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Acute and chronic prostatitis discussion. Arnon Krongrad, MD, moderator.

True prostatitis or pelvic floor problems?

I have come to believe through all my reading in forums and my own personal experience that there are 2 main categories of CPPS. These are true prostatitis, and pelvic floor muscular problems.
I have mentioned to many UK urologists the possibility of prostate removal for severe chronic prostatitis. They all say that they are not certain that the pain is coming from the prostate so it would be crazy to remove it on that basis.
I do not understand why this is so difficult to ascertain. Myself & many other prostatitis sufferers have the following symptoms, which I find difficult to understand how pelvic floor problems could be the cause of:

1.Slightly off colour/light yellow ejaculate, more obvious the longer time between ejaculations. Ejaculate was always white before suffering from prostatitis.
2.Low sperm counts. (Is the sperm dying quickly in the abnormal prostate fluid?)
3.Burning feeling in urethra.
4.Pain/swelling after ejaculation.
5.Pain when doctor pushes prostate during DRE.
6.Stool size varying depending on amount of inflammation in prostate area, i.e. stools generally larger during times of reduced symptoms/inflammation & smaller during flare up's. (OK I guess you could attribute this to a muscular problem possibly?)
7.Much more calcification of prostate than normal for age shown on TRUS.

In David Radford's case I believe it was more straight forward to define him in the true prostatitis category due to his fevers he would get after sitting playing the drums. After all how could fevers after sitting & compressing the prostate be attributed to a pelvic floor muscular problem?
I believe from David's outcome (and Chris Eden's yet unpublicised CPPS patients), that in time, nerve sparing LRP will be shown to be highly effective in the majority of true prostatitis sufferers. I really think the pelvic floor type CPPS is another problem which shares many symptoms with prostatitis, making diagnosis very difficult.

Oh, I forgot to mention an anecdotal case I know about. A friends father came home from work in the 60's in massive pain in the prostate area. He was on the floor curled up, so they called an ambulance. He was taken away and had his prostate removed by open surgery. The pain was gone when he woke up, replaced by post op pain which was considerably less and went in the next few weeks during recovery. CPPS was not even a recognised phrase back then. Coincidently (or not-genetic perhaps-who knows?) my friend now suffers from chronic prostatitis too.

Anybody have any thoughts about this?

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Would it not be good to get a more objective work up for prostatitis so we can differentiate the two?
Antonio E. Feliciano,Jr.MD said:
Would it not be good to get a more objective work up for prostatitis so we can differentiate the two?

Absolutely, it would help those with true prostatitis make a "sure/no regrets" decision before doing LRP.
Yeah right, this is my main feat to realize the LRP, that the pain could be remain; i had all the symptoms that you described included intensive pain in presence of low temperatures.
But how differentiate between bacterial prostatitis and pelvic floor problems? Exist some kind of test to ascertain it?
Maybe another kind of specialist like a anestesiologist or neurologist could know more about that kind of pelvic floor problems,but even talking with some of thems the issue is not really clear. (At least in Poland).
I forget to say that like David Radford, actually i cannot sit... some body is suffering the same big inconvenience?
But how differentiate between bacterial prostatitis and pelvic floor problems? E

Simple.. Visit a Pt who specializes in pelvic floor issues. I did 5 visits last year. I was told that my pelvic floor was not my issue. I assumed so all along. It was well worth the money to get a sure answer.
Mike can you be more specific about the tests please, did you have a Electromyography (EMG), or something else more specialized?
Actually t trouble in Poland is that its not easy to found good assessment about this issue, and i have to look for my self (and for private) every single test, then if you can help me with your experience i would be really gratefull.
Regards ans good energy. G
I live in florida. I was very hard for me to find a pt pelvic floor person who does treats male patients. Out of desperation i called a female pt, who then found me a pt who works on men.

As far as tests. She uses the Stanford protocol book for reference {head ache in the pelvis} she checks for so called trigger points and feels for sore areas around the pelvic floor. Checks for spasms and tone.

After 3 appointments she told me that my pelvic floor was perfect. She had seen many men with pelvic floor prostatitis symptoms. And my pelvic floor was nothing like others she saw with symptoms. . I went for 2 more appointments just to make sure. On the last anointment she stuck a probe with a sensor on it up me. The readings also confirmed everything was ok

She then told me that i either had a prostate infection or bladder/ ic

Since my trus revealed a enlarged inflamed prostate, and i am only 28. we then could say it was 99.9 percent my prostate.

just to be even more sure i had a cystocopy . That test revealed all normal. bladder looked ok, but prostate was slightly red
Question to Mike and others. Does anyone with what we have aslo experience constipation no mater what you do to get ride of the problem. I wonder if it could be a pelvic floor issue or something conected.
christos said:
Question to Mike and others. Does anyone with what we have aslo experience constipation no mater what you do to get ride of the problem. I wonder if it could be a pelvic floor issue or something conected.

Yes Christos, I suffer from constipation because of this damn problem. I feel that the prostate swells so much it pushes into my rectum causing a blockage, this in turn worsens hemoroids. Since I have improved after the EDTA treatment and prostate is reduced in size from what it was, my stools have increased in diameter. During a flare up the stools become ribbon like & flat and my hemoroids become worse. It all makes perfect anatomical sense when you look at the relationship of the organs in that area, hence the much repeated description of "golf ball feeling in the rectum" as Radford described in his patient story.
When I use a prostate massager at this point it often reliefs the costipation as I think it decongests the build up of fluids in the gland.
Hi every body, talking with a friend living in the USA (PROSTATITIS suffer of course), told me that this serie of tests is one of the best methods to evaluates pelvic floor problems, check it out:

If some body else besides of Mike, have some experience with the diagnosis of the pelvic floor problems, just let us to know; in my opinion this is a key point in the real diagnosis and possible treatment of this bloody illness (over all for them who are thinking in the LRP).
Good energy. G
In reference to the constipation issue. I don't have that problem. I did have that problem when i took antiflamatorys and prostatitis medication.

Remember a major side effect from most typical prostatitis medication is constipation. If you are on any meds, that could be the reason. Pain meds are the worst for constipation, but any rx drug causes it

Back to pelvic floor. There is a clinic in cali called the Stanford protocol. At this clinic they evalute pelvic floor issues and teach relaxation for prostatitis.

If someone were to attend that clinic and get no relief after a few months, that would be a good signal, the prostate is the issue
anybody know of a pelvic floor clinic in ontario canada?

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