A right pain in the rear


02 October 2002.


It's an uncomfortable condition that affects most menat some time in their lives. Here, Andrew Cullen recalls his occasionally alarming experiences as a prostatitis sufferer in search of a cure.


Imagine having a golf ball stuck up your backside. That's what prostatitis feels like. I first noticed that something was wrong about 18 months ago. I was peeing normally, but a minute or so later, a small amount of urine was leaking out. Rather than bother my doctor, I decided to refer to the vast range of medical resources on the internet. I went to a search engine and typed in two words that described my symptoms: "urine dribbling". In a fraction of a second, I was given a list of 21,000 websites. The first 10 were all entitled: "Prostate cancer". I went to bother my doctor.


My GP referred me to a specialist. Blood and urine tests showed no trace of infection. I peed into a bowl that measured my rate of flow. I measured how much I peed over the course of several days. The results were all normal. Yet I still had "post-voiding dribbling". When I asked my GP what the cause might be, he said: "Don't worry. Leave the details to me."


Feeling uninformed and patronised, I did my own research. Although you have to be wary about using the internet for self-diagnosis – you can develop cyberchondria – it is a useful source of detailed information that your doctor may be too busy or too disdainful to offer. I was relieved to learn that I didn't necessarily have cancer. My symptoms could also be caused by other disorders of the prostate.


At my next appointment I was invited to drop my trousers and lie on my side. The doctor said she was just going to check my prostate by sticking her finger up my bottom. I said, "Oh, right," casually, as if that kind of thing happened to me every day. The examination lasted a few seconds and wasn't painful. I asked what she had discovered up there, and she said my prostate felt normal. I assumed that she meant that I wouldn't need a cystoscopy, which involves pushing a flexible telescope up your penis. I was delighted. And I was wrong.


I had to wait six months for the operation (undersökning med cystoskop). I was starting to dread the treatment more than the disease. On the day itself, the surgeon was matter-of-fact. "There will be some discomfort," he said. "We do give some anaesthetic, but it doesn't really do much." The anaesthetic was a cool gel, which he squirted up the urethra. Then he prepared the telescope, a black tube about 3 m (felskrivning, bör vara 3 feet) long. "OK," he said, "take deep breaths."


It isn't as bad as you imagine. No, honestly. It's mildly embarrassing to have strangers fiddling with your private parts, but you soon forget about your embarrassment when the telescope begins its journey. It is especially uncomfortable when the tube travels through the section of the urethra enveloped by the swollen prostate gland. It wasn't the most pleasant two minutes 54 seconds of my life, but the examination was worthwhile because the surgeon was able to examine my genito-urinary system on the video monitor and confirm that I didn't have cancer.


I was diagnosed with prostatitis. The surgeon told me that it would recur periodically and I would need courses of antibiotics. He made it sound so straightforward. None of the doctors warned me what to expect in the next few months, so I was surprised as my condition worsened.


Prostatitis isn't deadly, but it can be debilitating. An off-hand doctor can give you the impression that it is no big deal. Yet in a survey of men with prostatitis, 63 per cent reported some minor depression as a result of the condition, 10 per cent major depression, and 5 per cent thoughts of suicide. The symptoms are persistent and troubling without being spectacular. They wear you down rather than strike you down. Sufferers commonly report extreme fatigue; a frequent need to urinate; pain during urination and ejaculation; pain in the penis, groin, testicles or scrotum or around the perineum or anus. And there is the sensation of having a golf ball stuck up your backside. Some days, it is a hot golf ball.


When I asked my GP if there was anything I could do to alleviate these problems, he said no. So, once again, I turned to the internet. Websites such as www.prostatitis. org and www.chronicprostatitis.com provide a variety of information that GPs don't offer, and you don't feel like a nuisance when you're seeking answers to your questions.


Prostatitis is the medical term for inflammation of the prostate, a walnut-sized gland located below a man's bladder. Your prostate produces a milky white fluid for your semen. As men grow older, the prostate becomes enlarged anyway. By the age of 60, most men have some degree of prostate enlargement. Some men, however, develop swollen prostates earlier in life, typically in their thirties (I am 37). The enlargement interferes with the urethra, which passes through the prostate, creating a variety or urological and related problems. Most men will suffer from some form of prostatitis in their lifetime. It affects men differently, with varying degrees of discomfort or pain. It can be irritating, or it can be devastating. According to current evidence, chronic prostatitis doesn't increase the risk of prostate cancer and doesn't cause impotence (enligt vår erfarenhet ett helt felaktigt påstående). It may or may not have fertility implications.


Five per cent of prostatitis cases are bacterial in origin and responsive to antibiotics. In the 95 per cent of cases that are non-bacterial, GPs still use antibiotics and anti-inflammatories as a first resort. They have no second resort. Some men find that a month's course of Ciproxin relieves their symptoms, but many are disappointed. One problem is that the prostate is sheathed in a protective shell, which antibiotics can't easily penetrate.


As well as the physical effects, chronic prostatitis comes as a hefty psychological blow. Suddenly you feel mortal, fragile, old. Reading the accounts of other sufferers in a newsgroup such as sci.med.prostate.prostatitis gives you permission to feel pain and anxiety and other natural feelings that are regarded as unmanly. Learning about other men's experiences of the illness makes you feel less alone and less of a wimp.


Prostatitis is, figuratively and literally, a pain in the arse. It isn't life-threatening, but it can be life-changing. The good news is that, contrary to what your doctor may tell you, antibiotics are not your only resource. Sitz baths are reported to improve circulation and ease discomfort. And a recent medical trial concluded that regular ejaculation causes contractions that soothe the symptoms. I know what you're thinking. Trust men to develop a disease cured by masturbation and lying in the bath. Alas, it's not that simple. Some men say they avoid masturbation because it makes their symptoms worse. Nobody really knows what causes or cures prostatitis.


Diet can be crucial for maintaining or restoring prostate health. Avoid spicy foods, chocolate, alcohol and caffeine, which are irritants. There is a long list of foods, herbs and supplements that sufferers have found helpful: broccoli, lycopene (found in tomatoes), saw palmetto, quercetin, pygeum extract, zinc, pumpkin-seed oil, flax-seed oil, beta carotene, selenium, nettle-leaf tea. There are various prostate supplements (typically costing £7–10 for a month's supply) containing a combination of those ingredients. Some men find them useful.


There is no magic solution to prostatitis that suits everyone. Illness is a prison, but there's the prospect (ungefär, det kan finnas en möjlighet) of early release for good behaviour (??).


Ovanstående artikel finns på The Independents hemsida: http://www.independent.co.uk/story.jsp?story=338746


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