Does Chronic Prostatitis Exist?

[Dimdem]

Hope that title didn't sound inflammatory... I don't mean to start trouble. I'm a new member, and I guess I'm trying to get a handle on the board and its dominant viewpoint. Clearly there is considerable support here for the notion that many men diagnosed with chronic prostatitis actually have issues with their pelvic floor muscles and are best treated via the SP. What I haven't quite figured out from my reading is whether there is room in this viewpoint for the idea that other guys really do just have inflammatory problems centered in the prostate without major pelvic floor involvement. 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. I take him to be saying that similar symptoms can come from different causes and requirement different treatments, and while pelvic floor issues may be responsible for a significant number of cases, other guys may just have "plain old prostatitis" for some reason or other. What I'm not so clear about is whether the more regular posters on here would agree with that position or not.

Where this question comes from, of course, is my interest in figuring out whether my own condition is prostatitis or might be a mild (fortunately) case of chronic prostatitis / chronic pelvic pain syndrome (which I will use here to refer to pelvic floor issues). I was diagnosed with prostatitis in the early 90s. Went through a rough year or 18 months then, with some discomfort and larger issues with frequency/urgency. My uro at the time treated me initially with a course of cirpo and NSAIDs, but since he could not culture anything in EPS he treated later flares with NSAIDs alone. And then it went away and didn't trouble me again for approx. 15 years.

Just to keep the post short I won't go into every detail about latest flare-up. Suffice to say that it involves more pain than frequency issues, although there has been some nocturia (and also, at one point, a weak stream). Pain initially presented in left testicle then moved to tip of penis. I did 6 weeks of Cipro/levaquin (not simultaneously). That ended four weeks ago. Pain diminished without disappearing over the time that I was on ABs and continued to diminish for the first three weeks I was off. I started quercetin as soon as I went off of ABs... GNC at first, and then, for the last week, Quercetin. The last week has seen the pain come back to some degree.

All of this is perfectly consistent with CPPS, I know. On the other hand, ejaculation doesn't hurt. I would say that some of the pleasure has gone out of it, but it doesn't register as painful, either. (Except maybe when I took some online advice about draining the prostate too literally and ejaculated several days in a row. ) Plus, my prostate is apparently pretty "boggy. " I just had an exam done by a uro's NP a few days ago, just as the recent recurrence of pain was getting going.

So hence the question... Is this more likely to be mild chronic prostatitis / chronic pelvic pain syndrome or is it more likely that my problems really are just to do with the prostate.

Oh, maybe I should add... I would say that I probably do tend to be slightly anxious, mostly in the form of mild social phobia. (Not something that causes me day to day problems; only in particular situations. ) Also, I have a mild tendency toward constipation, which I've seen mentioned here, although again not to the degree that it usually gives me trouble on a day to day basis.

[webslave]

Some men, a minority, develop chronic prostatitis / chronic pelvic pain syndrome without pelvic floor spasm. But I have yet to hear of a case where the patient has an issue purely with the prostate gland and not with stress, anxiety, or allergy. Your social phobia, an anxiety-spectrum disorder, is highly suggestive.

The gland does not simply become inflamed of its own accord, although it is possible you may have another condition, especially if you lack the post-ejaculatory pain that is a hallmark of this disorder.

[Dimdem]

That's helpful, thanks. Here's to another 15 year remission.

[Jay]

Hi Dimdem,

When I've spoken with Dr. Wise, he's always been clear that he offers no guarantees when it comes to his approach. Tim Sawyer, the SP's therapist, has also said that there's a certain subset of people he can help and others that he can't. So, I am inclined to believe that there are variations of chronic prostatitis / chronic pelvic pain syndrome which do not directly involve pelvic floor dysfunction.

Having said that, the research increasingly indicates that PFD is a common feature in chronic pelvic pain, for both men and women. Years of study have revealed little to indicate the prostate as a cause of the problem, and upon further consideration, it was also noted that women often suffered from strikingly similar symptoms. Some even believe that Interstitial Cystitis and chronic prostatitis / chronic pelvic pain syndrome are the same thing. This is partly what led to the change from Chronic Prostatitis to Chronic Pelvic Pain Syndrome.

As Webslave mentioned, pain following ejaculation is a hallmark symptom. However, we've also discussed on here that the opposite can be true, with ejaculation providing relief. I would guess that it doesn't necessarily rule anything out for you. If you're interested in the muscular approach (I assume you are, being here), then I would encourage you to visit a physical therapist experienced in treating pelvic pain with appropriate techniques, such as trigger point release. Stay away from anyone who wants you to do Kegel's.

Lastly, having been a moderator once, I would say that you have little to fear in taking another viewpoint here. The people who get into trouble are usually the ones who push quackery, such as 'stealth bacteria' or dangerous and unproven surgeries.

[Dimdem]

Thanks, Jay. The honest truth is, I didn't know that this board was so focused on the muscular approach when I signed up. I signed up because I saw that Dr. Shoskes had some posts on here that I wanted to read, and the predominant emphasis on the SP surprised me. Not because I had negative views about it, based on what I read, but because I had thought that the problems it addressed accounted for a relatively small number of cases. That was just a vague impression I had picked up... I'm not saying that it is right. (REALLY not looking for any flame war. :))

In any case, I have to hope that I don't end up needing the full SP treatment. I'm a long way from there, and there aren't any therapists near me doing it, as far as I know. Given that I'm not suffering too badly, and that I cleared this up for a long time before without doing anything like the SP, I think I'm going to keep plugging away with quercetine and the old sitz bath for now. I am doing some relaxation exercises, which I guess might help if it turns out to be PFD. And I do know where to go for PT that would include yoga stretching and myofascial release. Since my wife is always battling yeast infections, my next step might be trying to get my uro to check me for that.

Anyway, thanks.

[webslave]

... keep plugging away with ... the old sitz bath for now.

Does a sitz bath help you?

[Dimdem]

... keep plugging away with ... the old sitz bath for now.

Does a sitz bath help you?

Temporarily, partially, and not every time.

[webslave]

If it helps even temporarily and partially, that indicates an element of neuromuscular spasm. This is a psychoneuromuscular condition, in most men. And in all men is it is a psycho-neuro-immunological condition, or a psycho-neuro-endocrinological disorder (see Theoharides's and Dimitrakov's work).

For that reason, it's not easy to explain to men why they have pain, or why their uroepithelium (and hence their bladder/prostate) is inflamed.

Many men end up opting to believe that they have an infection, which is a simple and even comforting belief, because it suggests that basic remedies will help, and that a cure is only a bottle of antibiotics away (or a few injections of antibiotics away), etc.

[Dimdem]

If it helps even temporarily and partially, that indicates an element of neuromuscular spasm.

Well, I don't believe that I have an infection. I'm with you that far. But heat is used to treat inflammation, in addition to muscle spasm, so I guess I'm not seeing why the fact that a sitz bath helps necessarily indicates muscle spasm.

[webslave]

No, that's not quite right. In CP/CPPS, blood flow to the prostate is increased, as monitored by Doppler. But the main goal of heat therapy is to increase blood flow, when it is used to treat painful conditions (usually injuries to tendons or ligaments), but that's not applicable here. So why would you wish to increase unwanted blood flow in the prostate further?

In addition, a sitz bath only heats up the skin, connective tissues and muscles, not a deeply sited organ like the prostate gland. To apply heat to the prostate, you'd need to use electric currents (diathermy) or high-frequency sound waves (ultrasound), or a transurethral instrument.

From a page on sports medicine:

Heat Therapy
Heat is generally used for chronic injuries or injuries that have no inflammation or swelling. Sore, stiff, nagging muscle or joint pain is ideal for the use of heat therapy. Athletes with chronic pain or injuries may use heat therapy before exercise to increase the elasticity of joint connective tissues and to stimulate blood flow. Heat can also help relax tight muscles or muscle spasms. Don't apply heat after exercise. Because heat increases circulation and raises skin temperature, you should not apply heat to acute injuries or injuries that show signs of inflammation.

In there is significant inflammation, heat is not recommended at all.

[Dimdem]

This is interesting, although I see sitz baths being recommended for BPH. That may be to relax the muscle in the prostate, but it still suggests that you can heat the prostate this way.

[webslave]

There are no studies published linking the treatment of BPH to sitz baths. So that's just some doctors opinion, not a fact.

[webslave]

Aust Fam Physician. 2007 Jun;36(6):449-52.
Levator ani syndrome - a case study and literature review.
Ng CL.
Kowloon West Cluster, Hospital Authority, Hong Kong, China. [email protected]

BACKGROUND: Although anorectal symptoms are a common problem seen in general practice, general practitioners may sometimes encounter patients presenting with anorectal pain without a detectable cause. OBJECTIVE: This article discusses a case of recurrent anorectal pain in a young woman due to levator ani syndrome, and the current evidence for treatment of levator ani syndrome. DISCUSSION: Levator ani syndrome usually presents with recurrent or chronic rectal pain without detectable organic pathology. Digital massage, sitz bath, muscle relaxants, electrogalvanic stimulation and biofeedback are the treatment modalities most frequently described in the literature.

[Dimdem]

There are no studies published linking the treatment of BPH to sitz baths. So that's just some doctors opinion, not a fact.

Fair enough. Well, it may be a fact even if it hasn't been proved to be one, but I have no idea if it has been proved.

[webslave]

You're not going to make a boggy, congested, heavily blood perfused gland feel better by heating it up. Common sense tells you that. It's obvious that a hot bath works on the pelvic musculature, if anything.