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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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The clinic Christopher Eden does surgery shows one treatment being ultrasound guided prostate block injection as a long lasting pain control, which also could help determine if its the prostate or not.

mike said:
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
You also have to use common sense. Like if you cant sit and you feel pain in your prostate. Your are most likely dealing with a prostate issue. If you have ever had fevers or a general ill feeling, fatigue, frequent urination, dribble. Most likely the prostate.

From what i read very few prostatitis is pelvic floor related.

If it feels like a prostate, gives symptoms like a prostate, reacts like a prostate when stimulated etc etc... odds are its your prostate

Dr edens injections are injected near the prostate not into it. Dr bahn in cali will inject steroids right into the gland. He can even see pockets of infection and judge your illness by looking at blood flow areas in the prostate with his color ultrasound.

I would say try bahn first, then you will have a better idea. The ultrasound alone may even give you a definite answer. Odds are if you cant sit, its your prostate.

I agree and I am so sure it is my prostate that I almost would not bother doing any more checks. Another simple thing to do is to have a PSA test. Its well known that Prostatitis raises PSA. Pelvic floor problems may not.

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