Anecdotal information indicates that coffee, citrus fruit, tomatoes, vinegar, alcohol and spicy foods may worsen symptoms, but a study of 1759 participants shows no correlation with these (1). (It may be interesting to note that porphyria, AIP, may be triggered by some of these irritants.) The same irritants are also mentioned by IC patients(2). But it may be so that foods increasing uric acid (protein rich foods) or potassium levels (like apple and orange juice) are causing exacerbations, if the patients problems are caused by uric acid or potassium irritation from reflux of urine or bladder epithelium abnormalities.
Alcohol and caffeine (in coffee, tea and chocolate) and nicotine cause increased urgency and frequency because both inhibit vasopressin (AVP) production. AVP may also affect mood – anger, anxiety, depression etc (3).
Finally substances causing muscle relaxation may cause disruption.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, vasopressin
___________________
(1) Hochreiter WW, Madersbacher S, Temml C, Zbrun S, Wolfensberger P, Studer UE Prevalence of prostatitis symptoms and LUTS in 1759 men using validated questionnaires. 2005 EAU meeting, Istanbul.
(2) Shorter B, Lesser M, Moldwin RM, Kushner L. Effect of comestibles on symptoms of interstitial cystitis. J Urol. 178(1):145-152, 2007.
(3) Caldwell HK, Lee HJ, Macbeth AH, Young WS 3rd. Vasopressin: behavioral roles of an "original" neuropeptide. Prog Neurobiol. 84(1):1-24, 2008.
Tuesday, March 17, 2009
Seasonality, cyclicity and circadian rhythm
There seems to be a distinct seasonality in CP/CPPS. Overall symptoms worsen the more northerly you live. Over the year symptoms improve from about may to august and worsen from october to april. Overlying this longer cycle there is anecdotal evidence of a shorter cycle of about 3-6 weeks for dysuria and of a diurnal cycle were symptoms, especially dysuria and muscle pain, are worse in the morning and improve during the day.
I'll revisit this topic later.
I'll revisit this topic later.
Wednesday, March 11, 2009
Disease progression
N.B. there is very little scientific data and tons of anecdotal. The following is mainly based on personal recollection and anecdotal data from websites. It is very sketchy. There is notable personal variation in pain experience and symptom intensity.
The disease/condition develops over many years. Initial symptoms are diffuse and mainly concern dripping progressing to obviously split stream (but most likely muscular pain has preceded that). At some point back pain and occasional perineal spasms start occurring. Unclear if the back pain and spasms precede dripping or developes during or even after.
In addition to the above vague problems with “penile sensitivity” start occurring and slowly semen/ejaculate start changing appearance. Parallel to this bouts of fatigue and malaise occur with increasing frequency and usually during winter with possibly a late winter early spring peak. Spring does also see an increase in depression-like symptoms. Palpitations do also occur but have no obvious pattern. Painful and/or uncoordinated (early and/or unexpected) ejaculation and “discoloring” of glans seems to be some sort of “end stage” problem.
Cold and freezing seems to precipitate spells of dysuria, but initiation of really bothersome dysuria and frequency seem to need a precipitating event. It seems that many sufferers seek medical attention at this point. Thus explaining the focus on urological causes.
Full blown CPPS tends to persist “unabated” for years, while milder forms tend to resolve with a few years. (In small study by Nickel symptoms resolved within a year in 38% of the subjects.) Or at least get manageable.
There may be a hereditary component!
A flare may look like this: dripping and nocturia begins, then back pain and some events of short inexplicable bursts of irritation and anger occur (hours), after these longer periods (days) of listlessness follow and finally palpitations occasionally occur. During the flare intestinal motility and libido diminishes and a progressive feeling of tiredness and fatigue develops. Micturition intervals decrease. Pain may occur during micturition and intercourse. Back pain is relieved by micturition. Flare ends pretty abruptly. Duration may be 3-4 weeks.
There is a collection of patient stories on this page: http://home.swipnet.se/isop/fallbeskrivningar.htm. The numbered links lead to english text.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, ISOP
The disease/condition develops over many years. Initial symptoms are diffuse and mainly concern dripping progressing to obviously split stream (but most likely muscular pain has preceded that). At some point back pain and occasional perineal spasms start occurring. Unclear if the back pain and spasms precede dripping or developes during or even after.
In addition to the above vague problems with “penile sensitivity” start occurring and slowly semen/ejaculate start changing appearance. Parallel to this bouts of fatigue and malaise occur with increasing frequency and usually during winter with possibly a late winter early spring peak. Spring does also see an increase in depression-like symptoms. Palpitations do also occur but have no obvious pattern. Painful and/or uncoordinated (early and/or unexpected) ejaculation and “discoloring” of glans seems to be some sort of “end stage” problem.
Cold and freezing seems to precipitate spells of dysuria, but initiation of really bothersome dysuria and frequency seem to need a precipitating event. It seems that many sufferers seek medical attention at this point. Thus explaining the focus on urological causes.
Full blown CPPS tends to persist “unabated” for years, while milder forms tend to resolve with a few years. (In small study by Nickel symptoms resolved within a year in 38% of the subjects.) Or at least get manageable.
There may be a hereditary component!
A flare may look like this: dripping and nocturia begins, then back pain and some events of short inexplicable bursts of irritation and anger occur (hours), after these longer periods (days) of listlessness follow and finally palpitations occasionally occur. During the flare intestinal motility and libido diminishes and a progressive feeling of tiredness and fatigue develops. Micturition intervals decrease. Pain may occur during micturition and intercourse. Back pain is relieved by micturition. Flare ends pretty abruptly. Duration may be 3-4 weeks.
There is a collection of patient stories on this page: http://home.swipnet.se/isop/fallbeskrivningar.htm. The numbered links lead to english text.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, ISOP
Sunday, March 8, 2009
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
_________________
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.
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
_________________
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.
Remaining symptoms and signs
Below follow some anecdotal symptoms and signs that do not fit any cluster and that may or may not be related to CPPS.
• Improvement of symptoms during other infection: e.g. influenza and cold.
• Decrease lung capacity (by decreased bronchodilation)?
• Sudden feeling of mouth dryness (no noticeable concomitant thirst -- disruption of water balance?)
• Lower back pain / burning sensation.
• Inter-scapular (thoracic) back pain / burning sensation.
• Axel pain and weakness and arm paresthesias especially with carrying and physical exercise.
• Sinusitis.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, symptomkluster
• Improvement of symptoms during other infection: e.g. influenza and cold.
• Decrease lung capacity (by decreased bronchodilation)?
• Sudden feeling of mouth dryness (no noticeable concomitant thirst -- disruption of water balance?)
• Lower back pain / burning sensation.
• Inter-scapular (thoracic) back pain / burning sensation.
• Axel pain and weakness and arm paresthesias especially with carrying and physical exercise.
• Sinusitis.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, symptomkluster
Tuesday, March 3, 2009
Cardio-vascular symptom cluster
The part about blood clotting is tentative and inferred from the fact that many of the of treatments (incl. phytotherapies) have an anti-thrombotic component.
• Increased propensity för blood-clotting due to cold. Increased fibrinogen production?
• Platelet disruption?
• Palpitations (i.e. different heart rhythm) occuring e.g. at bedtime or at wakening.
• Tachycardia, i.e. a faster than normal heart rhythm occuring despite an absence of physical effort.
(There are many causes of heart arrythmias. In our case it could e.g. be caused by disruptions of water and electrolyte balance or acid-base imbalance.)
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, symptomkluster, hjärt-kärlsystemet
• Increased propensity för blood-clotting due to cold. Increased fibrinogen production?
• Platelet disruption?
• Palpitations (i.e. different heart rhythm) occuring e.g. at bedtime or at wakening.
• Tachycardia, i.e. a faster than normal heart rhythm occuring despite an absence of physical effort.
(There are many causes of heart arrythmias. In our case it could e.g. be caused by disruptions of water and electrolyte balance or acid-base imbalance.)
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, symptomkluster, hjärt-kärlsystemet
Sunday, March 1, 2009
Pituitary symptom cluster
This is a tentative cluster. It is based on anecdotal evidence, facets of urinary and sickness behaviour symptoms, and foods reported to exacerbate symptoms. (The pituitary is also called hypophysis.)
Possibly pituitary / HPA-axis related problems
• Problems with vasopressin regulation. This is indicated by increased susceptibility to vasopressin antagonists. E.g. worsening of nocturia, diuresis and urgency after alcohol and caffeine intake. (I.e. symptoms showing a similarity with diabetes insipidus.)
• Sleep disruption (nocturia-caused or not?)
• Abrupt mood fluctuations (irritability, aggression and anger).
• Sudden feelings axiety with no obvious cause.
• Cold sweats. Similar to night sweats. Body temperature regulation. Anecdotal.
• Depression.
• Fatigue.
• Leg weakness.
• Lower than average bone density.
• Decreased / low libido. (Added march 4th 2009)
Possibly thyroid related problems
These symptoms may be caused by hypothyroidism. And yes there is a point in mentioning those with pituitary/HPA problems as pituitary regulation problems may cause secondary hypothyroidism.
• “Uncontrollable” nightly sweating / hot flashes. Indicates problems with body temperature regulation. Anecdotal.
• Cold sweats. Similar to night sweats. Body temperature regulation. Anecdotal.
• Feeling unfocused / not alert.
• Fatigue.
• Constipation.
• Feeling cold.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, symptomkluster, hypofysen, sköldkörteln
________________
Further reading
Sievers C, Ising M, Pfister H, Dimopoulou C, Schneider H, Roemmler J, Schopohl J, Stalla G. Personality in patients with pituitary adenomas is characterized by increased anxiety related traits: comparison of 70 acromegalic patients to patients with non-functioning pituitary adenomas and age- and gender matched controls. Europ J Endocrin 160:367, 2009.
Possibly pituitary / HPA-axis related problems
• Problems with vasopressin regulation. This is indicated by increased susceptibility to vasopressin antagonists. E.g. worsening of nocturia, diuresis and urgency after alcohol and caffeine intake. (I.e. symptoms showing a similarity with diabetes insipidus.)
• Sleep disruption (nocturia-caused or not?)
• Abrupt mood fluctuations (irritability, aggression and anger).
• Sudden feelings axiety with no obvious cause.
• Cold sweats. Similar to night sweats. Body temperature regulation. Anecdotal.
• Depression.
• Fatigue.
• Leg weakness.
• Lower than average bone density.
• Decreased / low libido. (Added march 4th 2009)
Possibly thyroid related problems
These symptoms may be caused by hypothyroidism. And yes there is a point in mentioning those with pituitary/HPA problems as pituitary regulation problems may cause secondary hypothyroidism.
• “Uncontrollable” nightly sweating / hot flashes. Indicates problems with body temperature regulation. Anecdotal.
• Cold sweats. Similar to night sweats. Body temperature regulation. Anecdotal.
• Feeling unfocused / not alert.
• Fatigue.
• Constipation.
• Feeling cold.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, symptomkluster, hypofysen, sköldkörteln
________________
Further reading
Sievers C, Ising M, Pfister H, Dimopoulou C, Schneider H, Roemmler J, Schopohl J, Stalla G. Personality in patients with pituitary adenomas is characterized by increased anxiety related traits: comparison of 70 acromegalic patients to patients with non-functioning pituitary adenomas and age- and gender matched controls. Europ J Endocrin 160:367, 2009.
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