My Case (please help! )

[webslave]

I suggest you have a TRUS to put your mind at ease.

[charlie222]

I've had 2 already. They both showed serious inflammation. But I wasn't knowledgeable enough at the time to ask more questions or specifics.

If I ask for the results from my uro, what should I look for from a TRUS?

[stoic]

Hi Charlie,

Does your abdominal symptoms stop exactly at the navel level? -- as in feeling sick in the entire lower abdomen but fine immediately above the belly button? If yes I think they may simply be caused by a tight and shortened pelvic floor, more specifically the PC muscle.

My speculation is that pain and pressure that stops exactly at the navel level suggests a tight rectus abdominis, more specifically the lower two packs of the "six-pack" muscle. The navel is at the level where the lower two packs meet with the middle ones. If symptoms come from other abdominal muscles (internal or external obliques or transversus abdominis) there's no reason why they are exactly limited to the lower abdomen.

But why the rectus abdominis is tight? I believe it's because among all the abdominals, it's the one that's most intimately connected with the PC muscle. The PC muscle is fascially continuous with the rectus abdominis. When actively goes into spasm, it may pull on the rectus abdominis, making it reflexively tighten and causing symptoms.

From what I've learned from multiple sources, in muscular pain caused by muscle inbalances, shortened muscles are usually silent or only painful when palpated, while muscles that are pulled tight by shortened muscles are more likely to complain/be painful. This is exactly consistent with what I feel -- my pelvic floor is only painful when palpated (excruciatinglly so when I first started internal therapy), the annoying tight and raw sensation all comes from the lower abdomen.

As to why your belly seems to be swollen, I'am not sure but another possibility besides having IBS is simply you may have excess belly fat. For a long time I also had this suspicion that my lower abdomen my be abnormally swollen, until I went on a low-carb mostly paleo diet and saw my belly fat slowly melting away -- it turns out I was just skinny fat, the swollen-looking appearance seemed to have nothing to do with the bloated sensation. It's most likely just a coincidence creating an illusion.

I agree with Webslave that your bulge can not be caused by the prostate, however inflamed or enlarged it may be. It just seems to be biomechanically impossible. Consider the fact that BPH usually does not cause pain and pressure symptoms in the abdomen. Also consider the fact that merely filling your bladder to full capacity will probably displace higher organs/intestines much more than putting some extra tissue around your prostate.

[webslave]

what should I look for from a TRUS?

Ask for prostate volume and all other measurements.

[charlie222]

Well this is certainly news to me. I was convinced that this bulge was due to my prostate pushing up on my bladder.

Now I'm questioning if there is something else wrong with me and causing these pains at night?

Stoic what you say makes sense- however I can very certainly rule out IBS and excess fat. I am extremely fit. Also more than one person I have showed the bulge to admit that it just looks odd.

The only thing I can think of is that before this issue I had hemorrhoids and developed constipation after it cleared; I was constantly pushing and stressing on those muscles down there. Then this issue came up and maybe the masturbation plus constipation caused a small hernia or some other muscle tears ?

But the TRUS would have found this right?

[davyboy]

Hey Charlie,

I too have noticed bulges in this area before. Particularly on my right side. I thought it was a hernia. I am extremely fit too. I believe now that it was just a shortened or tight muscle because it has reduced since starting the protocol.

Good luck!

[stoic]

Yet another possibility for a bulging belly is psoas dysfunction. You can check out http://www.somatics.com/psoas.htm and prostatitis--dot--org/muscle.html for some quick information.

Although given your symptoms, which seem to quite like mine, I think your problem is more likely due to the pelvic floor being tight rather than a tight psoas.

The Wise book seems to suggest trigger points on the abdominal muscles, rather than on the pelvic floor, are the immediate cause of abdominal symptoms. What frustrates me is that I don't seem to have very specific abdominal trigger points at all. Rather it's a vague, almost evenly distributed tight sensation (mild at baseline but annoying when stressed by tight pants or belts) throughout the area that bothers me. I've been wondering all along whether resolving all the pelvic floor trigger points could contribute to symptom relief not just limited to perineum and the urethra, but also in the suprapubic lower abdomen.

[charlie222]

i took a couple photos. does this look normal to u?

[webslave]

Firstly, that bulge is far away from the bladder and prostate. Secondly, it's within the bounds of normal as far as I can see (but get a doctor's comment).

A bulge at or just below the umbilicus is possibly an umbilical hernia, although your bulge looks too indistinct.

hernia locations

hernias.jpg (22.67 KiB) Viewed 529 times

[stoic]

To my eyes the bulge does looks a bit odd (not like mine at all), although not as distinct as a hernia.

I used to suspect psoas being the culprit behind my abdominal discomfort. After having a lumbar x-ray (which showed no lordosis which would caused by a tight psoas) and losing my belly fat I've pretty much ruled out that possibility.

[charlie222]

Hello all,

Not much has changed in the past 6 months.

In fact everything is exactly the same. The bulge in my lower abdomen is still there, and the supra-pubic pain is worse than ever. I don't know what do do to fix this. I tried abstaining for 6 weeks and it didn't do much.

I am falling back into depression because I was hoping this would resolve itself over time but it seems to be stuck at the point that it is.

What's worse is that I feel completely alone in this (other than internet sufferers). No one around my understands my pain and frustration, and I don't expect them to. And the 3 Uros I saw are all the same. In, out, diagnose "prostatitis" and they don't give a shit.

I wonder if my stomach muscles were ruined and that's what is causing this abdominal pain? Or what could it possibly be???

My case is unique ( altho all are ) in that I am 100% certain that my issues started and were borne out of excessive masturbation and ejaculations.

I just don't know what do to anymore.

I need a doctor who specialises in how the ejaculations affect abdominal muscles and all the organs down there and vice versa. Who would that be? A Uro I suppose?

[webslave]

What steps have you taken, other than abstaining from sex, to get better?

[snowbro]

This is an interesting case. From the way you write, I sense quite a bit of anxiety. Does the pain affect your work-performance? Do you have anyone to support you through this?

To ease your mind regarding the bulge, that is quite unlikely to be related to your prostate being enlarged. Even with an enormous prostate pressing on the bladder, it would be exceedingly rare to go that far. Trust me, I have seen HUGE prostates before, as large as 200+ cc, considering the typical prostate is around 30 cc. I have to say there IS a bulge visible though. My guess is a weakened lower abdominal wall (perhaps early hernia). It could also be an unusual anatomic variant (like a fat pocket).

Have you had this all your life?

In general, I find masturbation or sex RELIEVES my pain (secondary to endorphins? decreased prostatic or seminal vesicle pressure?). But I could see how it could exacerbate pain in people as well (hypercontraction of the pelvic floor during ejaculation and immediately afterwards, retractile testicles, ischemic injury, etc).

Don't give up. My suggestion is to see a pain specialist, perhaps they will have some suggestions for you.

[charlie222]

@ webslave- I have eliminated all the supplements that I was on and was focusing on a healthy diet and exercise. But over time (say the last 18 months) I was improving so It felt like I was doing something right. But over the last few months, nothing. Maybe I need to take it to the next level but I just WISH I knew what to do.

@snowbro yes I've been told that before- that the bulge has NOTHING to do with my enlarged prostate. No it was never there before, it only started to appear after this whole thing started in April 2011.

The thing is that I am 100% certain that there is a direct correlation between this bulge and my ejaculations. The pain tho I'm not sure about.

You could be absolutely correct that its a weak lower abdominal wall. If I was to picture what was happening down there when this was at its worst almost 2 years ago now, is that after each ejaculation, when I had this horribly piercing puncturing pain, as if something was stretching far more than it should be stretched, and was about to explode, that it must have pierced thru something or was torn or something of that sort.

Something like that doesn't just heal on its own I suppose? I will continue to search for answers.

[dockuda]

Dr. Wise do you have any idea why some guys with chronic prostatitis have no problems with erections, but do experience pain at the tip of the penis and with ejaculations? Then there are men like myself who experience the pain at tip of penis but cannot get or maintain an erections. This is mind boggling for me and I am so frustrated and almost hopeless.