PROSTADYNIA

(PROSTATODYNIA)

The Wise-Anderson Protocol (Stanford Protocol) successfully treats a large majority of men with diagnosed with prostadynia (prostatodynia)

Prostadynia (Prostatodynia) is an outmoded term although sometimes still used as a term to diagnose men with symptoms identical to what is more commonly called prostatitis, chronic pelvic pain syndrome, or pelvic floor dysfunction.  A large group of men diagnosed with Prostadynia have been significantly helped by the Wise-Anderson Protocol (popularly called the Stanford Protocol) 

This new treatment was developed at Stanford University and is typically caused by the chronic contraction or spasm of the muscles of the pelvic floor and perpetuated by a self feeding cycle of tension, anxiety, pain and protective guarding. Even though the name implies prostate pain or discomfort in the area of the prostate, the prostate gland is rarely a cause of prostadynia.  

While symptoms include  pain or discomfort typically felt in the genitals, perineum and areas up inside where the prostate is located, as well as urinary frequency and urgency, post ejaculatory pain/discomfort, sitting pain etc.,  there is typically no infection of the prostate gland and treating the prostate gland with antibiotics, alpha blockers and anti-inflammatory drugs does not resolve symptoms. Even when inflammation is found in the prostate, treating the inflammation is usually unsuccessful because the problem is not with the prostate gland but the chronically contracted muscles of the pelvic floor. 

 

Definition, symptoms, diagnosis, causes of prostadynia (prostatodynia)  and the Wise-Anderson Protocol.

 

Some men with prostadynia say that they don’t actually feel pain but some variation of discomfort, aching, burning, fullness, squeezing, tightness, sharp or dull sensation.  Typical symptoms include one or more of the following.

 

SYMPTOMS OF PROSTADYNIA (PROSTATODYNIA)

 

  • Genital pain/discomfort, anal and rectal pain/discomfort, pain/discomfort in the perineum, suprapubic (above pubic bone) pain,  pain/discomfort in bladder area, tail bone pain, groin pain, low back pain
  • Pain/discomfort when sitting (often feels like a golf ball), post bowel movement pain
  • Urinary frequency, urgency, hesitancy, burning, frequent night time urination
  • Sexual pain including orgasm and post orgasm discomfort (often the next day)
  • Anxiety, depression, helplessness regarding symptoms

 

For a more complete list of prostadynia symptoms SEE BELOW

 

 

SCHEDULE OF 6 DAY WISE-ANDERSON (STANFORD PROTOCOL) IMMERSION CLINICS IN CALIFORNIA FOR PATIENTS WITH PROSTADYNIA (PROSTATODYNIA)

 

Qualifying patients with prostadynia (prostatodynia) can receive treatment in the monthly comprehensive 6 day Stanford Protocol immersion clinics held in northern California or in Concierge Treatment for a single patient  alone over a period of 1-10 days in a chosen location.  One of the central purposes of treatment offered is to teach patients to self administer the Stanford Protocol at home so that little if any additional professional help is needed when patients return home.  For information about eligibility for the clinic and a schedule of dates for these clinics, click below.

 

CLICK HERE TO GO TO SCHEDULE

 

 

 

Symptoms of prostadynia

•           Urinary frequency (need to urinate more than once every two hours)

•              Urinary urgency (hard to hold urination once urge occurs)

•              Discomfort or pain in the rectum (feels like a “golf ball” in the rectum)

                •              Sitting is uncomfortable or painful 

                •              Pain or discomfort during or after ejaculation (post ejaculatory discomfort)      

                •              Penis discomfort or pain (commonly at the tip or shaft)

                •              Testicle discomfort or pain (on one side or both)

                •              Pubic bone or bladder discomfort or pain (suprapublic pain)

                •              Perineum discomfort or pain (area between the scrotum and anus)

                •             Tailbone discomfort or pain (coccygeal pain)

                •              Low back discomfort or pain (on one side or both)

                •              Groin discomfort or pain (on one side or both)

                •              Pain or burning during or after urination (dysuria)

                •              Frequent night time urination (nocturia)

                •              Reduced urinary stream

•              Dribbling of urine after urination

                •              Sense of incomplete urination

                •              Hesitancy before or during urination or difficulty starting urination

                •              Reduced sex drive and anxiety about having sex (reduced libido)

•              Difficulty maintaining an erection  (erectile dysfunction)

                •              Discomfort or relief after a bowel movement

                •             Anxiety and pessimism about condition

                •              Depression

                •              Social withdrawal and impairment of intimate relations

                •              Loss of self-confidence

•             Alcohol either relieves or aggravates symptoms

•              Hot bath, shower or heat temporarily helps alleviate symptoms

•              Valium, Xanax, Ativan, Clonipin, Ambien (benzodiazepines) temporarily can

reduce symptoms (but are not recommended as any long term treatment)

 

 

ADDITIONAL INFORMATION ON PROSTATODYNIA (PROSTATODYNIA)

 

The understanding and definition of prostatodynia, including its symptoms, causes, risk factors, diagnostic tests, the understanding of its complications and other relevant matters is currently in transition.  The treatment, drugs, lifestyle issues and concepts about home treatment are also in transition.  What was formerly considered alternative medicine for this condition has been shown to be far more effective than conventional treatment.  That is to say that direct physical and behavioral treatment that is the substance of the Wise-Anderson Protocol has often been far more effective and safer in the treatment of prostatodynia  than the conventional treatment of drugs and surgery.

Below are excerpts from A Headache in the Pelvis on prostatodynia (see category IIIB prostatitis).

 

Categories of Prostatitis (including prostatodynia)

 

Note: prostatodynia (prostadynia) refers to the same condition as category IIIB Prostatitis.  Below, we review all the categories of prostatitis including category 111B Prostatitis which is what Prostadynia refers to.  The reader should note that his confusion about this subject is often the confusion of his doctors as well. Prostadynia is typically not a prostate issue even though it sounds like a prostate issue, but a problem of muscles that have been tightened up inside the pelvic floor for too long.  If you have difficulty understanding this, please call our office and we will help you understand  all of this.

 

Category I – Acute Bacterial Prostatitis

 

Description

 

Acute Bacterial Prostatitis is quite clear both in its diagnosis and in its treatment. Infection and inflammation are evident and traditional treatments work well. We do offer the idea that chronic pelvic tension may be its initiating cause. 

 

It can occur at any age and manifest with symptoms such as fever, chills, pain, and urinary dysfunction. Positive findings involving the presence of white blood cells in the urine confirm this diagnosis. Acute bacterial prostatitis develops relatively quickly and is often associated with a feeling of being sick. Newer antibiotics produce good results. It is important to have this condition treated quickly because of the risk of the spread of bacteria into the bloodstream, retention of urine, and potential abscess formation. Chronic bacterial prostatitis can develop from acute bacterial prostatitis that is poorly treated. Antibiotic therapy should be extended to 28 days to assure eradication of the infection.

 

Symptoms

 

                •               Fever and chills

                •               Prostate pain

                •               Dysuria

                •               Lower back pain

                •               Perineal pain (pain between the anus and scrotum)

                •               Difficulty urinating

                •               Urinary retention 

 

Because of retention of urine due to swelling of the prostate gland, a catheter may be inserted into the penis to allow for proper flow of urine. While this catheter may increase the risk of prostatic abscess or infection in the gland, catheterization is an important part of therapy when there is urinary retention. Some men with acute urinary retention may be better served with a small plastic catheter inserted directly into the bladder through the skin of the suprapubic area.

 

Factors associated with onset

 

                •               Migration of bacteria up the urethra

                •               Unprotected anal intercourse

                •               Immune disorders

                •               Urinary retention or instrumentation

 

Prevalence  

 

                •               Relatively rare (approximately 5% of reported diagnoses of

prostatitis)

 

 

Tests for Diagnosis

 

                •               Urinalysis (microscopic inspection)

                •               Culture of urine (important and often neglected by physicians)

 

Traditional treatments used

 

                •               Antibiotics (muscle injection of aminoglycosides or penicillin, oral fluoroquinolones)

 

Success of traditional treatment

 

                •               The most successfully treated type of prostatitis

 

Category II – Chronic Bacterial Prostatitis

 

Description

 

Chronic Bacterial Prostatitis represents a more difficult condition than acute bacterial prostatitis. Most chronic bacterial prostatitis develops because of inadequately treated acute prostatitis. Men who have recurrent bacterial colonization of the urethra because of poor hygiene, poor sexual practices, or a need to instrument the urethra may have bacterial colonization and infection. Men who have strictures or scar tissue in the urethra that narrow the tube restricting urinary flow may be prone to developing recurrent bacterial infection. Often there is no bacterial growth in the bladder and one can be completely asymptomatic between episodes of acute flare-up, at which time the bacteria grow, spread, and begin to infect the bladder. This is a hallmark of chronic bacterial prostatitis. Men are usually free of symptoms between episodes.

 

Symptoms (may be intermittent or constant)

 

                •               Urinary frequency (need to urinate more than every two hours)

                •               Dysuria (pain or burning during urination)

                •               Recurring urinary tract dysfunction with poor flow, hesitancy, and nocturia (frequent voiding at night). These symptoms also mimic enlargement of the prostate gland.

                •               Symptoms are intermittent depending on the bacterial burden. In an individual, repeated episodes tend to be associated with the same bacteria.

 

Factors associated with onset

 

                •               Inadequately treated acute bacterial prostatitis

                •               Calculi or stones in the prostate

                •               Uncircumcised, with poor hygiene

 

 

Prevalence

 

                •               Relatively rare (approximately 5% of all men who have prostatitis)

 

Tests for diagnosis

 

                •               Localized urinary and prostate fluid cultures are very important but often neglected by physicians

                •               Positive bacterial localization from prostate during periods with no symptoms

 

Traditional treatments used

 

                •               Fluoroquinolone antibiotics have proven to be the most effective, usually requiring a minimum of six weeks of therapy

                •               Nitrofurantoin can suppress flare-ups of infection but does not eradicate the organism

                •               Occasionally, because of enlargement of the prostate with age and the occurrence of multiple stones in the prostate, a patient may                 benefit from transurethral resection of the recurrently infected tissue

 

Success of traditional treatment

 

                •               Antibiotics are usually effective for acute flare-ups

                •               Eradicating  recurrent episodes is difficult. Antibiotics used for this condition may become less effective over time because the bacteria may mutate and become resistant

 

Category III – Chronic Nonbacterial Prostatitis (sometimes with inflammation IIIA, or without inflammation IIIB).  This is the category of prostadynia (prostatodynia)

 

Description

 

Chronic Nonbacterial Prostatitis represents by far the largest number of cases of men diagnosed with prostatitis. It has been estimated that this category involves 90-95% of all cases diagnosed as “prostatitis.”  In terms of numbers in the United States, this condition affects tens of millions of men at some time in their lives. Recent research has increasingly pointed out that conventional ideas and treatments for nonbacterial prostatitis have simply failed to both explain and treat the problem. Traditional approaches have treated this kind of prostatitis as an infection, although in recent years, doctors have acknowledged their befuddlement about the cause and cure of this condition. In 1995, the National Institutes of Health, in a consensus conference on prostatitis, acknowledged that the terms chronic nonbacterial prostatitis and prostadodynia, neither explained nor were even related to the symptoms. A new name was then adopted for this condition: chronic pelvic pain syndrome (CPPS).  In changing the name of the most common disorder seen by urologists, there was the clear implication that the prostate could not be indicted as a cause of this disorder.

 

Studies have shown that men undergo severe impairment in their self-esteem and their ability to enjoy life in general because the pain and urinary dysfunction is so profoundly intimate and intrusive. The effect on a person’s life with nonbacterial prostatitis has been likened to the effects of having a heart attack, having chest pain (angina), or active Crohn’s disease (bleeding/inflammation of the bowel). If nonbacterial prostatitis moves from a mild and intermittent phase to a chronic phase, sufferers tend to live lives of quiet desperation. Having no one to talk to about their problem, usually knowing no one else who has it, and receiving no help from the doctor in its management or cure, they often suffer depression and anxiety.

 

Symptoms (may be intermittent or constant and include one or more of the following)

 

                •               Discomfort/aching/pain in the rectum (often described as a “golf ball” 
                   in the rectum)

                •               Sitting triggers or exacerbates discomfort/pain/symptoms

                •               Pain or discomfort during or after ejaculation

                •               Reduced libido (reduced interest in sex)

                •               Urinary frequency (need to urinate often, usually more than once                                              every two hours)

                •               Urinary urgency (hard to hold urination once urge occurs)

                •               Discomfort/pain in the penis (commonly at the tip or shaft)

                •               Ache/pain/sensitivity of testicles

                •               Suprapubic pain (pain above the pubic bone)

                •               Perineal pain (pain between the scrotum and anus)

                •               Coccygeal pain (pain in and around the tailbone)

                •               Low back pain (on one side or both)

                •               Groin pain (on one side or both)

                •               Dysuria (pain or burning during urination)

                •               Nocturia (frequent urination at night)

                •               Reduced urinary stream

                •               Sense of incomplete urinating

                •               Hesitancy before or during urination

                •               Anxiety about having sex

                •               Discomfort or relief after a bowel movement

                •               Anxiety in general

                •               Depression

                •               Social withdrawal and impairment of intimate relations

                •               Impairment of self-esteem

 

Nonbacterial prostatitis is a condition that produces much suffering. There are no curative drugs or effective surgical procedures. We reiterate several times in this book that

we have never seen surgery be helpful for this condition as it usually complicates the condition and sometimes makes it worse. Antibiotics are not useful here. Experimental treatments have been attempted and have also failed. These treatments include acupuncture, reflexology (foot acupressure), magnetotherapy (magnets inside the rectum), broccoli, optical-quantum-generator radiation therapy, rectally-administered ultrasound, bee pollen, corticosteroids, mud therapy, intrarectal electrical stimulation, saw palmetto (herb), and zinc (mineral).

 

What is often more troubling to men who have this condition than their actual physical symptoms is the depression and discouragement that comes from their helpless and catastrophic thinking. Many doctors are less than enthusiastic to treat nonbacterial prostatitis because they know that they have very little to offer the patient. This often leads patients to feel that no doctor gives them any time or consideration when they seek help for this problem.

 

Furthermore, it is common to see high levels of anxiety in men with nonbacterial prostatitis because of their fear that their symptoms indicate they have cancer or some undiagnosed catastrophic disease.

 

The desperation of men with this condition leads some of them to find doctors who do heroic and unwarranted kinds of interventions. In our clinic we have seen patients who have had resection or removal of prostate tissue or years of antibiotics, all in the service of “doing something” about the problem.

 

Factors associated with onset (may include one or more of the following)

 

                •               High periods of stress

                •               Weight lifting

                •               Pelvic surgery

                •               Anxiety-producing sexual encounter

                •               Trauma to the pelvis

                •               Bacterial prostatitis

                •               Compulsive sexual activity or masturbation

                •               Prolonged sitting at work

 

Prevalence

 

                •               It has been estimated that up to 50% of all men at some time in their lives (in U.S., tens of millions) suffer from this condition.

 

Tests for diagnosis

 

                •               Absence of significant bacteria as determined by culturing and counting load from the prostatic secretion. This requires laboratory bacterial culture

                •               Microscopic analysis of prostatic fluid to determine the presence of white blood cells or inflammation.  This category may involve inflammation or be completely without inflammation

                •               Analysis of urinary bladder and pelvic floor behavior utilizing physiologic testing (urodynamics) such as urine flow rate, retention of urine, measurement of bladder pressure, and nerve activity

                •               Digital rectal examination and prostate serum enzyme to rule out cancer or other abnormalities of the prostate

                •               Transrectal ultrasound (TRUS) may be beneficial to evaluate the image of the prostate and sperm storage organs (seminal vesicles), but most importantly to perform prostate biopsies in the event of abnormal blood tests or palpation

 

 

Traditional treatments used

 

                •               Antibiotics almost always given whether or not there is a sign of infection

                •               Prostate massage

                •               Adrenal nerve blocking agents (alpha blockers) to relax the smooth muscle of the prostate and bladder neck

                •               Low dose antidepressants (low doses of Elavil®)

                •               Muscle relaxants/tranquilizers (antidepressants such as Prozac® or Paxil®)

 

Success of traditional treatment

 

                •               Antibiotics generally not useful

                •               Prostate massage occasionally gives symptomatic relief, but                                   is of limited effect

                •               Alpha blockers (Hytrin®, Cardura®, Flomax®) sometimes give limited symptomatic relief but may have high levels of adverse side effects

                •               Muscle relaxants/tranquilizers, especially benzodiazepines such             as Valium®, offer some temporary reduction in pain but because of side effects and tendency towards dependence, are not useful as a main-line treatment

 

Category IV– Asymptomatic Prostatitis

 

Description

 

Asymptomatic Prostatitis can be thought of as a ‘sleeper condition’ in that a man will not recognize he has it because there are no subjective symptoms. Usually it is discovered when a man sees a doctor who finds evidence of inflammation through either a biopsy or examination of prostatic fluid under a microscope. This is a significant condition because there is evidence that inflammation of the prostatic fluid or semen may cause a rise in the PSA level (prostate specific antigen), which is routinely screened now in men over 50 and thought to be an indicator of possible prostate cancer. When men eliminate infection through antibiotic treatment, the PSA level returns to normal, and the concern about cancer is removed. Diagnosing this condition therefore eliminates the need for further testing for prostate cancer including prostate biopsy. PSA also usually rises in proportion to enlargement of the prostate gland.

 

Symptoms (may be intermittent or constant)

 

                •               No subjective symptoms for patient

                •               Increased level of white cells in prostatic fluid or semen

                •               PSA often elevated (prostate specific antigen that sometimes                                   indicates prostate cancer when elevated)

 

Factors associated with onset

 

                •               Unknown

 

Prevalence (number of people)

 

                •               Number unknown. This condition is poorly understood, and is                              usually only detectable through PSA screening or prostatic                                   fluid analysis

 

Tests for diagnosis

 

                •               Elevated PSA

                •               Indications of inflammation in the prostatic fluid/semen

 

Traditional treatments used

 

                •               Four weeks of antibiotics

 

Success of traditional treatment

 

                •               Unknown

 


Most of the symptoms of pelvic pain or discomfort, urinary frequency and urgency, and pain related to sitting or sexual activity in cases diagnosed as prostatitis are not related to infection but are caused by chronically tightened muscles in and around the pelvis. Our natural protective instincts can tighten the pelvic basin, causing pain and other perplexing and distressing symptoms. Stress is intimately involved in creating and continuing these symptoms. Once the condition starts, the symptoms tend to have a life of their own.

And the good news is that it is possible for a large majority of sufferers to reduce and sometimes eliminate symptoms. The groundbreaking book, A Headache in the Pelvis: A New Understanding and Treatment for Prostatitis and Chronic Pelvic Pain Syndromes, now out in the 5th edition, by Drs. David Wise and Rodney Anderson, describes how chronic tension in the pelvic muscles can cause many of the bewildering symptoms of prostatitis and chronic pelvic pain syndromes.

In most cases of prostatitis, (which have been called prostatodynia), the prostate is not the problem

In 95% of prostatitis cases, the prostate is not the problem. In the case of men with prostatitis and chronic pelvic pain syndromes, 95% of patients who are diagnosed with prostatitis do not have an infection or inflammation that can account for their symptoms. In a word, in the overwhelming number of cases of men diagnosed with prostatitis, the prostate is not the issue. Chronic Nonbacterial Prostatitis represents by far the largest number of cases of men diagnosed with prostatitis. It has been estimated that this category involves 90-95% of all cases diagnosed as “prostatitis.” Studies have shown that men undergo impairment in their self-esteem and their ability to enjoy life in general because the pain and urinary dysfunction is so profoundly intimate and intrusive. The effect on a person’s life of nonbacterial prostatitis has been likened to the effects of having a heart attack, having chest pain (angina), or having active Crohn’s disease (bleeding/inflammation of the bowel). If nonbacterial prostatitis moves from a mild and intermittent phase to a chronic phase, sufferers tend to live lives of quiet desperation. Having no one to talk to about their problem, usually knowing no one else who has it, and receiving no help from the doctor in its management or cure, they often suffer depression and anxiety. Symptoms may be intermittent or constant. Few sufferers have all of the following symptoms

The Inappropriate Use of Surgery and Antibiotics in Treating chronic prostatitis

Those of us who developed the Stanford Protocol for muscle related pelvic pain with no evidence of infection and no anatomical abnormality, have never seen a satisfactory surgical intervention. We have seen patients who have undergone multiple surgeries in a vain attempt to eradicate their problem. In fact, for these conditions surgery, in our experience, has often hurt the patient, complicated management of their condition, and sometimes created new pain and made it more difficult to treat the original pain and dysfunction. We strongly advise against surgery for the kind of pelvic pain we describe on this website and in our book, A Headache in the Pelvis. Furthermore, pelvic pain with no evidence of infection rarely responds to antibiotic treatment, and we have occasionally seen patients suffer increased problems from antibiotic treatment, particularly when antibiotics are given over long periods of time.”