Conclusions about vitamin D in CPPS

As vitamin D is a strong immuno-regulatory hormone(1) and has been proven effective for treating conditions, like musculoskeletal pain, there is reason to believe low D-levels, even if not causative, may exacerbate CP/CPPS. The findings above do also suggest why prostaglandin inhibitors are effective in treating CPPS, and why symptoms go in remission during summer.

This also lends support to the hypothesis that CP/CPPS has a neuromuscular/myofascial component. Cold and freezing may cause muscular tension. D-vitamin deficiency is implicated in myopathies, as are calcium and magnesium deficiencies, and depression (SAD).(2)

As Melatonin enhances cellular immunity and cold has an effect on at least some of the components involved in immunity this may also be a cause of winter-time flares, especially when bodily levels of D3 are low.

Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, överaktiv blåsa, värme, sommar, D-vitamin, inkontinens.
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(1) Hewison M. Vitamin D and the intracrinology of innate immunity. Mol Cell Endocrinol 321(2):103-11, 2010.
(2) Verstuyf A, Carmeliet G, Bouillon R, Mathieu C. Vitamin D: a pleiotropic hormone. Kidney Int. 2010 Feb 24. Epub ahead of print

Conclusions about sleep in CPPS

The following is speculative, but sleep deprivation caused by nocturia and sleep disturbances due to CPPS effects on the enteric nervous system (and thus in the end on the HPA axis and on sickness behaviour) is probably an important cause of the severe discomfort and psychological effects seen in CPPS. Especially in non-retired individuals who cannot recover lost sleep during daytime because of work duties. The exact directionality of effects is likely complicated. Are the problem driven by HPA axis disturbances or enteric effects, mediated by the vagus nerve, or by the sleep disturbance caused by nocturia. Regardless of the ultimate cause it is well worth finding strategies for getting a good nights sleep. Strategies such as avoiding caffeinated products, chocolate, alcohol, strawberries and other products know to be diuretic. Especially in the evening and late afternoon.

Prostatit, sömn, cytokiner, CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, immunförsvaret, nokturi.

Concluding remark about the urodynmic findings

Urodynamic and ecographic studies have shown a high prevalence of urodynamic abnormalities. Are these under-diagnosed in male urologic patients? The problem with any of the above conditions is: what came first? In some cases physiological changes may be the obvious precursor, in other case they may be caused by the subsequent chronic inflammation. Urography and trans-rectal ultrasound should be performed to rule out these problems.

CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, miktionsfysiologi, miktion, urodynamic findings, ultrasonography.

Some final words on androgens

As androgens, and especially testosterone, are important for male health they are an interesting field of research. Unfortunately the research is scant on the relation between androgens and CPPS. But it is definitively a good idea to try to minimize androgen disruption by trying to get enough sleep. Especially due to the fact that nocturia disrupts sleep in CPPS. A possible solution could be very small doses of desmopressin, to see if sleep improves leading to improved wellbeing and vigour. It would also be interesting to research thyroid and gonadal-pituitary function.

CPPS, prostatit, kroniskt bäckenbottensmärtsyndrom, nokturi, trängningar, androgens, erection, estrogens, nocturia, testosterone.

Sexual health-concluding remark

Erectile dysfunction (ED) and ejaculatory dyssynergia (EDS) strongly affect quality of life in some CPPS sufferers. Why these occur and how many men that are affected is not clear. Research in ED and EDS is in my opinion lacking in standardized procedures and useful measurables (the 2-minute limit is not a good parameter-it is in fact ridiculous). The fact that circumcised and normal men are not distinguished is also a confounding factor. Lack of detailed information on thyroid and gonadal function (prolactin, SHBG, DHEA etc) is yet another.

Micturition-concluding thought

Micturition troubles are a strong cause of worsened quality of life (QoL). There is no good explanation for those in CPPS, but the fact that many of the "irritants" affect vasopressin regulation and the pituitary is an indication of cause. Especially nocturia is very troublesome as it deeply affects daily life for persons with family and work. Improving nocturia by dietary changes and maybe additional small doses of vasopressin analogues would probably lead to much improved QoL for the average CPPS sufferer.

Do all these symptom clusters mean anything

What conclusions or inferences can be drawn from the symptom clusters?

If only there were the Sickness behaviour, Ejaculatory-genital and Micturition problems symptom clusters it would reasonable to assume some urinary or kidney infection, but some signs, like e.g. fever and hematouria are missing.

What may the Seasonal cluster indicate? Seasonality and a cyclical pattern of excacerbations and remissions is a common finding in auto-immune disease. Could there be an auto-immune component to CPPS? Research is unfortunately not too helpful here. Most studies are small and preliminary.

What can the Pituitary cluster indicate? Yes the name of the cluster is very leading. I choose it to point out that the pituitary may be implicated in many odd symptoms reported by CPPS sufferers. What is interesting is that the Micturition, Cardio-vascular and, maybe, the Seasonal clusters also fit in. Sickness behaviour may fit in as indicative of a condition that cause the release of pro-inflammatory cytokines that activates the HPA axis. Could that cause be infectious, auto-immune, dietary or environmental?

What about the remaining clusters? These are more difficult to fit in. Some, like mouth dryness, may be related to the pituitary (diabetes insipidus), abdominal pains may be caused by referred pain from the scrotum. Abdominal distension may be caused by pituitary dysfunction.

You may wonder if there are there any studies on the HPA axis and CPPS, or if these are only my personal musings? Yes, the pituitary angle is my personal idea, but when I perused PubMed to see if there were any studies made I did actually find a couple (see below for references).

A distinctive problem with the pituitary/HPA axis idea is that it may be related with dental amalgam fillings and mercury accumulation in the pituitary and not adrenal dysfunction as suggested by some. The association of amalgam and CPPS seems to never have been researched and the pretty infected debate re. mercury toxicity makes it doubtful if any researcher would be eager to endure the, possibly, years of controversy such a study would cause.

In the following I will review general information about CP/CPPS, current treatment and research into various etiologies, before returning to the symptom subject.

Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, symptomkluster
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Anderson RU, Orenberg EK, Chan CA, Morey A, Flores V. Psychometric Profiles and Hypothalamic-Pituitary-Adrenal Axis Function in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome. J Urol. 179(3):956-960, 2008.
Dimitrakov J, Joffe HV, Soldin SJ, Bolus R, Buffington CA, Nickel JC. Adrenocortical hormone abnormalities in men with chronic prostatitis/chronic pelvic pain syndrome. Urology 71(2):261-6, 2008.
Dimitrakov J, Guthrie D. Genetics and Phenotyping of Urological Chronic Pelvic Pain Syndrome. J Urol. 2009 Feb 19.
Björkman L, Lundekvam BF, Laegreid T, Bertelsen BI, Morild I, Lilleng P, Lind B, Palm B, Vahter M. Mercury in human brain, blood, muscle and toenails in relation to exposure: an autopsy study. Environ Health. 6:30, 2007.