I saw another urologist, the head of the prostate center at a major New York City hospital. He put my blood, urine, prostatic fluid, and semen under the microscope, looking for leukocytes and other things of proven irrelevance, and he put me on expensive antibiotics, anti-inflammatories, alpha blockers, and Elavil, an antidepressant given in low doses for chronic pain syndromes. The only certainty was bankruptcy: Prostatitis, he said, was a “frustrating” disease to treat. A third of patients get well, a third show no change, a third get worse.
If women had prostatitis, they’d go on Oprah. But men don’t like to talk about what goes wrong between their legs. “Guys think there’s a stigma,” says Mike Hennenfent, president of the Prostatitis Foundation, a patient advocacy group. It’s often the wives who contact him. “A minister’s wife told me, ‘Our congregation wouldn’t understand this.’ ”
Men’s silence is reflected in federal spending on the disease, which, until 1995, was practically zero. Prostatitis was the Rodney Dangerfield of urologic conditions, a research backwater and “a wastebasket of clinical ignorance,” as one doctor put it. It was thought to be a bacterial infection of the prostate gland, resulting in inflammation. Doctors gave antibiotics, anti-inflammatories, and, beginning in the 1990s, alpha blockers, which help relax the prostate. When this failed, they gave more antibiotics. “My doctor kept upping the dosage to the point where my pharmacist was freaking out,” says the Portland lawyer.
“The patient will be given anything that gets him out of the office,” says Richard Alexander, M.D., a professor of surgery and urology at the University of Maryland. “That’s how the disease is managed.”
Hennenfent was a 67-year-old Angus cattle breeder from Illinois who had suffered for 35 years when he helped start the Prostatitis Foundation in 1995 to press for research and serve as an information clearinghouse. Patients organized on its Web site (prostatitis.org) and lobbied Congress, which authorized the National Institutes of Health to fund research. Eleven North American academic centers, including Stanford’s esteemed urology department, were chosen to conduct research, recruit patients, and run clinical trials. The results are in:
• Prostatitis patients have less bacteria in their semen than men in control groups.
• There is no correlation between the presence or absence of inflammation and symptoms.
• No drug in the pipeline holds promise.
• None of the standard treatments work.
Which is why men end up lying on their backs and learning about paradoxical relaxation.
Wise, a man of modest height, crinkly eyes, and a long-standing Zen meditation practice, spent 22 years in pain from what felt like a golf ball lodged in his rectum, frequent and urgent urination, and a variety of other distressing, perplexing, and painful symptoms. In 1998, he left San Francisco for Sonoma County, where he lives amid deer and wild turkeys on 11 hilly acres punctuated with a gazebo and nine profusely carved buildings built with his own hands. Wise came to understand that prostatitis is not a disease of the prostate but a kind of ongoing charley horse in the pelvic-floor muscles that surround it—a neuromuscular disorder that strikes men who chronically hold tension in their pelvis much the way TMJ pain strikes those who hold tension in their jaws. For a variety of reasons—anxiety, pelvic trauma, compulsive masturbation or sexual activity, even traumatic toilet training—some men add to the burden of their hardworking pelvic muscles by chronically clenching them. In such predisposed, usually type-A men, Wise believes, a period of intense physical or mental stress can be the final straw, triggering the muscles to constrict. This chronic tension takes on a life of its own, continuing long after any injury or stress abates.
Wise spent a decade learning how to stop the unconscious tightening of his pelvic muscles, eliminating his pain through paradoxical relaxation, certain yogalike stretches, and an eyebrow-raising form of physical therapy based on the concept of trigger-point release. Trigger points are taut bands within muscles, formed through stress, tension, or injury, which radiate pain but can be neutralized by applying pressure. Tim Sawyer, an expert in trigger-point release and a physical therapist, mapped trigger points inside, outside, and around the pelvis that are associated with prostatitis symptoms.
Wise spent a decade learning how to stop the unconscious tightening of his pelvic muscles, eliminating his pain through paradoxical relaxation, certain yogalike stretches, and an eyebrow-raising form of physical therapy based on the concept of trigger-point release. Trigger points are taut bands within muscles, formed through stress, tension, or injury, which radiate pain but can be neutralized by applying pressure. Tim Sawyer, an expert in trigger-point release and a physical therapist, mapped trigger points inside, outside, and around the pelvis that are associated with prostatitis symptoms.
