Prostatitis, CPPS, PNE. My solution
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Prostatitis, CPPS, PNE
I am a 60 year old male and three months ago I was diagnosed with Prostatitis for which a month’s course of the antibiotic Trimethoprim was prescribed and taken. Towards the end of the period of medication it was becoming clear that the drug was having little effect. It might have made the urinary tract feel more comfortable but the major discomfort in the perineum remained.
My symptoms were ‘typical’. Great discomfort when sitting (except on the toilet) with the pain easing upon standing. They rarely caused sleepless nights as lying prone was more comfortable than sitting although a little pain was still noticeable. Having said that there was usually a point overnight where the sensation of fullness in the bladder necessitated a trip to the toilet. Other symptoms included a sensation like cystitis, fullness in the digestive system, pain in the kidney areas, pains down the inside of the thighs and a few times a stinging sensation in the scrotum.
During the initial medical the Practitioner performed a Digital Rectal Examination (DRE) of the prostate. I had expected to go through the roof with pain but there was the first surprise. The prostate gland was ‘normal’ and the DRE was painless. To me this seemed an inconsistency. More followed. My immune system has seemed absolutely fine and the only infections I have ever suffered over my career as a science teacher have been an annual cold and a small number of bouts of ‘flu’. Age apart, my lifestyle equally makes infection a low risk.
Inevitably in this information age we turn to the internet for answers and here again more inconsistencies became apparent. What exactly is Prostatitis? With perhaps fewer than 10% of cases having a clear microbial diagnosis it seems that the remaining 90% or more have very uncertain cause including vague pointers to unidentified microbes and the preferred renaming to ‘Chronic Pelvic Pain Syndrome’ (CPPS). However there is more recent thinking that for me, started to make a huge amount of sense. There is a strong movement suggesting that these symptoms are caused by pelvic instability and such instability has a likely origin in physical damage in the past plus tension and poor posture up to the present.
Up to retirement I had fewer than ten periods of absence from work. Most were for a day or two but one was for over a month. It was due to a lower spine injury that ended my 25 year career playing rugby and left me continually prone to back pain. For me retirement brought much more sitting than I was used to and often with poor posture. Add in tension of working/playing for long periods at a computer and it is easy to conceive that nerves become agitated and muscles put into spasm.
In my case I have suspicion that the damage is to the Pudendal nerve. I understand that it radiates to all the areas that have caused my symptoms; that it originates from the region of the lumbar vertebrae and passes near the sacroiliac joint which can be a point of compression during poor posture. I don’t necessarily believe I have pudendal nerve entrapment (PNE) but the symptoms are very similar. Apparently, rectifying this condition isn’t straightforward and seems mainly reliant upon lifestyle changes with possible help from physical therapy (and maybe less conventional medical approaches). It is understandable why antibiotics are used as a first line therapy. Prostatitis/ CPPS/PNE symptoms really are like those of an infection without any external signs. Antibiotics have some analgesic effect. There may well be urinary tract infection (UTI) in addition. However, that UTI in my case I strongly suspect was a secondary consequence of ‘Prostatitis’ not the primary cause of it. Many sources indicate that the muscular spasms in the pelvic floor might well cause constrictions of the urethra and subsequent pooling or backing up of urine. This in turn could become a site for infection.
This theory is all very well (after all I have no qualifications in medicine) ... but for the practical application. Only a few days ago I was in poor health with this ‘syndrome’. Through some lifestyle changes that I have made since, I no longer feel so ill and I believe that I am on the road to a vastly improved situation. With the aim of getting more stability and less inflammation in the pelvis I spend long periods lying flat on an exercise mat on the floor. I absolutely avoid sitting. I made no changes to my exercise routines, swim a couple of miles a week, walk my dogs a mile or two a day and otherwise live normally. I am fortunate that retirement gives me those opportunities. It would be a serious challenge to getting better if I had a desk bound job.
1 like, 8 replies
david26293 richardd77
Posted
Many thanks for your post - I am 60 years old
I developed what I believe to be chronic prostatitis about 8 weeks ago - don't know if it is more than a coincidence but the week before I took some Mucron decongestant which affected my urine flow .
At first my GP diagnosed a UTI
and after 2 courses of different antibiotic tablets no difference was evident -
Last week I went to see a Urologist and he agreed with my self diagnosis and we agreed to see how things are in a month or so.
I have had a PSA test which was normal and my prostate is slightly enlarged -
I do not relish the idea of long term use of antibiotic
And am hoping it will eventually clear naturally -
I do not drink or smoke and have modified my diet -
Decaf tea and coffee, drastic cut back on read meat
And Zinc supplements .
Unfortunately I have a desk job but take regular
Walks outside every hour - I believe brisk walking to be beneficial -
David
richardd77 david26293
Posted
Apologies for my tardy reply. I did start taking zinc tablets but gave these up partly because the theory behind their use wasn't that well supported by practical recovery and partly because I came across the pudendal nerve stuff.
I've added more info ... a bit OTT and you might lose the will to live reading it ... but I had a need to document it so people could give their own for/against logic.
Hope you are doing well
Regards. Richard
john02 richardd77
Posted
What solved it for me is a low dose of amytriptiline 10mg. Starting on a low dose of 5mg, increasing over three or four weeks until, in my case, 20mg once a day has removed the pain entirely. At these low levels the drug has no addictive effects.
It is necessary to persist as at first it causes some sleepiness. Experimentation showed me that if I take it about 8pm the sleepiness coincides with bedtime 10-11 pm and no sleepiness in the morning. Of course it is not a cure and is merely blocking the pain to the pelvic area - but it brought me a transformed quality of life and the ability again to do any movements, sit on any chair and so on. Worth a try, though I know it does not work for everyone. Good luck.
richardd77 john02
Posted
I think Amitriptyline can be useful. However I wish to avoid certain drugs if I can because I fly light aircraft and the CAA will suspend my licence if I am prescribed Amitriptylene etc.
I am now very convinced that I have the pudendal nerve damage version of 'prostatitis/CPPS'. Everything fits. The history, the symptoms, what aggravates it, and the method of recovery.
I am pinning my hopes on better than 90% improvement although that depends how much damage has been done. However I have found that my quality of life is now significantly better after only two weeks. This has been through avoidance of flexing at the hip e.g sitting, squatting etc.
I shall copy and paste below a reply I made in another area of the forum but it just elaborates on what I've said here so not important reading.
Thanks again for your support and good luck with your progress too
Richard
richardd77
Posted
My understanding about Pudendal nerve damage is that although the nerve originates in the lower spine the compression is usually at the sacroiliac joint (SIJ). So I interpret the damage to it as less being directly due to spinal injury itself but more to years of sitting badly compensating for that spinal injury. The recommended treatments for the two are rather different and for pudendal therapy advice is against further agitation of the nerve by any aggressive movements. It is frustrating because we want to DO something to make it better but by all accounts it seems that ‘NOT doing’ is important and while walking and swimming (not breast stroke) are appropriate there are several exercises that could at best undermine healing.
I am cautious about giving advice that I am not qualified to give. However if the main message is ‘good posture’ then it should at worst be harmless and best helpful. The danger is that readers of this might waste time trying this approach when they actually have a condition that needs medical attention. Some might consider that self help is irresponsible and that I should be further consulting with a GP. Yes and no. If I wasn’t improving then yes I would. But ‘No’ because I believe that I am on the right track and getting Pudendal nerve damage settled needs to start as soon as possible if you want to increase the chances of healing. Severely damaged pudendal nerves are potentially unrepairable. Also ‘Prostatitis’ is poorly understood so you face months possibly years of likely inconclusive tests.
Many authorities say Prostatitis is very common and Pudendal nerve damage relatively uncommon. But some of the most recent thinking states that what is diagnosed as Prostatitis, is in many cases, very likely to be Pudendal nerve damage. When possibly over 90% of Prostatitis cases have no positive diagnosis it seems very logical.
After two weeks of substituting lying on an exercise mat for sitting or even lying on the settee (it allows too much curvature) my condition has vastly improved.
maciek76755 richardd77
Posted
richardd77 maciek76755
Posted
Compared to over a year ago I am vastly improved. I would say better than 90 percent. I can sit on hard chairs for reasonable lenngths of time although I 'listen' to what my body tells me so not to aggravate any symptoms. I have not revisited my GP nor have I taken any medication.
richardd77 maciek76755
Posted