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sci.med.prostate.prostatitis FAQ Part 1 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 I through IX.

I.  ABOUT SCI.MED.PROSTATE.PROSTATITIS

The newsgroup alt.support.prostate.prostatitis was founded in
the summer of 1994 as a forum for those interested in the
causes and treatment of prostatitis.  Besides that, it has
become a center for discussion of political and public awareness
actions we can take to work towards finding cures for chronic
prostatitis.  Because some servers have blocked all alt. newsgroups
the name was changed in 1995 to sci.med.prostate.prostatitis.

This list was not intended for the discussion of prostate cancer or
benign prostate hypertrophy (BPH) (see section 3).  Prostate cancer is
discussed in the group sci.med.prostate.cancer.  BPH is discussed in
sci.med.prostate.bph.  Recently there has been some blurring of the
distinction between prostatitis and BPH and there is some indication
that these may be different phases of the same disease.  BPH sufferers
are therefore urged to monitor both groups.

Those interested in discussing other medical topics should use
the sci.med newsgroup or the appropriate alt.support
newsgroup.

II.  ABOUT THIS FAQ

An initial draft of this FAQ was prepared by John Koch in
November 1994.  This FAQ is not an official statement of
policy, and even less a statement of absolute truth.  It is meant
simply to orient newcomers.  This FAQ was extensively revised by Ron
Kinner in Jan 1997.

This FAQ also includes a Glossary which defines words and
abbreviations often seen in the newsgroup or at the doctor's
office.  If your question is not found in the index then check the
Glossary for key words.  In an attempt to reduce download times the
glossary may be stored separately from this FAQ.

This FAQ will be posted to sci.med.prostate.prostatitis on or
about the 1st and 15th of every month.

Corrections and amplifications to this FAQ should be sent to
[e-mail].  Questions about statements made in
the FAQ are welcome,  but are likely to be more productive if
posted to the newsgroup for discussion by the group.

This FAQ was last updated Jan 31, 1997.

III.  WHAT AND WHERE IS THE PROSTATE?

The prostate is part of male sexual anatomy.  It is a walnut-
sized gland which surrounds part of the urethra (the "tube"
that carries urine from the bladder to the penis).  The prostate is
located approximately 2 inches inward from the anus.

The prostate is made up of many small glands which are
connected together like small bunches of grapes.  There are
somewhere between 20 and 60 of these bunches called acini in
the prostate.  Each bunch connects to the urethra.

The prostate has several functions.

1. It manufactures and stores a portion of the seminal fluid in
the acini.  This fluid provides lubrication, protects the
sperm, and has an antibacterial effect.
2. It blocks the flow of urine during sex and insures that the
seminal fluid flows in the correct direction.
3. It delivers its portion (1/6) of seminal fluid during sex by
contraction of the smooth muscle in the prostate.
4. It acts as a junction for seminal fluid produced by the
seminal vesicles and testicles. The ejaculatory ducts which
combine these outputs pass through the prostate to the
urethra.

During ejaculation, contractions of the smooth muscle in the
prostate force the fluid out of the acini and into the urethra
where it mixes with the secretions from the seminal vesicles,
the testicles, and other glands and is carried to the tip of the
penis.  Prior to ejaculation, ringlike muscles in the part of the
prostate closest to the bladder will tighten to prevent urine from
flowing and to insure that the ejaculant goes where it should and does
not pass into the bladder.

The prostate provides around one sixth part of the seminal
fluid.  (Around four sixths of the fluid comes from the two
seminal vesicles located slightly above and to the left and right of
the prostate.  (These can also become infected.) The remainder of the
fluid is made up of secretions from other small glands in the urethra
with only one percent coming from the testicles.)

There are three bad things which can happen to the prostate:

--prostate cancer.  A cancerous tumor may appear in the
prostate.  Normally these are very slow growing and often if
discovered late in life, the attitude is something else will
probably kill you before it does, so don't worry about it.  Quickly
increasing readings on the PSA test (over a period of several months)
may indicate the presence of cancer.  A TRUS and biopsy may be
performed to be sure.  (In Germany there was some controversy about
the wisdom of a biopsy.  One doctor (who was shouted down by his
peers) suggested that a biopsy might actually cause the cancer to
spread by releasing cancerous cells into the blood.  Biopsies have
also been known to introduce bacteria into the prostate.  A recent
study of removed prostates shows that often the cells around a biopsy
puncture die.)

The most common treatment is surgical removal of the prostate
and the seminal vesicles.  This makes many men impotent and
some may have problems with urine leakage.  A new treatment
using three X-ray beams appears to be just as effective and
have fewer side effects.  Other treatments which may be used to
fight the cancer or prevent its growth are implantation of
radioactive beads, chemotherapy, removal of the testicles
(Orchiectomy), radiation, and drugs such as PROSCAR which
prevent the body from using testosterone.  For more
information on prostate cancer see the newsgroup
sci.med.prostate.cancer, the website at
http:///www.prostate.com, and the Glossary entries for PSA and
Prostate Cancer.

--benign prostatic hypertrophy (BPH), which is a non-
cancerous increase in size of the prostate.  This increase in size
impacts the urethra and can partially or totally block urine flow.  It
appears that some cases of BPH may be forms of prostatitis.  Patients
with the same symptoms are often diagnosed with prostatitis if they
are under 50 and with BPH if they are older.  There is also
speculation that untreated prostatitis can eventually become BPH.
There is a newsgroup: sci.med.prostate.bph.  See also Glossary entries
for BPH, Saw Palmetto, Alpha 1 Blockers, TURP, TUNA, TULIP.

--prostatitis, which is an inflammation of the prostate or a
pain in the prostate similar to that caused by an inflammation
(see sections IV & VII).

IV.  WHAT ARE THE SYMPTOMS OF PROSTATITIS?

There are a variety of symptoms and problems associated with
prostatitis.  Each case seems to be different and each sufferer
can have a different list of symptoms and problems. Most men
will not have all of the symptoms at one time. The symptoms
can be continual or they may come and go.  Some men may
have prostatitis and not have any of the symptoms.  Many of
the symptoms can be caused by other diseases so a doctor
should be consulted.

A. Urinary problems (The first 14 of these are caused by the
swollen prostate partially blocking the urethra and are common
to BPH.):

1.  pain when urinating
2.  increased frequency
3.  urgency
4.  difficulty in starting urination
5.  difficulty in completely emptying the bladder
6.  waking at night one or more times to urinate
7.  weak stream
8.  split stream
9.  interruptions during urination (stop and start)
10.  dribbling or difficulty in stopping cleanly (large wet spot on
underwear) 11. bloated feeling 12. frequent bladder/kidney infections
13. bladder stones 14. blood in the urine 15. dehydration (caused by
attempting to reduce the frequency by cutting back on fluid intake)
16. itching sensation at the tip of the penis 17. burning sensation
between the legs 18. sand like particles in urine

B. Pain/ache/discomfort (Besides the pain caused by the
swollen prostate, there are several nerves which pass through
the area and which can be stimulated by the pressure of the
swollen prostate.  This results in pain which may be far
removed from the prostate (referred pain).  Also the infection
can spread into the epididymides (the spiral ducting from the
testicles to the vas deferens) and into the testicles and seminal
vesicles:

1.  centered in the perineum (the area between the anus
and the base of the penis)
2.  in the penis
3.  in one or both testicles (with or without swelling)
4.  in the scrotum
5.  in the lower stomach
6.  in the lower back.
7.  just above the anus
8.  before, during or after ejaculation.
9.  when sitting
10. during bowel movements
11. when walking
12. when riding a bike

C. Sexual problems.  (Besides the obvious problem that it is
hard to enjoy sex when ejaculation (or arousal) causes pain
several major blood vessels run through the area and may be
constricted making it hard to have or maintain an erection.)
Several of the popular drugs which may be prescribed by a
doctor in an attempt to increase urine flow (notably Hytrin and
Proscar) can both have adverse effects on your sex life.  Some
women have reported burning sensations from their partner's
semen.  Premature ejaculation has also been reported.

D. Fertility problems.  Sperm count and mobility can be
seriously reduced by prostatitis.  The sperm must pass through
a narrow duct in order to get to the urethra.  This narrow
passage can be squeezed shut by the swelling in the prostate.
The prostatic secretion of an infected prostate is much thicker
and its pH varies considerably from the normal value.  This has
a detrimental effect on the mobility of sperm.  If the infection
spreads to the epididymides these may become blocked with pus or scar
tissue.

E. Psychological problems:  These may just be caused by the
frustration of being told that it's all in your head or that
nothing can be done so just live with it or there may be some
hormonal imbalance at work.

1.  Depression
2.  Stress
3.  Low Libido
4.  Apathy

F. Miscellaneous Problems:

1.  Urine smells strong or bad
2.  Semen smells bad
3.  Semen appears lumpy or yellowish
4.  Discoloration of the penis
5.  Semen volume low
6.  Retrograde ejaculation (usually as a side effect of
treatment.)
7.  Blood in semen

G. Chills and fever.  (Generally only in the acute form)  THIS
IS A MEDICAL EMERGENCY!  Get medical help
immediately.

V.  HOW IS PROSTATITIS DISTINGUISHED FROM BPH
AND PROSTATE CANCER?

Some of the same symptoms may be caused by BPH or prostate
cancer or prostatitis.

To tell the difference, a doctor will usually perform a digital
rectal exam(putting a rubber-gloved finger up the rectum to feel the
outside of the prostate for lumps, hardness, and size) and order a PSA
blood test.  (See "What is a DRE" and the Glossary entry for PSA).

In some cases where the PSA is very high (Generally over 4.0 is
the usual rule of thumb though this may vary depending upon
the patient's age or race.) or appears to be climbing steadily, a TRUS
and biopsy may be scheduled to rule out prostate cancer.  (See "What
is a TRUS" elsewhere in this FAQ.)

If cancer is not indicated by the results of the DRE, PSA,
TRUS, or biopsy but the prostate is enlarged prostatitis or BPH
can be assumed to be the problem.  If the problem is confined to
urinary tract symptoms (see above) and the patient is over a certain
age (it appears 50 is the magic number per Dr. O'Leary at Harvard)
then the patient is told he has BPH.  Otherwise he has prostatitis.
Kohnen and Drach found some inflammation in 98% of 162 surgically
resected hyperplastic [BPH] prostates so the possibility that most if
not all BPH is (or originates with) prostatitis can not be ruled out.

A cystoscopy, in which a tube is inserted through the penis to
look at the prostate from the inside is sometimes done to
determine if there is inflammation or some physical blockage.
(See "What is a Cystoscopy" elsewhere in this FAQ).

During a digital rectal exam (DRE), the doctor
may press on the prostate to force out some of the fluid; the
fluid can be examined for signs of infection.  See "What is a
DRE" and "Why should the EPS be Cultured?"  The presence of
white blood cells in the EPS is considered a definite sign of
prostatitis, however, absence of white blood cells does not mean that
prostatitis is not present.  The acini can be so badly clogged that
none of the EPS comes from infected acini.  It sometimes takes several
prostate drainages before the white blood cell count becomes
significant.

VI.  HOW COMMON IS PROSTATITIS?

It is estimated that at least 40% of men's visits to urologists are
caused by prostatitis.  It can affect young men, while BPH and
prostate cancer are more typical of older men.  Because prostatitis
varies in severity and because it has attracted little attention from
researchers, no one knows how many men suffer from it but the usual
statistic quoted is that over 50% of all men will suffer from it
sometime in their life.

VII.  ARE THERE DIFFERENT KINDS OF
PROSTATITIS?

Most discussion of prostatitis divides it into four types.
However, they are often hard to tell apart, and the dividing
lines are often not clear.  The general feeling in the newsgroup is
that they are all aspects of the same disease.

Acute bacterial prostatitis comes on quickly, can cause intense
pain, fever, and chills, can require hospitalization, but is
usually "cured" quickly with antibiotics.  (Some newsgroup
members have reported that their supposedly cured acute
bacterial prostatitis turned chronic after the cure.)

Chronic bacterial prostatitis is less intense, but is not cured
quickly by antibiotics alone.  Examination of the urine and
prostatic fluid, particularly via the Meares and Stamey
technique or the Feliciano technique, indicate that disease-
causing bacteria and/or fungi are present in the prostate.  The
condition may clear up after several months of antibiotics, or it may
not.  Often after treatment with antibiotics alone the condition will
go dormant for a while then return immune to the original antibiotic.

The symptoms of chronic nonbacterial prostatitis are the same,
but no disease-causing bacteria can be identified via the Meares and
Stamey technique.  Signs of inflammation are seen.  The Feliciano
technique often reveals the presence of bacteria or fungi in these
cases.

In prostatodynia (which means simply "prostate pain"), there is
no sign of inflammation, even though there is pain in the
prostate.  The Feliciano technique often reveals the presence of
bacteria or fungi in these cases.

VIII. WHAT CAUSES PROSTATITIS?

There are many theories about the causes of prostatitis.  The
most popular theory among the members of the newsgroup is
Dr. A. E. Feliciano's.  His theories are, however, not yet widely
accepted by urologists in the US.

Per Dr. Feliciano, prostatitis is usually caused by an infection of
the prostate.  Sometimes the infection is caused by common bacteria
and fungi which are usually considered benign.  The infective agent
can be acquired in a variety of ways: Sex, poor hygiene, contamination
during an operation, swimming in polluted water, or some other unknown
mechanism.  Dr. Feliciano believes that the bacteria and fungi which
cause prostatitis can be passed back and forth between sexual partners
so that both should be treated at the same time.

The prostate has some 20-50 smaller fluid producing glands
called acini.  Per Dr. Feliciano when an infective agent enters
an acinus, the acinus quickly becomes blocked.  It is not clear
whether this is an attempt by the body to isolate the infection
or a side effect of the infection.

The infected acinus, once blocked, begins to swell as fluid
accumulates.  The infection and swelling of a single acinus may
not be noticeable.  Only when the number of infected acini
reaches a certain percentage of the total does it seem that the
infection begin to cause problems.  Note that each acinus can be
infected individually so that there may be more than one infectious
agent involved.

There is some speculation that in some men the infection
happens so slowly that the prostate and the surrounding tissue
and nerves are able to adjust and the only symptoms may be a
slightly restricted urine flow.  This restriction may happen so
gradually that the patient does not realize that anything is
wrong. This is likely to be diagnosed as BPH especially if the
patient is over 50.

In others, when the infection spreads more rapidly, the swelling is
more sudden and the effect can be quite painful.

When all of the infected acini are not completely clogged they
may leak a caustic fluid which causes a burning sensation in
the urethra and may account for the sexual partner's
complaints of semen causing a burning or itching sensation.

Once clogged the acini seldom unclog on their own even if the
body manages to defeat the trapped bacteria.  The body
attempts to fight the bacteria by coating them with calcium
much like an oyster coats a grain of sand to make a pearl.
These calcium coated bacteria can combine into a prostate
stone or may, if the acinus opens for some reason (perhaps after a DRE
or a hard bowel movement which actually massages the prostate), be
added to the urine where they give the appearance of sand in the
urine.  Other plugs can form made up of solidified prostatic fluid and
urine.

The fluid from infected acini is also much thicker and has a pH
value much different than normal.  This and any blockage of
the ejaculatory ducts caused by the swelling can reduce sperm
count and mobility.

A recent study (J. C. Nickel & J. W. Costerton (Department of
Urology, Queen's University, Kingston, Ontario, Canada.)
Bacterial localization in antibiotic-refractory chronic bacterial
prostatitis. Prostate 23: 107-14 (1993)[93391211] of biopsies of
prostatitis patients) revealed "...exopolysaccharide coated
microcolonies of bacteria firmly attached to the ductal and acinar
walls.  This implies that even unblocked acini can harbor bacteria
which are protected from antibiotics by a sugar like coating and may
explain why the disease is so hard to treat.

A second theory, based on the discovery that only housebroken
dogs have prostatitis, is that holding the urine damages the
prostate in some way.  The assumption is that pressure builds
up and forces urine backwards into the acini where it combines
with prostatic secretions to cause clogs to form.  The urine can also
carry bacteria into the prostate.  This flow of urine backwards into
the acini is called reflux.  Lending additional support to this theory
is the fact that a drug used for gout sufferers, allopurinol, is
sometimes helpful in the treatment of prostatitis.

A third theory, based on the fact that certain middle European
countries where the diet is high in zinc have much lower levels
of prostatitis, is that a zinc deficiency reduces the prostate's
ability to resist an infection.

A fourth theory, based on the fact that prostatitis was once
known as the monk's disease, is that a sudden reduction in the
average number of ejaculations per time period or a complete
stoppage of ejaculations can lead to "old" prostatic secretions
hardening and forming clogs.  As monks were also prone to long
vigils the reflux theory may also have some support here.
Recent information is that new recruits into the armed forces
are prone to prostatitis.  Whether this is because the sudden
enforced celibacy and lack of privacy (making masturbation
difficult) causes the problem or whether the sudden opportunity
to "visit ladies of the evening" when given a pass into town
increases the chance of infection is not known.

A fifth theory is that many cases of prostatitis are caused by
auto-immune reactions.  Auto-immune prostatitis has been
demonstrated in laboratory animals.

Anatomical problems have also been cited as the cause in a few
patients.  A stricture (narrowing of the urethra) can cause
symptoms which mimic prostatitis.  Overly tight sphincter
muscles have also been blamed.

The real cause of prostatitis may be some mixture of all of the
above and may vary for each patient.  The one thing we are
sure of is that it is not "...all in your head."

IX.  CAN PROSTATITIS BE CURED?

Dr. A. E. Feliciano, a physician in the Philippines who has
successfully treated several of the newsgroup members along
with some 4000 Filipino sufferers, believes most (if not all)
prostatitis (and most BPH)is caused by an infection.  He has
developed a special adaptation of the usual DRE which he calls
"prostate drainage."  This drainage has two purposes:  1. It
provides a sample of the infectious agent for culturing and 2. It
opens the acini and allows them to get rid of the infected material
while at the same time allowing fresh antibiotic laden fluid to enter.


He cultures the prostatic fluid and then prescribes one or more
antibiotics or antifungals based on the results of the culture.  He
also continues culturing the fluid throughout the treatment in order
to see whether a different antibiotic or antifungal might be required.

He believes the EPS should be completely sterile so that any
bacteria found (no matter how benign or common they are
thought to be elsewhere in or on the body) may be the cause of
the infection. Throughout the course of the antibiotic
treatment, he continues his drainage technique.  When the
White Blood Cell (WBC) count drops to zero and the cultures
come out clean the patient is considered cured.  In most cases
all symptoms of prostatitis disappear during the treatment and
do not return.

The Feliciano treatment is not widely known or accepted.  Some
members of the newsgroup reported complete cures after
visiting Dr. Feliciano.  Others have reported only partial or no
relief of symptoms.

A number of the men who made the long trip to the Philippines
were part of a scientific study to determine how good Dr.
Feliciano's treatment really is.  The results of the study will be
released in the near future but early reports are that the cure rate
was not as high as hoped.

Recently a new doctor has become active in the newsgroup.
Also from the Philippines and also named Dr. Feliciano, Dr. A.
N. Feliciano is often confused with Dr. A. E. Feliciano.  Dr. A. N.
Feliciano seems to agree with Dr. Feliciano about the bacterial nature
of prostatitis and the need for prostate drainage but advocates a
mixture of three antibiotics instead of the one used by Dr. A. E.
Feliciano.

In the meantime, several of the members of the prostatitis
newsgroup have developed their own variations of Dr.
Felciano's treatment.

Ron has been doing the drainage by himself with no antibiotics
and reports that the symptoms have gone away and the
prostate has shrunk considerably.  He has created a Do It
Yourself Prostate Massage FAQ which is available on the
prostatitis website or go straight to:
http://www.prostatitis.org/doityourself.html

Scott who started about the same time but who had a friendly
doctor who prescribed a combination of Augmentin and Bactrim
and arranged for cultures reports that he considers himself
completely cured but plans to continue the drainages for a
while just to be sure.

Ken and John and many other members have loving spouses
who are willing to do the drainage for them.  Ken reports no
cure but a definite relief of symptoms.  John, too, is feeling
better.

Mike has found a commercial product "the Crystal Clear Wand"
which allows even a man with short arms to drain his own
prostate.  He reports a big improvement.  John's wife says the
wand makes it easier.  See Glossary entry for details.

Though not yet widespread the full Felicano treatment of
prostatic drainage, EPS culturing, and using sensitivity testing for
antibiotic selection is now available in certain areas of the United
States.

The following is a selection of other treatments which have
been reported by members of the newsgroup to be of some use.
Usually more detailed information is available in the glossary:

Antibiotics:  A wide selection of antibiotics have been tried.
Sometimes they help, sometimes they don't and sometimes they
help for a while and then don't do anything.  See the glossary
for information on the various antibiotics which are used
against prostatitis.  NOTE: Dr. Feliciano is strongly against the use
of any antibiotics without the accompanying drainage and sensitivity
testing.  He believes (and his experience with members of the
newsgroup certainly seems to back up his belief) that use of
antibiotics without the drainage just results in antibiotic resistant
infections which are harder to cure.

Anti-inflammatory steroid drugs:  Sometimes Prednisone or
other anti-inflammatory drugs are given in the belief that if the
inflammation can be reduced the problem may go away.  Generally have
no effect but there have been reports of "cures."

Antifungals:  Diflucan is the most commonly used antifungal
drugs.  Per Dr. Feliciano, antibiotics pave the way for a fungal
infection by killing off the bacteria which normally hold them in
check.  He prescribes Diflucan routinely, usually in the end phase of
the treatment, in order to prevent a fungal infection of the prostate.
 Fungal infections of the prostate often reveal themselves by sores
which form near the tip of the penis, especially in men with intact
foreskin.  Sometimes the foreskin becomes painful to withdraw.

Saw Palmetto Extract:  Provides relief in many men for BPH
type symptoms such as weak stream, urgency, nocturnia.

Zinc supplements:  The role of zinc in prostate health is
unclear.  The prostate is one of the big users of zinc but
additional zinc in the diet does not seem to show up in prostatic
secretions when prostatitis is present.  May have more benefit as a
preventive than a treatment.

Chinese Herbs:  Recently several sufferers have reported that
certain Chinese herb preparations (Kai Kit Wan, Sexoton)have
been of use.  The theory is that something in them opens the
acini and allows them to drain more easily.  Jim who is
undergoing long term drainage from his doctor reports that
after he took them, his doctor reported that the prostate seemed
smaller and easier to drain than before.  There is a page on the
website dedicated to Chinese herbs.
http://www.prostate.org/chinesepills.html.

Tranquilizers:  Valium and other common tranquilizers are
often prescribed in the belief that stress is a factor in
prostatitis.  Sometimes there is some benefit but this may be
more the result of lowered blood pressure.  See alpha-blockers
in the glossary.

Alpha-blockers:  Originally developed to lower blood pressure
it was found that as a side effect many also reduce the tension
of smooth muscle in the prostate thus resulting in better flow
rates and a more complete emptying of the bladder.  Hytrin.
Cardura.

Surgery:  Generally not recommended for prostatitis except for
the removal of strictures downstream from the prostate.
Unless the complete prostate is removed the problem usually
remains and may get worse as scarring of the acinus openings
into the urethra may result in more clogging and swelling
instead of less.

Microwaves:  Results are similar to surgery.

Balloon Dilation:  Provides symptomatic relief of urinary flow
restriction.  A balloon type device is inserted in the urethra via the
penis opening and positioned in the narrowed area where it is
expanded.  This opens up the passage and improves flow.  However,
effects are usually temporary.