Prostatitis is "a garbage term" says expert

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Prostatitis is "a garbage term" says expert

Post by webslave »

Prostatitis is used to describe almost all pelvic complaints in men, making it the most common urologic diagnosis in men younger than age 50 and the third most common in those older than 50.

"Frankly, it’s a garbage term," said Dr. J. Quentin Clemens, one of the nation’s leading experts on the subject of male pelvic pain.

....

Dr. Clemens said that his typical approach with CP/CPPS patients is to start with alpha blockers and physical therapy if pelvic floor muscle tenderness is present. "There is no good evidence to suggest that alpha blockers work better than placebo, but I still use them," he said. "There is some effect and they are relatively benign, especially compared with gabapentin and pregabalin."

Amitriptyline (Elavil) can be useful, as is pregabalin, if burning pain is present. For particularly difficult-to-treat cases, Dr. Clemens recommends referral to a pain specialist, but he said that narcotics should be used as a last resort because of long-term use issues.

From Internal Medicine News

He also says some things with which I disagree:
  1. Dr. Clemens and his colleagues suggested that the prevalence increases with age, peaking between at age 71-75 years (it's much younger, and I think he's conflating BPH with CPPS)
  2. "When Dr. Clemens’ talk proceeded to "proven effective treatments," a blank slide appeared before the audience." (there are effective treatments, you have to keep trying them all until you find the one that's effective for you)
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Jay
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Re: Prostatitis is "a garbage term" says expert

Post by Jay »

Dr. Clemens and his colleagues suggested that the prevalence increases with age, peaking between at age 71-75 years (it's much younger, and I think he's conflating BPH with CPPS)
This seems to be a common point of confusion among physicians and urologists. I remember having a bad flareup years ago, before I'd really gone full-on chronic. I was in my early 20s at the time, and my doctor said that it simply couldn't be prostatitis. It was, he protested, an old man's condition.

Of course, things progressed and I went chronic. The first urologist I saw about it was an asshole (pardon my language), yet he did diagnose me correctly with CPPS. Unfortunately, he told me that nothing could be done for this 'grueling, horrible condition.' You can imagine the mental state that left me in. I was lucky to find a new urologist after that, a young and caring one who supported me as I went on to pursue PT.

Urologists really need to catch up with the realities of this. Dr. Clemens seems to be halfway there in that he recognizes prostatitis as a 'garbage' term, and he prescribes such treatments as pelvic floor PT, but I think (based upon my experience and my acquaintances with others) that this is a condition of the young. Some of the men I have met through PT have been younger than myself by a number of years, even.
I am not a physician. This is not medical advice. Consult your doctor!

Age: 26 Onset Age: 17 Symptoms: Shooting, nerve-like pains throughout the penis, which abruptly hit and leave. Testicular pain, perineum pain, burning/irritative urination, extended pain after ejaculation. Occasionally, some allodynia or ache in the coccyx/sacrum/thigh/buttocks/legs. Diagnosis: Pelvic floor dysfunction, degenerated lumbar disk, and mildly herniated lumbar disk. Helped By: Physical therapy, pain management doctor, hot baths, therapy pool, stretching regimen, breathing exercises, relaxation, distraction. Worsened By: Arousal/ejaculation (worst), constipation, panicking/obsessing, other triggers depend upon current symptoms. Tests/Prior Treatments: Too many antibiotics to count, multiple urine tests (all normal), testicular ultrasound (normal), bladder and renal ultrasound (normal), lumbar and pelvic MRI with and w/o contrast (revealed disk problems), Elavil 25mg (caused retention), Flomax 0.4mg.
superuse
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Re: Prostatitis is "a garbage term" says expert

Post by superuse »

If "prostatitis" is the most common complaint in men younger than 50 it is defacto a younger man's problem (chronic abacterial prostatitis type III or whatever, aka CPPS)

In women CPPS (presumably if IC can be ruled out) has a bunch of garbage terms such as honeymoon bladder, hysterical higgly giggledy, or whatever. Many report the same symptoms as men, some with the same lump or pain where their prostate would be if they were men.

Whereas it seems to me almost 70% (2/3+) of males report considerable exercise (almost 1/2 on a bike or pedaled object alone) it may be perhaps 50% for women. A hysterectomy history seems very common, which may be a confounding factor as a hysterectomy seems sometimes a suggested treatment for pelvic pain in itself.
Age:43 | Onset Age:36 | Symptoms: First urinary and backside, golf ball feeling, now ok (no heavy exercise) . Major onset seemed to be with heavy coughing spell , felt "tearing" or nerve pain in rectum/prostate. | Helped By:Hot showers,sleep.Worsened By: Type A obsessiveness ... Stressing, what-if thinking, weights.
Not a doctor. -

The usual... anxiety prone programmer (my case), accountant, lawyer or self employed sitting 50 hrs/week combined with compulsively exercising on a bike,weights or running to compensate for stress. Also aka "graduate student syndrome" New email sigma556@hotmail
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