatitis / chronic pelvic pain syndrome patients will benefit from PT + relaxation therapy or that this approach is the only hope for all but a few chronic prostatitis / chronic pelvic pain syndrome patients. I'm definitely convinced of the first view. The second view takes a lot more evidence to demonstrate, and I'm not convinced of it yet, but maybe someday. The first view fits in well with the Shoskes/Nickel "snow flake" hypothesis, which just on a gut level rings true to me.