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QUESTION: For several days now I have had a mild mild throbbing pain which I assume is coming from the prostate area. The other possibility is that its bowel/anus pain but I am fairly sure it is the prostate. I have had various other symptoms in the past like testicular pain and also more intense prostate pain so on that basis I think it is a reasonable assumption.

Anyway, the pain is not intense but annoying and nothing seems to relieve it. It does go away for short periods. But it has been ongoing for several days.

Assuming its reflux type prostatitis, or some other prostate inflammation will it go away on its own or not?

How long would it typically take?

what tests would the doctor need to do to investigate something like this?

ANSWER: Jim:

The pain may or may not ultimately be due to the prostate.  Usually, we check a urine sample and do a Digital Rectal Examination or DRE.  If it is prostatitis, it can tend to linger for quite a while.  Even with treatment, discomfort can last for days, weeks or even months.  Most of the time, the problem is resolved in 4-6 weeks.

You'll need to check with your local physician to verify the diagnosis.  For now, try to avoid hot spices and caffeine.  Also, sit in a hot tub for 5-10 minutes twice a day as this will help.

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QUESTION: i have read that prostatitus is quite a common thing. Have you had it yourself? It seems there is nothing I could do to avoid it since it is quite a common thing.

I already tried sitting in a hot bath hoping it would help but as I sat there I could still feel the throbbing so I don't think it works. As I say nothing seems to relieve it.

I am going to have to start using herbs now. Can you give your opinion on the use of herbal products as a treatment option? There appears to be a variety of herbs which might be useful and which target the prostate.

Does the DRE not allow faeces to come out since the bowels are not emptied beforehand are they?  can I do the prostate exam myself or is it risky?

ANSWER: Jim:

No, I have not had it myself, but I treat many patients with it.  Sitting in the tub is not a one time thing.  It is best done several times a day in really hot water for about 10 minutes.  You can also try some OTC remedies such as ibuprofen to help act as anti-inflammatories.  Another supplement, quercetin, has shown some activity in prostatitis and may be worth a try.  Quercetin is an ingredient found in various prostate supplements at health food stores.  Other herbal treatments have not had sufficient testing.  I have seen some good reports from a product called "PEENUTS" which was designed by urologist Dr. Ron Wheeler.  This may be worth a shot.

You cannot do the prostate exam yourself and the DRE will no affect bowel activity.  It's done by your physician and only takes about 30 seconds.

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QUESTION: Can you tell me where the prostate can be felt from the outside? can it be palpated through the perineum or from the front near the pubic bone?

Also I read that DRE is an invasive and horribly painful experience. Is that true? or perhaps I read that it was the prostate exam which is painful.
The problem is, for the additional discomfort you will feel during the exam, it doesn't actually offer any benefit in terms of healing does it? Its like many other diagnostic exams which may offer further insight into the condition but it remains incurable anyway. I dont see the point of having the exam done in that case.

And also the product called peenuts that you recommended is in fact based on traditional herbal remedies such as nettle, pumpkins and pollen. These are the same herbs which you would presumably criticise for lacking evidence to demonstrate their efficacy. Are you aware that the ingredients of peenuts was based on such herbs and does it change your view on the effectiveness of herbal remedies?

Also in a previous message you stated that herbs which supposedly increase testosterone cannot lead to an increase in testicular size since the testicle is surrounded by a thick muscle which would prevent any increase in size. But I read that if one testicle is lost due to injury or disease, the other will compensate for the loss of function by increasing its size. How can this be true given what you said previously?

Answer
Jim:

The prostate can only be examined from the outside through a rectal exam.  It cannot be directly examined any other way.

DRE is a little invasive, but it only takes 30 seconds and it's absolutely essential in making a diagnosis.  It certainly is not normally a horribly painful experience as you've mentioned.  

The exam is not for therapy; it's for diagnosis.

Prostatitis is not incurable, but many cases can linger and require longer treatment.  

If you were my patient and declined the DRE but expected me to treat your prostatitis I would probably refuse and ask you to find another physician.  Why?  Because there are very limited tests that are helpful in prostatitis and if the patient refuses to do them, how can you make the diagnosis?

With regards to PEENUTS, it does contain a number of herbal remedies that individually have not been tested but for which there is some evidence that they might be helpful.  A urologist who specializes in prostatitis patented his particular formula and uses it in his most difficult prostatitis cases.  He has done some research into this and has found it to be helpful but I take any data from the producer or manufacturer as potentially biased.  I have also seen some of my own patients try it on their own and some report it helps, others not.  This information does not change my opinion of herbal remedies which are generally unproven.

If one testicle is lost, the other does not increase in size.  This does happen to some degree in kidneys, but not testicles.  

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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