A Headache in the Pelvis

While I was happy to hear that my prostate and bladder were A-OK, I was still left with the question, well, then, why the hell am I feeling this discomfort.  I asked the urologist this question directly.  He answered that, well, he couldn’t say, only that it wasn’t the prostate or the bladder.  We are proceeding by a process of elimination, he indicated.

I said, maybe it’s all in my head.  And he seemed to indicate that it could be, and that just having him tell me it wasn’t my prostate or my bladder might make it go away.  Well, I said, I hoped it was the case.  He said also it might be some tumor in the colon pressing against the prostate region; but he just threw that one out off the cuff as a remote maybe perhaps because if that was the problem he would have noticed it earlier with his finger, given how far, it seemed to me at least, he voyaged up there.  And hell, I had a colonoscopy about 18 months ago. 

Then he said something about muscle spasms.  So after seeing the urologist, I started googling around about muscle spasms in the pelvic floor, and I came up with something called Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)  According to Wiki this accounts for 90%-95% of prostatitis diagnoses,[2]a  and is also known as chronic nonbacterial prostatitis. The annual prevalence in the population of chronic pelvic pain syndrome is 0.5%.[3] Men in this category have no known infection, but do have extensive pelvic pain lasting more than 3 months.[4] There are no standard diagnostic tests; diagnosis is by exclusion of other disease entities. Multimodal therapy is the most successful treatment option,[5] and includes α-blockers,[6] phytotherapy,[7][8] and protocols aimed at quieting the pelvic nerves through myofascial trigger point release with psychological re-training for anxiety control.[9][10] Antibiotics are not recommended.[11][12]

Other forms of chronic prostatitis involve infections, one very serious that would have presented in fevers and downright illness.  I have not had that. Could be some sort of infection is present, but I am inclined towards chronic nonbacterial not only because I have had no acute infection but also because chronic non-bacterial is related to something with which I am fully familiar:  chronic anxiety.  The co-authors of A Headache in the Pelvis write:

 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.

They use the word stress here—but in other places in their writing and in the writing of others ugly old anxiety (especially with reference to anxiety trigger points) comes up quite a bit.

A few days ago, I called my trusty psychiatrist.  He is a decent guy by the way and keeps up with his field.  He had heard of this Chronic Prostatitis; so I figure it is not some web only syndrome or condition made up by crackpots who want to sell herbal medicines.  He is sending me a magazine article about things I might do.  And I see him in a couple of weeks and will discuss the issue.

In the meantime, at the worst, I occasionally feel as if I am sitting on a marble right down there where there shouldn’t be anything to sit on. For now, I find the matter more psychologically distressing than physically painful.

37 days without a cigarette!  What with the rigors of quitting (I do not think I have yet quit) and this strange complaint—I am most days in a state of near complete torpor.