Question Title: Chronic muscle tightness/spasms

I am 23 years old and have been dignosed with chronic prostatitis.
About 3-4 years ago I began having muscle spasms and tightness all throughout the
groin/rectal area especially during sexual contact. Erections are so tight that they
are uncomfortable. The muscles at the base of the penis and underneath the scrotal area are so tight
and spastic that it makes it uncomfortable to walk around during the day not to mention
having sex. The muscle that runs between the scrotum and the anus is so tight and constrictive
and will not relax. I have seen countless doctors and been on just as many antibiotics and alpha blockers
I've even been put on valium and sent for psychiactric treatment. Nothing has helped.
Do you think that this is some kind of neuro muscular disorder?
I've been thinking about trying biofeedback. What if anything can you make of all this?

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Dear Bart,
I want to make sure your were evaluated by a urologist because we specialize in diseases of the prostate and urinary tract. It is difficult for me to beleive that you have chronic prostatitis at this early age, however it is not impossible. To make the diagnosis of prostatitis, a three part urinalysis should be performed. I would need a physical examine to comment on if you had a muscular disorder. Another good question would be, have you ever had any trauma to the groin, stradder injury or sharp penitrating trauma?
Men with prostatitis syndromes are frequent patients in the urologic office. Initially, they should be screened with urine analysis, urine culture, urine cytology, and uroflowmetry. If no bacterial pathogen is found then a special urine analysis , as I mentioned before with three samples, should be performed. Your prostatitis symptoms are vague and may or may not put you into the category of infectious prostatitis, either acute or chronic. There is another category that is a little less specified, known as nonbacterial prostatitis or a third category known as prostadynia. The three part urine sample would put you into a category of which type of prostatitis you have. I will briefly discuss each type below.
Acute bacterial prostatitis you probably do not have because this has been going on so long and you have had multiple courses of antibiotics. This accounts for less than 5% of cases. Symptoms would include fever ,chills, malaise, and myalgia. Local symptoms are frequency, urgency, low back pain and outlet obstruction(difficulty urinating). Digital rectal exam is exquisitely tender. The most common pathogens are E. coli, Klebsiella, Proteus mirabilis, Enterobacter, and Staphylococcus aureus.
Chronic Bacterial prostatitis is defined by recurrent Urinary tract infection and persistence of pathogenic bacteria in prostatic fluid. Primary complaints consist of genitourinary pain(61%),dysuria or painful urination(16%), clear urethral discharge(12%), recurrent UTI(9%), and sexual dysfunction(1%). Physical exam is usually normal, however the three part urine analysis shows a high number of white cells on one of the three samples. This may be what your doctors are telling you(>10WBC/HPF in the EPS) The most common organism found is E.coli in 80% of cases. Chronic bacterial prostatitis is simply a bacterial infection that recurs and is chiefly due to the ductal structure of the prostate you were born with.
Treatment with Bactrim or one of the Fluoroquinolones for 4-6 weeks is successful 30-50% of the time.
It sounds like this is what your doctors have labeled you to have so see if the above symptoms I described are consistent with your problem.
Nonbacterial prostatitis is an inflammatory condition of unknown etiology. The symptoms are similar to those with chronic prostatitis and this group of patients outnumber all other patients with prostatitis. Again the physical exam is unremarkable however on the three part urine test there is not only high numbers of white blood cells, but all lipid laden macrophages. These are cells not characteristically seen in the prostate secretions filled with fat. There may be a chemical irritation as a basis of this disease.
A trial of antibiotics should be tried but conservative measures such as over the counter anti-inflammatory agents(Motrin, Advil, Aleve), hot sitz bathes and support should be offered.
Prostadynia is a term used to define patients with proststitis type pain without specific findings related to the prostate. Typically these patients are younger and have variable urinary complaints. There is no etiology of this disease established and therefore a generalized work-up should be done. Again conservative measures should be performed in addition to some limited dietary restriction of caffeine,alcohol, and spicy foods. Other talked about treatments include Zinc and Saw palmetto however neither of these therapies have been proven.
My final suggestions would be to make sure you are seen by a urologist and consider having the above prostate specific urine analysis performed with prostatic massage. You mentioned biofeedback which can’t hurt but may not be necessary. If you are examined by a urologist , he or she could answer that question for you.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).

Sincerely,
HFHS M.D.-AK
*keyword:Prostatitis

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