Vigorous Prostate Massage

Questions? More on this at our Prostatitis Forum

Prostate Drainage Technique

What about having an energetic, “vigorous” prostate massage? Sounds like a healthy thing to do, doesn’t it? A lot of people become confused after reading about the supposedly good effects of vigorous massage or drainage at various fringe websites devoted to the subject of prostatitis. One such website states:

Your prostate gland is a complex structure of tiny acini, or sacs, in which bacteria can grow. Once they grow there, the swelling and inflammation caused by the infection closes off the sac, causing it not to “shed” bacteria, and protecting the bacteria inside from antibiotics and your body’s own immune cells. As more and more acini get closed off, your prostate begins to swell and interferes with your other normal urinary and sexual functions

This concept, this mental image of bacteria-filled acini, is not borne out by any research. But it’s an idea which has taken hold powerfully of many mens’ imaginations and now drives a good deal of the layman debate around chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). You need to be aware that it is not an idea with any support both experimentally or in the urological community generally.

It seems that gentle massage of the prostate, by a urologist, may (although unproven scientifically) be beneficial by:

  • helping to drain painfully sequestered secretions in a chronically inflamed prostate gland or seminal vesicles (although most men with CP/CPPS have small, firm, tender prostates); or
  • as a leading prostatitis researcher has stated, “prostate massage” may help by releasing the tension around nerve endings behind the prostate, in the lavator ani muscles, in a manner similar to Theile’s massage which helps women with IC. This represents a form of “myofascial release”.
Pushing on the prostate will affect trigger points in the anterior levator ani muscle insertions, a notorious trouble spot in men with CPPS

However, vigorous prostatic massage may be very dangerous:

  1. If you have acute bacterial prostatitis it can result in septicemia (blood poisoning).
  2. If you have the beginnings of a carcinoma in your prostate, it could conceivably result in the cancer being disturbed, broken up and metastasizing (spreading) around your body.
  3. It can result in prostatic calculi (little prostate stones made of calcium, if you have them, and they are quite common) tearing the delicate membranes in the prostate, exacerbating your CP/CPPS.
  4. There is a chance of perforation of the very thin rectal lining adjacent to the prostate, or tearing the rectal lining with a fingernail or implement.
  5. It may cause a hemorrhoid flare-up.

In short, do NOT ask your doctor for prostate “massage” unless you have considered all the above points carefully.

A researching urologist adds (note that this comment pre-dates the discovery that trigger points in pelvic muscles adjacent to the prostate can cause CPPS):

Vigorous pressure can result in tearing the very short segment of the urethra just below the prostate and immediately before the beginning of the penile urethra (this part is usually referred to as “membranous urethra”). The tearing can be very small and indistinguishable on routine examination but during the healing process this results in urethral stricture. In short, if the person giving you a massage has short fingers there is a significant probability that he/she might give you… a urethral stricture.

Moreover, indiscriminate (inappropriate massages) can result in pushing back even normal urethral flora into the epididymis and subsequent epididymitis. Therefore, I’d usually have my patients on antibiotics when I perform massages on them.

There is a general misconception that the prostate should appear enlarged, boggy or congested in “prostatitis”. While this probably is true in chronic bacterial prostatitis, most CP/CPPSers have small prostates, which are painful to massage. Therefore, if you don’t find relief from three massages, there is a small chance that massage will benefit you at all. It deserves a try, it is something that definitely works in some cases but it is not as simple as picking one’s nose (and even this can bleed from vigorous picking). Prostatic massage is a procedure and as such the person performing it should be aware of what he/she is doing, where he/she is supposed to press and how persevering he/she should be. I am very careful whenever I perform the procedure and listen carefully to my patients.

I once observed the most extraordinary complication of prostatic massage. A 28 year old presented with a history of a two-year right-sided discomfort in the right abdominal/cecal area (the place where the appendix is). I performed a very careful DRE during which the prostate was quite tender. Two days after the exam the patient developed visible anterior abdominal hematoma (collections of blood) above the bladder. Subsequent ultrasound exam revealed they were situated between the rectus abdominis fibers. They subsequently moved down to the testicles (because of the continuity of the anterior abdominal fascia with the scrotum). The bleeding was caused by the apprehension of the patient who contracted the anterior abdominal muscles (the rectus abdominis) strongly and abruptly thereby tearing some of the muscle fibers. My advice for patients: Be sure to relax COMPLETELY your abdomen during DRE/massage. Do it completely and slowly!

Some men do benefit from massage (alone or with antibiotics). However, remember that the increasing leukocyte count in EPS some people use as a mark of “unclogging the acini” might as well signify mechanical damage to the prostate (leukocytes are increased in trauma, too).

As regards technique: do not push in one place; rather move from lateral to the center line of gland. Pushing at one place only can damage that area, especially if you are pushing very hard. ”

Sometimes no drops of prostatic secretions are produced at the tip of the penis. Not all prostates yield fluid following all massages. There is an interesting concept put forward by Dr. Krieger in 1996 according to which the inflamed ducts empty following the massage, rather than during it. If you keep that in mind, massage can be beneficial even when no fluid comes out.

Remember that for some men, massage can be beneficial even when it is a massage of the muscles, surrounding the prostate, rather than the gland itself.

Lastly, an aggressive massage can theoretically precipitate an autoimmune response by releasing “forbidden antigens”, and this may explain why some men have a lot of pain after prostate manipulation.

J Dimitrakokov

Prostate massage warning!

The following study shows that prostate massage can have fatal consequences:

We report a case in which a regular prostate massage (chronic prostatitis) turned into a life-threatening event. After the prostate massage, an enormous periprostatic hemorrhage developed. During hospitalization the patient developed an embolic insult to the lungs. To our knowledge no other cases have been published. This report shows the potentially serious consequences, and we conclude that any pain after prostate massage needs further diagnostic steps (ultrasound, CT scan)

Urologe A. 2003 Jan;42(1):78-9.
Prostate massage with unwanted consequences. Case report
Buse S, Warzinek T, Hobi C, Ackerman D.
Klinik fur Urologie, Kantonspital St. Gallen, Switzerland.

Our view

It is certainly true that many men receive substantial improvement from pelvic floor massage. Massaging deep muscles adjacent to the bladder and prostate, such as the insertions of the levator ani muscles, is best accomplished by using a wand specifically designed for the purpose (see discussion in our forum). Note that recent research does not support the use of prostate massage to treat chronic prostatitis or CPPS.

Throw out the antibiotics and try these….

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