What is Prostatitis!?’
Movember is a month where across the globe the growth of upper lip warmers is on the increase, our hirsute brothers in all four corners of the world grow mustaches in order to raise awareness about prostate cancer and other male cancers. I tried it about 6 years ago now and it took over 3 weeks (the event only lasts 4 weeks, or a month to you and I) for people to stop asking what that dirty mark was on my upper lip… It was slightly less known about then and I am fair haired, not because I have a phobia of flannel and soap! For me Movember is a superb idea, the more information and awareness we can have about male cancers the more we (as males) may finally realise that we are not immortal, that we can be affected by these devastating illnesses too.
Yet, Prostate Cancers smaller cousin Prostatitis is a condition that hardly anyone has ever heard of. Prostatitis is not life threatening, yet many of its sufferers lives are pulled apart, destroying relationships and leaving them feeling desperate enough to take their own lives!
So, what is Prostatitis?
Prostatitis literally translates as inflammation of the prostate gland, yet it is considerably more complex than that and in a large majority of cases there is no inflammation within the small gland! Prostatitis is an umbrella term that is often used to pigeon hole male patients who suffer with pain in any the following areas:
• Penis (shaft, base or tip)
• Testicles
• Rectum
• Prostate
• Urethra
• Bladder
• Inner thigh
• Back pain
• Pain on and/or after ejaculation
• Pain during or after urination
• Increased urinary frequency
• Increased nocturnal urination
These are the most common symptoms reported by sufferers; some only have a few, others have lists that exceed the one above!
The National Institute of Health (NIH) has classified Prostatitis into the following 4 categories:
• Acute Bacterial Prostatitis
• Chronic Bacterial Prostatitis
• Chronic Non Bacterial Prostatitis, also known as Chronic Pelvic Pain (CPPS)
• Asymptomatic Inflammatory Prostatitis
It is estimated that over 80% of sufferers have Chronic Non Bacterial Prostatitis with some reports suggesting that only 5-8% of all sufferers have any form of bacterium present. The NIH states that up to 25% of all visits by males to Urologists are Prostatitis related!
Prostate Cancer and BPH (non cancerous swelling of the prostate gland) are well documented; there are a range of treatment protocols and very good clinical evidence of treatment success for both, yet there is little in the way of proven techniques for treating Prostatitis by Urologists worldwide! In fact most urologists prescribe lengthy courses of various antibiotics at various strengths (up to 6 months in some cases), with little or no success. I would like to state at this point that there are good success rates with patients who do have Bacterial Prostatitis (acute or chronic) through the correct use of antibiotics. For this to happen the patient needs to have the correct testing done; see a microbiologist, like Simon Rattenbury from the London Clinic and be given regular prostate massage, with secretions collected, analysed and prescribed correctly according to which bacteria are present.
Whilst we are talking about antibiotics, there were several reports in the press about resistance through the over use of antibiotics. You can certainly see how this may be applicable to Prostatitis sufferers given round after round, not to mention other health implications that come from using antibiotics for prolonged periods – http://www.telegraph.co.uk/science/9923954/Is-this-antibiotic-apocalypse.html
For me there are several reasons why Prostatitis is relatively unknown and as a result of this, poorly treated. The cynic in me may point to drug funding for research; with little or no money to be made from a condition that doesn’t respond well to prescription drugs why invest time and money into finding a cure? But that is a knee jerk reaction, I think there are a combination of factors that contribute.
A greater understanding into the condition is certainly required. I think there are probably sub groups within the 4 categories outlined by the NIH, other variants that are simply not recognised, other health conditions that effect the condition and other infections that cause flare ups etc. It is believed that STI’s often have implications in Prostatitis, Pudendal Nerve Entrapment PNE also has similar symptoms, as does Interstitial Cystitis IC, an imbalance in gut flora, candida, anxiety and stress may all cause Prostatitis like symptoms
Research is definitely required and to do this funding is undoubtedly needed. Both go hand in hand; we have seen the advances in Cancer research over the years and how these have helped sufferers and their families. For me these are the key areas that need to be addressed to gain forward momentum and progress in the understanding and subsequent successful treatment of Prostatitis.
To raise funds for research you need awareness; the awareness of Prostate Cancer is superb. Robert De Niro, Charlton Heston and Nelson Mandela are all men we know of who have openly admitted to having Prostate Cancer. Roger Kirby, Director of The Prostate Centre, one of the worlds leading experts in Prostate Cancer and my old boss, featured in an article in the Daily Mail revealing his diagnosis of aggressive Prostate Cancer and subsequent treatment – http://www.dailymail.co.uk/health/article-2291798/Prostate-cancer-In-cruel-twist-fate-prostate-cancer-experts-ALL-hit-disease-Their-stories-vital-reading-men–loved-ones.html
The vast majority of the patients I see have been prescribed heady cocktails of antibiotic after antibiotic, beta blockers, anti-depressants, muscle relaxants and given test after test; prostatic secretions, semen samples, GUM clinic visits, ultrasounds, cystoscopies, endoscopies and told that there is NOTHING wrong with them, their test results are all clear, that it must be in their head! How devastating can those words be? How much would it destroy someone’s hopes of getting better? As a pelvic pain therapist who has suffered with several bouts of pelvic pain since my mid 20’s, resulting in wrong diagnosis and a hospitalisation of 4 days with chronic epididymitis and orchitis I can empathise with the desperation Prostatitis sufferers endure; the frustration of hearing ‘it is nothing to worry about, go home, take these and come back if it gets worse!’ ‘Well I’m back and guess what, it is now MUCH WORSE..’
For this to stop there has to be a pooling of resources, a collective drive by experts and sufferers, to gather the right data, work alongside each other and create an awareness so as there can be improvements in care, support and treatment.
There are already Facebook pages, Forums and Support Groups in place, I know on many of these there is hope of change, progress and answers. So how do we move forward? Does there need to be a Prostatitis specific charity? Does there need to be a pelvic pain clinic where experts work alongside each other? Does there need to be an awareness day? Probably all of these things and much, much more..
Karl Monahan
Chronic Pelvic Pain and Prostatitis Therapist