Exercise, Karate (Updated November 2012)
For thirteen years I suffered with severe chronic prostatitis, from 1990 until 2003. "Prostatitis" was only a bacterial issue one time, the other times I had nothing to indicate anything except viral or "abacterial" prostatitis. I went through Floxin, other antibiotics, Prosed, drainage, Flexeril, cranberry juice, hot baths, hot compresses, and saw palmetto; eventually a cystoscopy which ruled out other issues (my urologist called down to my wife after the procedure and said "Joe has magnificent flow"; yes, but I still had prostatitis). I was very frustrated.
As I read about my condition, especially on the Prostatitis Foundation site I began to learn about the relatively new diagnosis of that time, "chronic pelvic pain syndrome" (CPPS). With the suspected origin as tightness of pelvic floor muscles, I saw all of my symptoms listed on Internet sites repeated regularly: debilitating radiating pain from the back, through the groin, and down one or both legs; urinary urgency forced me to learn where all of the rest areas and restaurant rest rooms were on I-95 between Rhode Island and New York. Before getting on a plane I would pop three or four ibuprofen and just hope to get through it. I would cancel business trips just not to sit on planes, affecting my income. I would have to take time out of each day to rest and hope the pain would subside when an attack would come. I would skip going to church to avoid the hard benches. I fit the profile of how one gets this way: lack of activity, such as sitting for hours at desks or in cars, contributing to a slow and cumulative atrophy, causing the pelvic area to fall out of condition. If this was muscular, I decided that acting aggressively was needed, and soon.
I bought hemorrhoid rings to use at my desk, car, and kitchen. Things were better, but I still had attacks. In December 2001, I decided to get out of the house for a weekly karate class at the same school my son attended on Saturdays. After a few months, I happened to notice my symptoms got better, but they were still there.
Another complicating factor came on the scene: I had serious side effects from statins. I stopped taking them and decided to take karate another time during the week, and to change my diet to lose more weight (I had put on 40 pounds on low fat diets through the 1990s; I started a low-carb/low-fat diet in May 2000 and to have kept off 40-50 pounds). My cholesterol readings improved; my semi-weekly karate classes got me into better shape, and my symptoms subsided some more.
My cardiologist (whom I stopped seeing after this incident) had me start Niaspan, a high dose but slow release Niacin product which is commonly given to those who have statin reactions. It caused me to have liver toxicity (it was described to me as "drug hepatitis"; it took six weeks for me to feel normal again). I upped my karate classes to three times a week, and swore off cholesterol medications for good.
Around this time I learned of the book "A Headache in My Pelvis" and purchased it from the Prostatitis Foundation. As I read the book I was very skeptical, as I had became skeptical of all prostate "cures." Having had some training in statistics, I can dissect studies about new cures, and often saw that 40%+ of placebo groups (people getting sugar pills) were reporting improved symptoms in some studies. This was usually just a bit less than the treatment groups; it was obvious that something other than the "innovative" treatment was at work. Because prostatitis symptoms increase and decrease in great swings, any improvement would be attributed to the last thing tried. This is much like the old saw about looking for something and always finding it in the last place you looked. As I flipped through the pages of "Headache," I saw the exercises the authors suggested. They looked suspiciously like some of the stretches and muscle relaxation techniques we were doing in our karate warmups. I showed the book to my teacher, and they looked a lot like yoga to him. We had a short discussion and tried some floor positions. I started to include the exercises in my pre-class stretching and at home. The difference was incredible, in just a few weeks.
I have not had to take any painkillers or analgesics (like ibuprofen) for since that time except twice for legitimate prostate inflammations. I do take it occasionally because I am still by some standards an out-of-shape middle-aged guy  taking karate classes with people half my age or less, and I get sore when they don't.
I heartily recommend increased physical activity as a principal means of working with CPPS. The original karate style I learned was traditional Okinawan karate; because of a relocation, I am now exploring the Japanese karate, Shotokan. The workout is intense, and it increases in intensity as your ability and stamina increases. As one who treadmilled about three times a week, I can say I have never had a workout like karate offers, which implies to me that one must become exhausted and drenched with sweat regularly before one can really say they are working out. Keeping a good, low, long karate stance and executing the various kicks, and practicing regularly, in addition to the stretches seem to be what help the pelvic symptoms most. Importantly, I am not particularly good at karate (throughout my study, students with less tenure regularly passed me for promotions; but they don't get the benefits of karate that I had, and if they stick with the art, they will probably never have to). No one should be intimidated or embarrassed about how they perform; if they are, it means they are in a poor school. I have always benefited from the encouragement of fellow students in the dojos I have practiced.
Over the years, I have discussed my experiences with CPPS/prostatitis with many by phone and e-mail. These are what I tell them:
- Be persistent: it took years and years to get prostatitis and CPPS, and it may take months to feel significantly better, and a couple of years to speak about prostatitis in the past tense. Every day of delay or skipped day means that your condition will last longer. You will always have a tendency for the condition, but you can take charge of the symptoms and they will stop controlling your life.
- My first rule of karate class: if you don't feel like going, physically or mentally, that's when you need class the most. Picking a dojo can seem difficult. Look for schools that are not dominated by kids classes (and kid's parties), but have good-size adult classes where adults have attended for years. Avoid dojos that consider promotions to senior ranks based only on the time that they have spent in the dojo. Black belts should be hard to get. Many dojos have started to offer training for "ultimate fighting." I would avoid dojos that are obsessed with that, and seek schools that teach technique, self defense, and karate traditions. I have a strong preference for good Okinawan and Japanese styles. Don't be concerned about being the oldest person in the class. Part of the training for senior students is to learn to teach karate to new students and pass on the art to others. Senior students, no matter their age, have learned discipline and persistence that you will need to conquer your symptoms.
- Continue your stretches and exercise, even when the symptoms subside. The symptoms will come back if you stop. Consider the process to be a new, lifelong routine, like brushing your teeth or shaving. Find time for the stretches, like while watching TV or sports, when you used to be sitting. What are the exercises and stretches? Sites like "A-B-C's of Yoga" have examples of yoga positions that are similar to the karate stretches. Basically, anything involving stretching the legs and groin area are helpful. Among the yoga positions that are similar to my stretches and have helped me most are warrior, toe-touch, wide-legged forward bend, seated forward bend, leg raises, leg pulls, leg lunges, wind relieving, and bridge. Search for these positions online. Exercises like leg raises are always helpful. A book I have found useful is "Ultimate Flexibility" by Sang Kim. Though written for karate students, it is worth borrowing from a library just to see the "how-to" pictures of leg stretches.
- Most prostatitis sufferers have problems with urgency. Use the amount of time between "bathroom breaks" to determine when you need a break, not by feelings of urgency. In chronic pelvic pain syndrome, the nerves found throughout the pelvic floor are inflamed, constantly sending incorrect signals of discomfort and bladder fullness. Your bladder is the same size it was before you had prostatitis, so it's a matter of retraining yourself. Just get your mind reoccupied on a different task and the feelings of urgency will get pushed into the background and you can manage them accordingly.
- Kegel exercises are excellent. These are often prescribed for incontinence, but they are very helpful for prostatitis. The exercises can be done while waiting at traffic lights, sitting in waiting rooms, or any place where you are sitting down, with no one the wiser.
Be sure to use products like foam or inflated cushions wherever you sit for extended periods of time. The two types that I use are made by Carex. This is not a product endorsement, but they are what I have been using for years, and they are available online if they can't be found elsewhere.
The Carex Inflatable Rubber Invalid Cushion (product number P-703-00) is an inflatable ring made of sturdy rubber. (Many of the rings made of plastic develop slow leaks and last only days or weeks; patching does not work). I've used this model for years before I have to replace it. I put it in a pillow case to make it look better on my desk chair. The foam cushions (Foam Invalid Cushion, P-701-00) are better in cars or at the dinner table, and have their own cloth cover. These are firmer, and I found them less comfortable when in use for hours at a time. There was a time when I brought the foam rings on planes, but that need ended as I got better. I have not used one in the car except on very long trips, and only for a small portion of the trips.
My contact information is below. This is a debilitating problem, and people who have it are subject to the claims of many charlatans and quacks. While I have had a good experience with a non-medical cure, it is not a simple one, as it requires much dedication to stay on top of the problem. In the process, I learned a martial art that has resulted in many friendly and supportive relationships, and has improved my focus in work situations. Not everyone can afford karate class, nor the six hours a week to participate enough to make a difference. I am lucky to have found something so interesting (my son stopped taking the classes in 2005; it is unusual for a parent to keep going for class, I am told). I am fortunate to have an understanding family and work situation that allowed me to explore it.
Joseph W. Webb, Ph.D. (management consultant, no connection to medical field)