What about having an energetic, "vigorous" prostate massage? Sounds like a
healthy thing to do, doesn't it? A lot of people become confused after reading
about the supposely good effects of vigorous massage or drainage at various
websites and newsgroups devoted to the subject of prostatitis. One such website
states:
"Your prostate gland is a complex structure of tiny acini, or sacs, in
which bacteria can grow. Once they grow there, the swelling and inflammation
caused by the infection closes off the sac, causing it not to "shed" bacteria,
and protecting the bacteria inside from antibiotics and your body's own immune
cells. As more and more acini get closed off, your prostate begins to swell
and interferes with your other normal urinary and sexual functions."
This concept, this image of bacteria-filled acini, is not borne out by any
research. But it's an idea which has taken hold of many men and now drives a
good deal of the layman debate around chronic prostatitis/chronic pelvic pain
syndrome (CP/CPPS). You need to be aware that it is not an idea with any support
both experimentally or in the urological community generally.
It seems that gentle massage of the prostate by a urologist
may be beneficial by:
- helping to drain painfully sequestered secretions in a chronically
inflamed prostate gland or seminal vesicles; or
- As a leading prostatitis researcher has stated, "prostate massage" may
help by releasing the tension around nerve endings near the prostate in a
manner similar to Theile's massage which helps women with IC. This represents
a form of "myofascial release".
However, vigorous prostatic massage may be very dangerous. If you have
acute bacterial prostatitis it can result in septicaemia (blood
poisoning). If you have the beginnings of a carcinoma in your prostate, it could
conceivably result in the cancer being disturbed, broken up and
metastasizing (spreading) around your body. Thirdly, it can
result in prostatic calculi (little stones -- if you have them)
tearing the delicate membranes in the prostate, exacerbating your CP/CPPS.
Fourthly, there is a chance of perforation of the very thin
rectal lining adjacent to the prostate, or tearing the rectal lining with a
fingernail or implement. Fifthly, it may cause a hemorrhoid
flare-up. In short, do NOT ask your doctor for prostate "massage"
unless you have considered all the above points carefully.
A researching urologist adds:
"Vigorous pressure can result in tearing the very short segment of the
urethra just below the prostate and immediately before the beginning of the
penile urethra (this part is usually referred to as "membranous urethra"). The
tearing can be very small and indistinguishable on routine examination but
during the healing process this results in urethral stricture. In short, if
the person giving you a massage has short fingers there is a significant
probability that he/she might give you... a urethral stricture.
"Moreover, indiscriminate (inappropriate massages) can result in
pushing back even normal urethral flora into the epididymis and subsequent
epididymitis. Therefore, I'd usually have my patients on antibiotics when I
perform massages on them.
"There is a general misconception that the prostate should appear
enlarged, boggy or congested in "prostatitis". While this probably is true in
chronic bacterial prostatitis, most CP/CPPSers have small prostates, which are
painful to massage. Therefore, if you don't find relief from three massages,
there is a small chance that massage will benefit you at all. It deserves a
try, it is something that definitely works in some cases but it is not as
simple as picking one's nose (and even this can bleed from vigorous picking).
Prostatic massage is a procedure and as such the person performing it should
be aware of what he/she is doing, where he/she is supposed to press and how
persevering he/she should be. I am very careful whenever I perform the
procedure and listen carefully to my patients.
"I once observed the
most extraordinary complication of prostatic massage. A 28 year old presented
with a history of a two-year right-sided discomfort in the right
abdominal/cecal area (the place where the appendix is). I performed a very
careful DRE during which the prostate was quite tender. Two days after the
exam the patient developed visible anterior abdominal hematoma (collections of
blood) above the bladder. Subsequent ultrasound exam revealed they were
situated between the rectus abdominis fibers. They subsequently moved down to
the testicles (because of the continuity of the anterior abdominal fascia with
the scrotum). The bleeding was caused by the apprehension of the patient who
contracted the anterior abdominal muscles (the rectus abdominis) strongly and
abruptly thereby tearing some of the muscle fibers. My advice for patients: Be
sure to relax COMPLETELY your abdomen during DRE/massage. Do it completely and
slowly!
"Some men do benefit from massage (alone or with antibiotics).
However, remember that the increasing leukocyte count in EPS some people use
as a mark of "unclogging the acini" might as well signify mechanical damage to
the prostate (leukocytes are increased in trauma, too)."
"As regards
technique: do not push in one place; rather move from lateral to the center
line of gland. Pushing at one place only can damage that area, especially if
you are pushing very hard. "
"Sometimes no drops of prostatic secretions are produced at the tip of the
penis. Not all prostates yield fluid following all massages. There is an
interesting concept put forward by Dr. Krieger in 1996 according to which the
inflamed ducts empty following the massage, rather than during it. If you keep
that in mind, massage can be beneficial even when no fluid comes out."
"Remember that for some men, massage can be beneficial even when it is a
massage of the muscles, surrounding the prostate, rather than the gland
itself."
"Lastly, an aggressive massage can theoretically precipitate an autoimmune
response by releasing "forbidden antigens", and this may explain why some men
have a lot of pain after prostate manipulation."
D A N G E R
Urologe A. 2003 Jan;42(1):78-9.
Prostate
massage with unwanted consequences. Case report [Article in German]
Buse S, Warzinek T, Hobi C, Ackerman D.
Klinik fur
Urologie, Kantonspital St. Gallen, Switzerland.
We report a case in which
a regular prostate massage (chronic prostatitis) turned into a life-threatening
event. After the prostate massage, an enormous periprostatic hemorrhage
developed. During hospitalization the patient developed an embolic insult to
the lungs. To our knowledge no other cases have been published. This report
shows the potentially serious consequences, and we conclude that any pain after
prostate massage needs further diagnostic steps (ultrasound, CT scan).
PMID: 14655640 [PubMed - in process]
