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sci.med.prostate.prostatitis FAQ2/5

From: ronk@planet.ho.att.com
Newsgroups: sci.med.prostate.prostatitis,alt.support.prostate.prostatitis,sci.answers,alt.answers,news.answers
Subject: sci.med.prostate.prostatitis FAQ2/5
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Followup-To: sci.med.prostate.prostatitis
Date: 3 Aug 1997 10:11:22 GMT
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Expires: 16 Sep 1997 10:10:46 GMT
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References: <medicine/prostatitis-faq/part1_870603046@rtfm.mit.edu>
X-Last-Updated: 1997/03/15

Archive-name: medicine/prostatitis-faq/part2
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sci.med.prostate.prostatitis FAQ Part 2 of 5

I. About sci.med.prostate.prostatitis
II. About this FAQ
III. What is the prostate and what is prostatitis?
IV. What are the symptoms of prostatitis?
V. How is prostatitis distinguished from prostate cancer 
and BPH?
VI. How common is prostatitis?
VII. Are there different kinds of prostatitis?
VIII. What causes prostatitis?
IX. Can prostatitis be cured?
X. What can be done to alleviate symptoms?
XI. Why is this newsgroup necessary?
XII. How can we work towards a cure?
XIII. What is a DRE?
XIV. Is there some way to make bike riding less painful? 
XV. Is there some way to make sitting more comfortable?
XVI. What happens during a TRUS?
XVII. What happens during a cystoscopy and why should I 
have one?
XVIII. What can be done to prevent prostatitis
XIX. What is Prostate Drainage and why does it help?
XX. Can prostatitis be sexually transmitted?
XXI. Does vasectomy lead to prostatitis?
XXII. How can I post a question to the newsgroup if I don't 
have a news reader or news service
XXIII. Are the Newsgroup posts Archived anywhere?
XXIV. The Glossary
XXV    Beginners guide to do-it-yourself prostate massage. 

This segment contains X through XX.

X.  WHAT CAN BE DONE TO ALLEVIATE SYMPTOMS?

When prostatitis is not cured, several things can be done to help
alleviate symptoms.  Not all of them work for everyone, and the best
techniques for you must be found through trial and error.

Water:  It is important to drink plenty of water.  The natural 
reaction to urgency and frequency problems is to cut back on 
fluid intake.  However, this is a mistake.  You risk dehydration and
the urine becomes so strong that a bladder infection is more likely. 
Drinking lots of fluid keeps the retained urine in the bladder fairly
dilute and reduces the risk of bladder infection and dehydration.

Prostate Drainage:  Draining the prostate regularly can often 
provide some or complete relief of symptoms. (XIX)

Dietary changes:  Caffeine, alcohol, spicy foods and/or acidic 
foods may irritate the prostate, and most doctors recommend 
either eliminating them or using them very lightly.  Some 
doctors recommend the Gillespie diet used in cases of interstitial
cystitis, which avoids acidic foods such as citrus fruits and
tomatoes.  (See the book, _Living with Cystitis_, by Dr. Lauren
Gillespie.)  Several newsgroup readers claim yeast reduction diets
have helped them.

Avoid decongestants and antihistamines:  Sudafed, Tavist-
D, Contact, Afrin etc. are all labeled with warnings in fine print not
to use if you have an enlarged prostate or BPH.  This warning should
be written in large letters on the front of the package.  These appear
to cause the prostate to contract which decreases urine flow.  There
is also some evidence that they tend to make the prostatic secretion
thicker and more prone to forming clogs.

Exercise:  Often walking will help.

Frequent ejaculation:  Frequent ejaculation (2-3 times per 
week) is recommended in many sources, particularly when using 
antibiotics.

Hot sitz baths:.  Hot sitz baths, in which the perineum is 
bathed in a pan of very hot water for at least 20 minutes, seem 
to reduce pain in many cases.

Avoid constipation:  Large hard bowel movements can press 
on a swollen prostrate and cause considerable pain.  Eat more 
bran (found in any bran cereal and in most whole grain bread) 
and try to train yourself to be as regular as possible.  Note:  
Some men have reported that a large hard movement, while 
painful at the time, actually brought some relief of symptoms.  It is
thought that the hard movement acts as a sort of primitive prostate
massage and promotes drainage.

Analgesics:  Over-the-counter analgesics (aspirin, Tylenol, 
Nuprin, Aleve, etc.) may help control pain.

Stress reduction:  Symptoms can worsen because of 
psychological stress, and changing your situation to avoid stress and
reduce blood pressure, meditation or biofeedback techniques have
helped some men.

Ice:  Ice packs sometimes help when heat doesn't.  Several 
readers have even been told by their doctors to put an ice cube 
into water until it has lost its sharpness and shrunk to a 
reasonable size and then insert the ice into their rectum.  They
report hours of relief from the pain.

Chinese Herbs:  Kai Kit Wan and Sexoton are sometimes 
helpful.  http://www.prostate.org/chinesepills.html.

Acupuncture:  A few readers have found some relief through 
acupuncture.

Antidepressants:  Prescription antidepressants, taken daily at 
a level lower than that normally prescribed for real cases of 
depression, have also helped in some cases.

Other alternative herbs and treatments:  See the 
Alternative FAQ.

XI.  WHY IS THIS NEWSGROUP NECESSARY?

Compared with prostate cancer, prostatitis has had little 
attention from researchers.  It is not life-threatening, and it is
difficult to treat.  Most urologists are unwilling to put much effort
into determining its causes and providing treatment. We hope to use
this forum to push for further research on prostatitis, with a view to
finding cures by the year 2000.

Many men are embarrassed by the problems caused by 
prostatitis, and put off seeing doctors or discussing the problems
with friends and family.  This newsgroup is a place where we can
exchange information and help make each other's lives a little easier.

XII.  HOW CAN WE WORK TOWARDS A CURE?

Call, write, or email your Congress Member or Senator.  Tell 
him or her how badly research into the causes and treatment of 
prostatitis is needed.  

Many now have their own webpages with email links:

To find the master list of House member's pages, go to:
http://www.house.gov/MemberWWW.html
Senate addresses are at:
http://www.senate.gov/senator/members.html

Support the Prostatitis Foundation with a (US tax deductible) 
check:
680 South Federal St., Suite 601
Chicago IL 60605

In May, 1995, members of this newsgroup founded The 
Prostatitis Foundation.  Relying on volunteers the foundation is
working to increase research into this ignored disease and provides a
clearing house for prostatitis related information.  The foundation
provides the website at http://www.prostate.org which currently
contains more than 10 megabytes of information on prostatitis
including an archive of all significant postings to the newsgroup.

Illinois State President - DadOfSix@aol.com
Wisconsin President - Maverick@msn.fullfeed.com
Artist and Production Manager - Oahu67@msn.fullfeed.com
Keeper of FAQ - JohnnK@aol.com and ronk@planet.ho.att.com
Scientific advisor:

Brad Hennenfent, MD, FACEP
680 S. Federal St., Suite 601
Chicago, IL 60605
Fax: (312) 786-9437
Email: BCapstone@aol.com

XIII.WHAT IS A DRE?

A DRE (Digital Rectal Examination) is a procedure where the 
doctor inserts his finger  (the Digit) in the patient's anus (the
entrance to the Rectum) in order to feel the condition of the
prostate.  While this sounds rather uncomfortable it is not as bad as
it sounds, especially if you know what to expect.

The patient drops his underpants and bends over the 
examination table resting on his elbows.  Some doctors believe it
makes the whole procedure a little easier if the patient stands with
his feet turned so that the toes are inward (pigeon-toed) and may so
instruct the patient.  While the patient is getting comfortable the
doctor puts on a latex glove and applies a large amount of KY jelly to
the index finger.  The index finger is applied to the target area and
slowly pushed inside.  

Once the finger is inserted as far as it will go the doctor presses
downward and moves his or her finger around to judge the size, shape,
and degree of firmness of the prostate.  It is also possible to detect
small nodules or growths which may indicate the presence of cancer. 
The doctor will usually ask if the pressure on the prostate hurts. 
The patient should reply as truthfully as possible.  This is not the
place for male stoicism!  A painful, swollen, prostate may have an
abscess which could make further examination very dangerous.

The doctor should (but many unfortunately do not, preferring 
instead to immediately prescribe an antibiotic and get on to 
their next patient) next press hard enough to force some 
prostatic fluid out for further tests.  It is important not to tense
up during this procedure.  The patient may feel like he is about to
urinate all over the nice clean floor but this will not happen.  He
may feel a few drops of prostatic fluid moving up the penis and if the
doctor presses hard enough a few drops may actually land on the floor.
 The doctor expects this to happen and will be pleased and not annoyed
or angry.  (I wish doctors would put a paper towel or something on the
floor to catch any "spillage" and explain what they are trying to do
but most seem to think the patient already knows and we men like to
pretend we already know it all so we don't ask.  It was not until my
6th DRE that I finally understood what the doctor was trying to do and
that was only after he complained about not getting any EPS.  And I
was so proud of holding it back and not making a mess on the floor! 
Oops!)  The patient should relax as much as possible and allow the
fluid to come out.  The doctor will usually collect this fluid either
on a microscope slide, on a swab, or in a small jar.  This is the same
EPS which Dr. Feliciano's drainage method attempts to get.  

When the examination is completed the patient is given a box of 
tissues and is expected to wipe off the excess jelly before pulling
his underpants back up.  Some doctors will immediately examine the
specimen under a microscope to see if there are any white blood cells
(WBC).  This is generally considered a sign that there may be an
infection present.

Ideally the fluid will be sent to a lab for culturing and 
sensitivity testing to determine first, what the pathogen is, and
second, which antibiotics can kill it.  It may take up to a week or
more to get the results of the culturing.

XIV.  IS THERE SOME WAY TO MAKE BIKE RIDING 
LESS PAINFUL?

Suggestions from fellow prostatitis sufferers who still ride:

Jonathon:  Try the seats with cushions only on the outside.  
Often sold for women bikers.

Ken:  Keep the saddle tilted down in front as far as it will go. 
Terry TSI and Serfa seats work for me.

Elliot:  Use after market gel pads.  Also try a light hard seat.

Someone else suggested trying one of the bikes you ride laying 
down.

XV.  IS THERE SOME WAY TO MAKE SITTING MORE 
COMFORTABLE?

Doughnut cushions are recommended by many sufferers.  These 
were originally designed for hemorrhoid sufferers but work well 
for prostatitis too. Usually available at drugstores and 
pharmacies for a nominal cost these come in foam and inflatable 
versions.

Other sufferers say a hard chair is easier on the prostate.

XVI.  WHAT HAPPENS DURING A TRUS?

A TRUS (TransRectal UltraSound) uses ultrasound to check the 
prostate for tumors and cysts.  This is a common test which you 
may experience at your doctor's office.  Really not much worse 
than a DRE.

The following is an excerpt from a posting to the newsgroup in 
which a fellow sufferer shares his experience:

Jim: I went in the room with the ultrasound machine, and the 
nurse asked me to sign a consent for the ultrasound and another 
for a biopsy. I said, wait a minute, I'm a motivated patient and I'll
undergo any pain, but a biopsy doesn't seem appropriate. We want to
try to get rid of bacteria already in the prostate, not introduce new
ones. She went and spoke to the doctor and came back and said, OK, no
biopsy. She said usually when they do the ultrasound, they're looking
for cancer, etc. I mention all this because it speaks to two newsgroup
themes: the nurse is not accustomed to taking prostatitis seriously,
and the more the patient knows and speaks up, the better. In this
case, I don't think the doc planned to do a biopsy. 

He came in at this point and I commented something about 
giving him the manila folder before he scrubbed. He said he 
wasn't going to scrub, his hands were probably a lot cleaner 
than my rectum. 

The ultrasound probe did not look quite Dr. Tarfusser's cartoon. It
was like a stick with a knob, kind of like the grip end of a baseball
bat, but only a couple centimeters on the largest diameter of the
ellipsoidal knob. The screen of the electronics showed the doc's name
and mine. So, I stripped to an undershirt and got on the table with
butts toward the electronics. The doc came back, I tried to relax.
Somebody put a condom (or similar) over the probe, then some slippery
goo, then the doc maneuvered the knob into the rectum.

I felt just a moment of pain and then it was your basic weird 
medical experience. I asked the doc if I could have a picture, he said
yes. Then he spent quite a while scanning different things. The
instrument had a flat keyboard (waterproof, cleanable). He worked the
probe with his right hand, commented that he couldn't type very fast
with just the left hand. So, he's working this thing around, then
stopping to go tap-a-tap with the other hand, I guess reaching across.
We chat pleasantly about what he sees: a small cyst (not sure about
the term) on a seminal vesicle that he might treat if the drainage,
etc, doesn't cure me. Big stones near the urethra, including some in
"the front" of the prostate where he says the massage can't reach.
(I'm not clear what this means.) But apparently there are some stones
that might yield to crushing and pushing them out. He also sees a
small anomaly in the prostate (abscess?) that is apparently a cancer
candidate ("food for thought," he says). In the end, he decides there
is no cancer or cyst that will prevent us from proceeding with the
drainages. 

XVII WHAT HAPPENS DURING A CYSTOSCOPY AND 
WHY SHOULD I HAVE ONE?

A cystoscopy uses a flexible fiber optic device which is inserted into
the urethra via the opening at the end of the penis.  It allows the
doctor to visually examine the complete length of the urethra plus the
bladder for polyps, strictures, abnormal growths and other problems.  

For a male this is probably the scariest test there is.  The 
thought of having something pushed down that little hole in the 
penis makes the skin crawl but as the following posters agree it is
not that bad in practice.  However, do insist on the most sterile
settings and procedures.  It is possible to introduce bacteria into
your bladder and prostate this way.  Patients are usually given a 3
day course of a powerful antibiotic to prevent an infection.  This is
important so insist on it.

John:  I've had this numerous times.  The first two were under 
anesthesia.  The last few have been office procedures with local
deadening.  My experience has not been as bad as it may sound.  It's
not that there is *no* pain or discomfort.  There is, but it isn't
anywhere near extreme.

My office procedures have gone as follows.

(1) A nurse gives a betadine wash, then inserts some deadener 
into the urethra, puts a clamp in place, and leaves for 15 
minutes or so.  The insertion of the deadener may be the most 
uncomfortable part of the whole procedure, but it doesn't take 
very long and it isn't all that bad.

(2) During the cysto itself, I have been uncomfortable but not in much
pain.  Again, this doesn't take very long - a few minutes - perhaps
less than 5.

(3) You may have a little blood on urinating, and possibly a little
pain, for a few days.

Roger: I have had two cysto's.  Since I have other kidney 
problems in
addition to my prostatitis, then for me they are merited.

If you have a problem, even if it turns out to be only prostatitis,
then you need to have the proper check-up.  You need to know what is
going on in there.  The cysto will check for physical problems,
obstructions, stones, etc.

Is it painful?  No, only for the ego.  I found it deeply 
embarassing and for my second trip, I elected to be put under.  
After the drugs wear off, your first few urinations will be A LOT OF
FUN!

The cysto did nothing for me related to prostatitis, but just 
eliminated cancer and urethral obstructions.  

Ed: in my case, cystoscopy turned out to be of the utmost 
importance and benefit as it disclosed a malignant polyp in my 
bladder which had simulated very well the symptoms of BPH 
and/or prostatitis.  There was no blood in my urine which is a 
classic indicator of bladder cancer.  According to my urologist, the
urine test for cancer was negative prior to the cystoscopy.

So, I cast a definite vote for having it done.  It is not comfortable
but not as bad as you think it will be.  Good luck!

Don:  I've had cystoscopic exams every three months for the past four
years because of a recurring bladder cancer.  IT IS VITAL THAT YOU
DETERMINE IN ADVANCE WHAT KIND OF EQUIPMENT YOUR UROLOGIST WILL USE.

If he uses a flexible telescoping cystoscope, the process is 
psychologically demeaning, but painless.  (Stretching a stricture is
not painless, but I know it can often be done quickly in a doctor's
office and kept open by occasional restretching.)

If he has a rigid cystoscope RUN, do not walk, to another 
urologist; I found those agony.

In either case, I found it is important to drink a lot and keep the
urine dilute to avoid discomfort on urination.  When I tried not to
drink, so I didn't have to urinate, it really hurt when I did for the
first day.   Now I drink a lot of iced tea and pee away without
discomfort.  

Be sure to get a good antibiotic for a 2-3 days following a 
cystoscopic exam.  Avoids infection from the process.

Really, with a flexible telescoping cystoscope it is no big deal.

WV:  An attempted cystoscopy was unsuccessful because of a 
narrowing or stricture at the bladder neck which prevented 
entry into the bladder and revealed that the stricture was 
indeed the cause of my symptoms.

Once the stricture was relieved via mechanical dilation the 
prostatitis symptoms were gone and a normal cystoscopy was 
possible without undue discomfort.

It's my (largely uninformed) opinion that many prostate 
symptoms are caused by strictures, especially at the bladder 
neck, and can be easily eased with dilation or a quick 
transurethral "snip" by a good urodoc.  Mine has suggested such 
a procedure but so far I have opted for periodic "stretches" and not
the knife. Quite satisfactory.

The "flex" scopes which are now used are virtually painless 
...unlike the old "iron bar of a few years ago.  I think it should be
used early on to look for scarring, strictures and other problems in
the urethra that could be causing the symptoms.  I believe these are
quite common and largely overlooked until late in the diagnosis
process.  In my case it was after 8 months of Bactrim and floxin that
they decided to scope it.  All those months of discomfort and worry 
when it was something simple all along.

XVIII WHAT CAN BE DONE TO PREVENT PROSTATITIS

While it is too late for most of us, many of us have sons or 
brothers who we would like to save from this disease. Those who 
do find a cure are also interested in not catching it again.  The
following suggestions are based on a combination of Dr. Feliciano's
theory of the causes of prostatitis and on some other material
discovered during research for this FAQ.

Good hygiene is a must.  Always use clean underwear and bathe 
or shower daily.  If not circumcised, the foreskin should be 
pushed back and the glans washed daily.  Wash hands BEFORE 
handling the penis and after using the toilet.

Never swim or bathe in polluted water.

Avoid unprotected sex.  Use condoms at all times.  If you don't 
use a condom, limit exposure to E coli bacteria by avoiding the 
anal area of your partner.  (Make sure you and your partner 
have bathed or showered since the last bowel movements.  Dr. 
Feliciano recommends a betadine wash once daily to prevent a 
recurrence in his cured patients.)  Urinate soon after sex.  Never
have unprotected sex with anyone suffering from a urinary tract,
bladder, or kidney infection, interstitial cystosis, venereal disease,
or yeast infection.

Keep up your body's resistance by making sure you have enough 
zinc, copper, and vitamin C in your system.  (Note:  White spots on
the fingernails are considered a sure sign of a zinc deficiency.)  

Drink plenty of fluids and void them as soon as you feel the 
urge.  Do not try and hold it because it is not convenient. 

Exercise and get enough sleep.

Avoid the use of over-the-counter and prescription cold and 
allergy medicines which have a warning not to use with 
enlarged prostate, prostatitis, or BPH.  These may contribute to acini
clogging.

Have an ejaculation at least two or three times a week even if 
you have to masturbate.  If your arms are long enough to do a 
DRE on yourself, learn to inspect and drain your own prostate.  
Regular drainage may keep the acini from clogging up and 
becoming infected.

Know the early signs of prostate trouble and get treatment 
immediately.  (Slower urination, more frequent urination, 
waking regularly at night to urinate, bad/strong smelling urine,
increase in wet spot on underwear.)

XIX  WHAT IS PROSTATE DRAINAGE AND WHY DOES 
IT HELP?

The prostate is made up of many small glands called acini.  
Normally these produce and store a small amount of fluid and 
the overproduction is allowed to drain into the urethra where it is
thought to perform an important antibacterial service.  During an
ejaculation the stored fluid is forced out by contractions of the
smooth muscle of the prostate.

If an acinus becomes clogged, for whatever reason, it no longer 
has any way to get rid of the overproduction, but continues to 
produce fluid.  This cause the pressure inside of the acinus to 
increase so that the acinus gradually begins to fill up and 
expand like a balloon.  Eventually the limit of expansion is 
reached and the acinus becomes hard like a ball with too much 
air pumped into it.  

One bloated acinus probably has little effect since they are very
small but when enough become clogged the inside of the prostate gets
crowded and the urethra which passes through the  prostate begins to
feel the effect.  

Prostate drainage is a method of relieving the pressure by 
forcing the acini to drain thus relieving the pressure.  The 
principle is very similar to squeezing a pimple to open the pore.

Prostate drainage appears outwardly like a DRE.  The same 
position is assumed by both parties.  The main difference is that
instead of lightly pressing on the prostate, the doctor puts as much
pressure as he or she can (or as much as the patient can stand
whichever is less) on a small area of the prostate.  Starting at the
far (most inside) left (or right) as much pressure as possible is
applied to the prostate.  The gloved finger is then moved slowly to
the center of the prostate.  Then the finger is pulled out a little
and the movement repeated until the whole lobe of the prostate has
been treated.  Then the movement is repeated on the other lobe. 
Finally the prostate is drained down the center line from deepest to
shallowest end.

If done properly and with enough pressure (and if the patient 
relaxes), several drops of prostatic secretion will appear at the end
of the penis.  (If no drops appear, a gentle stroking of the perineum
from back to front will usually force out enough for culturing.) 
Sometimes it takes several consecutive drainages before the first
drops begin to appear.

Drainages should be on a regular basis, ideally 2 days apart but no
more than three.  A hot sitz bath before the drainage is a good idea. 
Sexoton and Kai Kit Wan (Chinese herb pills) may actually make the
drainage more productive.

Drainages do not necessarily have to be done by a doctor.  Self 
drainage is also possible with long arms or the use of the 
"Crystal Clear Wand."  A partner can also do the drainages.  See
http://www.prostate.org/doityourself.html

XX CAN PROSTATITIS BE SEXUALLY TRANSMITTED?

If you ask a doctor you will probably be told that it cannot.  
Perhaps this is because women have no prostate so technically 
speaking this is true.  However, if the prostatitis is bacterial or
fungal in origin then it is quite likely that the pathogen, whatever
it may be, can be passed back and forth between partners.  There have
been many postings to the effect that "my spouse had this disease and
then I got prostatitis" or the reverse "I have prostatitis and every
time I visit my girl friend she comes down with a UTI or yeast
infection."  While these episodes do not prove that it can be
transmitted sexually it seems strange that the most doctors feel so
strongly that it can not.  

Some doctors, however, do say that the prostatitis pathogens can be
passed back and forth between couples.  Dr. A. E. Feliciano is a
strong advocate of this theory and for that reason prefers to treat
both partners at the same time.  Backing up his theory is a recent
study which claimed that 30% of all American women were vaginal
carriers of some of the same bacteria known to cause prostatitis. 
Another study using a more sensitive test than usually available has
shown that around 15% of American women are infected with Chlamydia
and that their male partner had a 68% chance of also having the
disease.  Chlamydia has also been known to cause prostatitis.

Other doctors, seem to say both yes and no.  Dr. Alexis Te of 
Columbia-Presbyterian Medical Center in NY on his website at:
http://cpmcnet.columbia.edu/dept/urology/prostatitis.html
says:

"Acute and chronic infectious prostatitis are not usually 
considered sexually transmitted diseases."

but then later in the same article he says:

"You are at higher risk for getting prostatitis if you...engage in
rectal intercourse or oral sex..."

It would seem to be wisest to assume that it is sexually 
transmittable in either direction and take the usual "safe sex" 
precaution of using a condom.