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- Men's Health: Protect Your Prostate
- Men's Health Lists: 9 Reproductive Problems You Can Prevent
- Urology Times: Managing Chronic Prostatitis: A Modern Approach
- IOL: The answer to years of pain and suffering
Men's Health: Protect Your Prostate
Stave off serious diseases down there
The Enemy: Prostatitis
What is it?: Inflammation of your prostate, which in some cases could be the result of a bacterial infection.
Symptoms: A burning sensation when you urinate or ejaculate; fever; more frequent need to pee. "Some also say it feels like sitting on a golf ball," says J. Brantley Thrasher, M.D., chairman, department of urology at the University of Kansas.
Take action: See your urologist, who will likely prescribe a round of anti-inflammatories or antibiotics. If it lingers, try a supplement called quercetin. In a UCLA study, 67 percent of men with chronic prostatitis experienced a significant improvement in their symptoms when they took 500 milligrams of the antioxidant twice a day for a month. Try a brand such as Prosta-Q.
The Enemy: Benign prostate hyperplasia
What is it?: An enlarged prostate
Symptoms: The swollen gland can press on your urethra, causing a weak stream and frequent urination, which can interrupt sleep.
Take action: Ask your doctor about saw palmetto extract, an over-the-counter herbal supplement. Two studies have found that a daily dose of 320 milligrams is just as effective as the prescription drug Flomax. What's more, saw palmetto is reported to come without the drug's negative side effects -- decreased ejaculate volume and sex drive.
The Enemy: Prostate cancer
What is it?: A disease in which the cells of your sex gland begin to mutate and multiply beyond its borders.
Symptoms: Rising blood levels of prostate specific antigen (PSA), a measurement your urologist will use to identify risk. Pair that with a digital rectal exam (DRE).
Take action: Early detection is key. "Every year I have a PSA test along with my physical, and compare results with the year before," says Men's Health advisor Larry Lipshultz, M.D. As for prevention, Harvard scientists found that men who ejaculate 21 or more times a month are 33 percent less likely to be diagnosed with prostate cancer than men who fire four to seven times.
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Men's Health Lists: 9 Reproductive Problems You Can Prevent
by Steve Mazzucchi
We men are a little uncomfortable with our genitals. Girls rock skirts sans undies (thanks, Britney), but most guys wouldn't dare don a kilt. R-rated movies showcase female pink parts, but they cover Borat's junk with a black rectangle. And while women have an entire area of medicine dedicated to the health of their private regions, if it wasn't for the hernia check, we men would hardly drop trou at the doctor's office.
The result? When it comes to caring for some of our most critical equipment—the stuff we need to, you know, keep our species going—we're virtually clueless. And that ain't good, because a lot can happen to a man's penis, testicles, and prostate: itchiness, infection, pain, bumps, sores, growths, rashes, burning, drooping, swelling, clogging, and, hell, cancer. If you're not paying attention, you can wind up sick, sterile, or dead. With a little knowledge, though, you can cut much of the bad stuff off at the pass. Start here. These nine scenarios may make you wince, but at least you'll know what to do if they happen to you.
# 1.
The cause: Assuming you weren't just kicked there, one of your testicles is probably twisted around something called the spermatic cord, cutting off the blood supply. "Think of a ball hanging on a rope," says Tony Makhlouf, M.D., Ph.D., a urologic surgeon at the University of Minnesota medical center. "As the rope turns, it bunches, and the ball rises." This knotting—testicular torsion, it's called—instantly causes a sharp pain.
The cure: Head to an E.R. "If it isn't treated within 4 hours, you can lose a testicle," warns Larry Lipshultz, M.D., a professor of urology at Baylor College of Medicine. "Why take a chance?" The docs at the E.R. will do an ultrasound to assess whether your testicle and cord are indeed twisted. If that's the case, a urologic surgeon will be called to untangle things. Then he'll suture each testicle to the inside of your scrotum to prevent the torsion from happening again.
# 2.
The cause: The coiled tube that carries sperm from your testicles has probably become inflamed due to a bacterial infection. The most common culprits are gonorrhea, chlamydia, and, in men over 40, a urinary-tract infection that migrated. The testicles themselves can also become inflamed.
The cure: Don't just pop some Advil and try to tough it out. "If you don't treat it, the tubes can become scarred and blocked," says Dr. Makhlouf. "You could become infertile." So see your doctor, who will probably prescribe at least 2 weeks on an oral antibiotic to tackle the bacteria. Swelling and pain should begin to lessen within 3 days, but it could take months for all symptoms to subside.
# 3.
The cause: Chronic pelvic pain syndrome, usually resulting from an inflamed prostate gland. "It's a collection of symptoms that originates from an injury, often an infection, and the problems come from how the body responds to that infection," says Daniel Shoskes, M.D., a Cleveland Clinic urologist.
The cure: Two-thirds of men will get better with antibiotics in the early stages. For those whose inflammation persists beyond initial infection, Dr. Shoskes prescribes herbal-based bioflavonoid preparations, such as Prosta-Q and Q-Urol, which reduce inflammation. Flomax and other prescription agents that block an important receptor in the region also reduce pain and can improve urinary flow. Still other men suffer from nerve and muscle spasms, requiring muscle relaxants and physical therapy.
See a urologist in any case, but you can help your own cause by taking hot baths; by avoiding alcohol, spicy foods, and caffeine; and by using a doughnut-shaped cushion when sitting for long periods of time.
# 4.
The cause: Sometimes the valves inside the veins of the scrotum don't close properly, so blood pools and they swell. The resulting bundle of enlarged veins, or varicoceles, doesn't always hurt, but the extra blood warms the testes. This jeopardizes sperm production (which requires temps cooler than 98.6˚F) and causes the testicles to hang away from the body. About 20 percent of men will experience a varicocele at some point.
The cure: "If you notice you have low-hanging fruit, see a urologist who specializes in infertility," says Harry Fisch, M.D., director of the male reproductive center at New York Presbyterian Hospital and author of The Male Biological Clock. He or she can stop blood from pooling by tying off the veins or blocking them. It's minor outpatient surgery and you can have sex again in 3 weeks, although you should schedule a follow-up semen analysis in 3 to 4 months. In 60 percent of infertile men, semen quality will improve after surgery, says Dr. Fisch.
Even if you're not trying to conceive, he adds, the problem should be corrected if it's painful or creates a size discrepancy between testicles.
# 5.
The cause: When infections begin to heal, scar tissue can form and create a blockage in the ejaculatory duct. "It's like a five-lane highway becoming a two-lane highway," says Dr. Fisch. The red tint is blood from the initial infection. Your ejaculate volume may drop below the average of half a tablespoon and continue to dribble like an NBA point guard after you achieve orgasm.
The cure: You can function with a dribbly ejaculate, but it's kind of a buzz kill. Fortunately, there's a surgical solution. The formal term is "transurethral resection of the ejaculatory ducts," but it's simpler than it sounds. "We just scrape out the scar tissue, and that opens it all up," says Dr. Fisch. You can resume sexual activity in 7 to 10 days.
# 6.
The cause: According to the American Urological Association, about 25 percent of erectile-dysfunction cases are psychological, and it could be anything from relationship issues to performance anxiety. For example, a man may have a sexual experience after heavy drinking and fail to get it up. "In subsequent sexual attempts without alcohol, he'll remember that episode, think something's wrong with him, and be unable to perform," says Karen Boyle, M.D., director of reproductive medicine and surgery at the Johns Hopkins Brady Urological Institute.
The cure: Once physical factors have been ruled out, try seducing her after a romantic breakfast. Your testosterone levels peak around 7 a.m., so your hormones, and your penis, will be at full attention then. In many cases, such as the aforementioned alcohol scenario, a pharmaceutical option can also offer a helping hand. "A little added self-confidence—such as receiving some extra 'lift' from Viagra—goes a long way in this arena," says Andrew McCullough, M.D., director of sexual health and male fertility at the New York University medical center. If all else fails, seek counseling to address the under-lying psychological issues.
# 7.
The cause: If it's on your thighs, it's often tinea cruris (a.k.a. jock itch), a fungus that thrives in warm, moist environments like, say, gym shorts that haven't been washed since the Clinton administration. If it's bright red and right on the penis, it may be a yeast infection, which can be passed from women to men through unprotected sex.
The cure: Preventionwise, shed damp gym clothes and shower immediately after exercising, and dry the area thoroughly before dressing. For treatment, an over-the-counter medication like Lotrimin can work wonders. "Continue using it for 1 to 2 weeks after the rash is gone to really knock it out and prevent it from coming back," says dermatologist Peter Kopelson, M.D., of the Kopelson Clinic, in Beverly Hills. For a yeast infection, try an over-the-counter antifungal cream, applying twice daily for a week.
Don't treat either condition with hydrocortisone cream. By suppressing your immune system, "hydrocortisone will actually make the fungus worse," says Dr. Kopelson.
# 8.
The causes: Have cauliflower-shaped growths on your penis, a watery drip from your penis, painful blisters on your genitals, a thick yellow drip at times, reddish chancre sores on your genitals, and raised bumps on your groin? You have, in order, genital HPV, chlamydia, genital herpes, gonorrhea, syphilis, and molluscum. You haven't been wearing a condom, have you?
The cures: We're not here to lecture you on STDs, but there are a few new things you should know. First, the FDA is reviewing the efficacy of a genital-HPV vaccine, Gardasil, for men. Currently, guys can get the three-shot treatment for a little over $300, says Stephen Tyring, M.D., Ph.D., medical director of the Center for Clinical Studies, in Houston. His research team helped secure approval for the female version of the vaccine.
Second, according to a CDC study, 8.2 percent of men between the ages of 16 and 24 are infected with chlamydia, but only 2.4 percent of those men have symptoms. And research by the New York City department of health and mental hygiene found that one in eight women treated for chlamydia were reinfected within a year. The point? If your girlfriend has had chlamydia, you should be screened and treated to avoid possibly reinfecting her.
Third, "Molluscum [a viral infection] is the newest scourge we are seeing on campus," says Joel Schlessinger, M.D., president of the American Society of Cosmetic Dermatology and Aesthetic Surgery. "The [raised bumps are] very contagious, and although they carry little or no risk, they can be a nuisance and require several treatments to fully eradicate." Keep one eye open, college boy.
# 9.
The cause: You should have hired movers to lift that fridge. Inguinal hernias occur when part of the intestine protrudes through a congenitally weak abdominal wall. "It's often associated with a major straining episode," says Dr. Fisch, but a simple sneeze can set it off.
The cure: If it's small and doesn't bother you, no action may be needed. If it's growing or painful, lying down with your pelvis higher than your head can reduce the discomfort, but ultimately you'll need surgery. This will come in the form of either a herniorrhaphy, in which the edges of healthy tissue are sewn together, or the more modern hernioplasty, in which a piece of synthetic mesh is laparascopically inserted to cover the entire inguinal area. (A surgeon will recommend the option best suited to repair your particular type of abdominal-wall tear.) You'll be back to work within a few days.
Urology Times: Managing Chronic Prostatitis: A Modern Approach
By Dr. J. Curtis Nickel
Modern evaluation, treatment will help many men with nonbacterial chronic pelvic pain
Nearly one in 10 men who walk into the outpatient office of a urologist leave with a coded diagnosis of prostatitis. Urologists have described the traditional approach to the diagnosis and management of the chronic prostatitis syndromes as one of the most frustrating areas of urologic practice. Urologists have no problem with the 5% to 10% of patients with a clear diagnosis of acute bacterial prostatitis (acute bacterial infection of the lower urinary tract and prostate) and chronic bacterial prostatitis (recurrent urinary tract infections, usually with the same organism whose nidus resides in the prostate gland).
Nearly one in 10 men who walk into the outpatient office of a urologist leave with a coded diagnosis of prostatitis. Urologists have described the traditional approach to the diagnosis and management of the chronic prostatitis syndromes as one of the most frustrating areas of urologic practice. Urologists have no problem with the 5% to 10% of patients with a clear diagnosis of acute bacterial prostatitis (acute bacterial infection of the lower urinary tract and prostate) and chronic bacterial prostatitis (recurrent urinary tract infections, usually with the same organism whose nidus resides in the prostate gland).
By contrast, urologists have great difficulty managing the vast majority of patients who present with genitourinary pain and voiding symptoms that are not associated with a clearly defined infection of the lower urinary tract or prostate.
There is light at the end of the tunnel for the practicing urologist. In fact, developments in the field are evolving so quickly, particularly over the last 3 years, that it is difficult for clinicians to keep up. North American and international consensus meetings have established definitions, classification systems, symptom indices, and diagnostic algorithms aimed at improving our diagnosis of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Numerous randomized, placebo-controlled trials are begin ning to provide a solid evidence-based approach to the treatment of the condition once it has been diagnosed, classified, and evaluated in a specific patient.
This article provides a stepwise approach to the evaluation and treatment of this condition, based on current evidence.
There is light at the end of the tunnel for the practicing urologist. In fact, developments in the field are evolving so quickly, particularly over the last 3 years, that it is difficult for clinicians to keep up. North American and international consensus meetings have established definitions, classification systems, symptom indices, and diagnostic algorithms aimed at improving our diagnosis of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Numerous randomized, placebo-controlled trials are begin ning to provide a solid evidence-based approach to the treatment of the condition once it has been diagnosed, classified, and evaluated in a specific patient.
This article provides a stepwise approach to the evaluation and treatment of this condition, based on current evidence.
Classification/evaluation
Patients with chronic genitourinary pain (perineal, suprapubic, penile, ejaculatory, etc.) associated with variable obstructive and irritative voiding symptoms and sexual dysfunction, and without a history of recurrent urinary tract infection and/or demonstration of uropathogenic bacteria localized to the prostate gland, are now classified as having category III CP/CPPS (JAMA 1999;282:236-7). Category III has been divided into an inflammatory subtype (category IIIA, similar to “chronic nonbacterial prostatitis”); and a non-inflammatory subtype (IIIB, similar to “prostatodynia”). These sub-classifications are based on the degree of inflammation, determined by counting the number of leukocytes in prostate-specific specimens. Recent studies, however, have not validated the differentiation of category IIIA and IIIB, either for diagnosis or treatment effects.
A National Institute of Diabetes and Digestive Kidney Diseases symposium held in 2002 developed recommendations (actually suggestions) for the evaluation of patients presenting with CP/CPPS (Urology 2003; 60[Suppl 6A]:20-3). A suggestion of the symposium was that various aspects of the evaluation should be categorized as mandatory, recommended, or optional, as follows (figure 1).
Mandatory. A history, physical examination, and urinalysis/urine culture are considered mandatory for the evaluation of all patients presenting with CP/CPPS.
Recommended. Recent studies have provided little evidence that the results provided by lower urinary tract localization testing (the Meares-Stamey four-glass test) change management in the majority of patients (Ann Intern Med 2000; 133:367- 81; J Urol 2002; 167[Suppl]:24[(Abs 96]). Localizing cultures for uropathogenic bacteria may suggest a possible bacterial cause for the pain and discomfort. Therefore, localization studies are now considered recommended rather than mandatory. (Consider the simpler pre- and post-massage screen [Tech Urol 1997; 3:38-43].)
The National Institutes of Health Chronic Prostatitis Symptom Index (NIH–CPSI), as shown in figure 2, has established its value for the initial evaluation and follow-up of patients being treated for CP/CPPS, both in scientific studies and clinical practice (J Urol 1999; 162:369-75; Urology 2002; 59:870-6; J Urol 2003; 169:580-3). Residual urine determination and urine cytology are also considered recommended evaluations.
Optional. Optional evaluations are not required in the majority of patients. However, findings on the history, physical examination, and mandatory and/or recommended evaluations will indicate which of these optional investigations may be required in an individual patient. Such investigations may include semen analysis/ culture, urethral swab for culture, pressure- flow studies, video urodynamics, cystoscopy, transrectal ultrasound, pelvic imaging, and PSA.
Treatment strategy
Once a patient has been diagnosed, the category of CPPS determined, and the patient evaluated as described above, the urologist must decide on a reasonable therapeutic strategy (figure 3). It was not long ago that the only treatment suggested for patients with uropathogenic bacteria (chronic bacterial prostatitis) was long-term antibiotic therapy. The vast majority of patients with a nonbacterial etiology were ignored. That is not the case today.
The most common treatments used by urologists for patients with CP/CPPS are antibiotics, alpha-blockers, anti-inflammatory agents, and phytotherapeutic treatments. Other prostate- and bladder-related treatments such as pentosan polysulfate sodium (Elmiron), finasteride (Proscar), transurethral thermotherapy, and neuromodulatory treatments (acupuncture, sacral nerve stimulation, etc.) are now being used to ameliorate symptoms in patients with CP/CPPS. Evidence is quickly accumulating that will allow urologists to decide on appropriate treatment for patients with CP/CPPS (Ann Intern Med 2000; 133:367- 81; Nickel JC: Prostatitis and related conditions. In: Walsh P et al, eds. “Campbell’s Urology,” 8th ed. Philadelphia, WB Saunders Co., 2002, 603-30).
Until recently, no large, well-designed, prospective placebo-controlled trials have evaluated the use of antibiotics, the most common treatment modality used for CP/CPPS. Many urologists strongly believe that antibiotic therapy is not only indicated but also helpful in many patients who initially present with CP/CPPS, especially those with a very short history. However, evidence is accumulating that antimicrobial therapy may be ineffective in patients who have suffered from CP/CPPS for a longer duration of time, especially those who have had the disease for years (data to be presented at the 2003 AUA annual meeting).
Similarly, urologists anecdotally believe that alpha-blockers help many patients with CP/CPPS, especially the voiding symptoms and pain associated with the condition. Studies from the 2002 and 2003 AUA annual meetings show that alpha-blockers do not ameliorate the symptoms associated with CP/CPPS as quickly as they do in men with lower urinary tract symptoms associated with BPH. In this condition, especially for the chronic patient, studies show that a long duration of alpha-blocker therapy will be necessary before any significant clinical effect is seen. Six weeks appears to be the minimum duration of therapy, but it is more likely that response will not be identified until 3 months (J Urol 2003; 169:592-6). Anti-inflammatory drugs (either overthe- counter agents or prescription agents such as COX-2 inhibitors) are becoming more popular, especially because prostatitis has been perceived to be an inflammatory, pain-related syndrome. Recent evidence has shown very little relationship between inflammation and pain in CP/CPPS, indicating that other factors may be responsible for symptoms.
Once a patient has been diagnosed, the category of CPPS determined, and the patient evaluated as described above, the urologist must decide on a reasonable therapeutic strategy (figure 3). It was not long ago that the only treatment suggested for patients with uropathogenic bacteria (chronic bacterial prostatitis) was long-term antibiotic therapy. The vast majority of patients with a nonbacterial etiology were ignored. That is not the case today.
The most common treatments used by urologists for patients with CP/CPPS are antibiotics, alpha-blockers, anti-inflammatory agents, and phytotherapeutic treatments. Other prostate- and bladder-related treatments such as pentosan polysulfate sodium (Elmiron), finasteride (Proscar), transurethral thermotherapy, and neuromodulatory treatments (acupuncture, sacral nerve stimulation, etc.) are now being used to ameliorate symptoms in patients with CP/CPPS. Evidence is quickly accumulating that will allow urologists to decide on appropriate treatment for patients with CP/CPPS (Ann Intern Med 2000; 133:367- 81; Nickel JC: Prostatitis and related conditions. In: Walsh P et al, eds. “Campbell’s Urology,” 8th ed. Philadelphia, WB Saunders Co., 2002, 603-30).
Until recently, no large, well-designed, prospective placebo-controlled trials have evaluated the use of antibiotics, the most common treatment modality used for CP/CPPS. Many urologists strongly believe that antibiotic therapy is not only indicated but also helpful in many patients who initially present with CP/CPPS, especially those with a very short history. However, evidence is accumulating that antimicrobial therapy may be ineffective in patients who have suffered from CP/CPPS for a longer duration of time, especially those who have had the disease for years (data to be presented at the 2003 AUA annual meeting).
Similarly, urologists anecdotally believe that alpha-blockers help many patients with CP/CPPS, especially the voiding symptoms and pain associated with the condition. Studies from the 2002 and 2003 AUA annual meetings show that alpha-blockers do not ameliorate the symptoms associated with CP/CPPS as quickly as they do in men with lower urinary tract symptoms associated with BPH. In this condition, especially for the chronic patient, studies show that a long duration of alpha-blocker therapy will be necessary before any significant clinical effect is seen. Six weeks appears to be the minimum duration of therapy, but it is more likely that response will not be identified until 3 months (J Urol 2003; 169:592-6). Anti-inflammatory drugs (either overthe- counter agents or prescription agents such as COX-2 inhibitors) are becoming more popular, especially because prostatitis has been perceived to be an inflammatory, pain-related syndrome. Recent evidence has shown very little relationship between inflammation and pain in CP/CPPS, indicating that other factors may be responsible for symptoms.
However, many patients experience modest relief of pain and symptoms of CP/CPPS with anti-inflammatory agents. COX-2 inhibitor therapy does demonstrate modest efficacy compared with placebo
following 6 weeks of high-dose therapy (J Urol 2003; in press).
On direct questioning, many men with CP/CPPS will volunteer that they are taking at least one, and usually many, herbal medications and supplements advertised for prostate problems. These include saw palmetto, pygeum africanum, beta-sitosterol, zinc supplements, pollen extracts, and quercetin preparations. At this time, only quercetin (Prosta-Q) has been shown to be more effective in small clinical trials compared with placebo (Urology 1999; 34:960- 3). Phytotherapeutic agents are not regulated, and both the physician and patient must be sure that a product comes from a reputable source.
Randomized, placebo-controlled trials have also shown modest efficacy (compared with placebo) with pentosan polysulfate, hormonal therapy (finasteride), and heat therapy (specifically transurethral microwave thermotherapy). However, all of these modalities need to be further evaluated in larger randomized, multicenter, placebo-controlled trials before they can be recommended as monotherapy for patients with CP/CPPS.
Numerous studies are presently being planned to evaluate other potential avenues of treatment for which small clinical trials have suggested efficacy. These treatments include acupuncture, biofeedback, specific physiotherapies, neuromodulation using the InterStim device (Medtronic, Minneapolis), immune modulation (etanercept [Enbrel]), transurethral thermotherapy, and other modalities of heat therapy.
following 6 weeks of high-dose therapy (J Urol 2003; in press).
On direct questioning, many men with CP/CPPS will volunteer that they are taking at least one, and usually many, herbal medications and supplements advertised for prostate problems. These include saw palmetto, pygeum africanum, beta-sitosterol, zinc supplements, pollen extracts, and quercetin preparations. At this time, only quercetin (Prosta-Q) has been shown to be more effective in small clinical trials compared with placebo (Urology 1999; 34:960- 3). Phytotherapeutic agents are not regulated, and both the physician and patient must be sure that a product comes from a reputable source.
Randomized, placebo-controlled trials have also shown modest efficacy (compared with placebo) with pentosan polysulfate, hormonal therapy (finasteride), and heat therapy (specifically transurethral microwave thermotherapy). However, all of these modalities need to be further evaluated in larger randomized, multicenter, placebo-controlled trials before they can be recommended as monotherapy for patients with CP/CPPS.
Numerous studies are presently being planned to evaluate other potential avenues of treatment for which small clinical trials have suggested efficacy. These treatments include acupuncture, biofeedback, specific physiotherapies, neuromodulation using the InterStim device (Medtronic, Minneapolis), immune modulation (etanercept [Enbrel]), transurethral thermotherapy, and other modalities of heat therapy.
Conclusion
The management of chronic prostatitis has been a rapidly evolving field over the last 5 to 10 years. Epidemiologic studies have identified CP/CPPS as a real medical problem. The distressing quality of life experienced by patients diagnosed with the condition and its associated health and socioeconomic costs have led to a surge in research funding that is helping to support a new generation of committed prostatitis researchers. Urologists and their patients can expect more evidence-based options for the management of CP/CPPS in the very near future. UT
Dr. Nickel has received research grants and/or has been a researcher, and/or consultant, and/speaker for Merck & Co., Inc., Boehringer- Ingelheim, Jansssen-Ortho Canada, Inc., Ortho-McNeil, Inc., and Farr Laboratories.
This project has been made possible, in part, by a grant from the William F. Mosher FoundationProstate Health Awareness Endowment Fund of the Community Foundation of Central Illinois.
IOL (South African News Source): The answer to years of pain and suffering
By Helen Grange
Do you feel a burning sensation when your bladder is full or when you urinate? Do you need to urinate frequently or all the time? Do you get lower back pain, despite having no spinal injury? Does your entire pelvic area feel as though it's on fire? Is there sometimes blood in your urine or semen, and is ejaculation always painful?
You may be suffering from Chronic Pelvic Pain Syndrome (CPPS), previously known as interstitial cystitis or painful bladder syndrome in females, and chronic prostatitis in males. It is a common malaise that has wreaked so much havoc in the lives of some that they feel suicidal. Indeed, it can be so debilitating that your quality of life is as impaired as people suffering from myocardial infarction, angina or Crohn's disease.
"It feels like a hot poker being placed up into your bladder," reports one sufferer. Another says: "It feels like shards of glass being ground into your bladder." In medical terms, CPPS is characterised by chronic pelvic pain and lower urinary tract pain that can last for months at a time.
In the absence of infection or in men, prostate cancer, researchers have theorised that the pain can be due to the mucosal wall of the bladder being damaged, and that instead of comfortably containing urine, the bladder wall is allowing leakage and becoming inflamed. What causes this to occur, however, remains a medical mystery. In men, the culprit may be an inflamed prostate gland (chronic prostatitis), although this has by no means been established either.
Thousands of South Africans are suffering from CPPS, yet it is often misdiagnosed or treated in ways that simply don't work or alleviate the symptoms only temporarily. Conventional treatments include antibiotics, prostate massage, anti-inflammatory medication, alpha-blockers and neuromuscular agents, which have had varied success rates, but at worst, have proved totally ineffective.
The frustration of some sufferers in getting relief - on average they visit five physicians over five to seven years before a diagnosis is made, according to specialist urologist Dr Corne van Graan - creates enormous psychological anguish, aside from the ongoing physical discomfort.
Amid all this gloom, however, there is a glimmer of hope. According to expert urologist Dr Shingai Mutambirwa from the Medical University of South Africa, extensive research conducted in the US has shown that quercetin, a plant-derived flavanoid (natural antioxidant) found in apples, onions, tea, berries, broccoli, Brussels sprouts, cabbage, cauliflower as well as many seeds, nuts and red wine, effectively combats CPPS, aside from having many other beneficial health effects.
Quercetin, in fact, is one of the molecules implicated in the beneficial cardiac effects of drinking red wine. It scavenges free radicals, reduces oxidative damage to the organs, and inhibits inflammation.
Although research is ongoing, its efficacy in cases of CPPS has been impressive to the extent that it is widely marketed in tablet form in the US, and has recently been brought to the South African market courtesy of the Medical Control Council of SA, a highly unusual route for a nutriceutical (as a food supplement believed to have pharmaceutical benefits).
The argument for it being taken in tablet form is that when digested as food, quercetin's bioavailability (the extent and rate that it is absorbed into the system) is variable and often poor. In one study of 30 men with CPPS who received quercetin as 500mg tablets twice daily for a month, results showed an improvement in symptoms in 35% of the cases.
"I have full confidence in this treatment. It does work, and it has no side effects at all, so it is completely safe to take," says Mutambirwa.
In South Africa, quercetin is sold in two containers, one called Urol Q (for men) and the other Cysta Q (for women), though the ingredients are basically the same. Although it can be bought over the counter, Mutambirwa strongly recommends seeing a doctor first to establish that CPPS is indeed what you have. "It is important to eliminate possible cancer or infection," he says.
The downside is that medical aids don't cover this treatment, and it is pricey at around R545 per tub of 60 tablets, which lasts a month.
For some CPPS sufferers who've already spent thousands on doctor's consultations and ineffective drugs, though, it may be small price to pay for the chance to live a normal life.
Ensure that your pharmacist doesn't divert you to an apparent substitute that is cheaper, as some confuse CPPS with urinary tract infection, and treatments for this ailment are completely different.
* This article was originally published on page 19 of The Star on October 30, 2009.
