For those who "can't sit" there seem to be a bunch of approaches.  This is my
attempt to summarize them.

I'm sure there are mistakes, incomplete statements, misleading parts, and
subliminal cupcake recipes in here -- I'm just a dude what hurts, and claim no
medical knowledge. But perhaps this will help someone organize their
investigation, as it guides mine.

In brief... there are several approaches, and each has a mainstream side, and
an extremist side, and a lot of debate about which is which.  Another thing...
is some of this relates to prostatitis, and some of it undoubtedly does not
(the assumption being that pain upon sitting may have several causes).

I have little ego wrapped up in this -- anyone who wants to point out the
especially stupid parts is encouraged to do so.

- Carlos

==== 09.15.04 summary == sitting and prostate pain === Carlos speaks! ==
[1] INFECTION APPROACH

The infection approach says bacteria or other infectious agents explain
everything, even if you can't prove the existence of any particular bug.  Many
people seem to better or cured by antibiotics.  The downside is you can't take
antibiotics forever, and some have nasty side effects.

Not all antibiotics are the same.  There are things Zithromax and Doxycycline
kill that Cipro and Levaquin will not.  Just because you failed with a month of
Cipro or Bactrim doesn't mean something else might not work.

There is also a debate about WHY antibiotics work.  One view is they only work
because they are anti-inflammatory, not because they're killing bugs. Another
is they are anti-inflammatory BECAUSE they are killing bugs.

On the quack side, some people take antibiotics for years (in small amounts),
or get them intravenously, or get them injected directly into the prostate.

Prostate drainage is an old technique of squishing the prostate (by a gloved
hand inside the rectum) which may be useful especially if you are on
antibiotics (the theory is you remove fluid that may contain bacteria).  (some
people think drainage helps because it's a kind of massage, relaxing trigger
points).  But it's difficult to find someone who knows how to do it, and some
speculate it has dangers (pressure causing injury, or spreading infection,
among them).

One big debate is whether and how to culture to evaluate the possibility of
infection.  A minority have testable bacterial prostatitis, take antibiotics,
and are cured.  More intensive testing (5 day tests, tests of semen as well as
urine) reveal more bacteria, but not necessarily the bacteria that is causing
the pain.

[2] TRIGGER POINT

This approach says that pain makes muscles tighten, and after
weeks/months/years of being tight in the wrong way (as a pain defense) they
stay that way even after the pain is gone.

Treatment can include:

- trigger point massage (http://www.ic-network.com/md/ptlistings.html)

- drugs that relax the pelvic floor (that baclofen and klonopin and dilatan)
(Dr. Guercini of Rome)

- Various injections (numbing agents, or on the more radical fringe, botox)
into muscles.

In my ignorant view, this mixes cause and effect.  Sure, if you have a point of
pain, muscles tighten to protect, and in time the infection might be gone but
the muscles remain in appropriately strong or inappropriately conditions.  But
my guess is as long as pain remains, the source of the pain remains.  And if
there is any science here, why do different massage therapists come to such
different conclusions with respect to particular patients.

Trigger point may mostly be pain management, not a cure -- but hey, pain
management that works is good.

[3] NEUROLOGICAL

Mainstream medicine recognizes that sitting on a narrow bicycle seat, or an
injury (fall from a ladder) can cause neurological damage.  Treatment is:

- waiting for nerves and blood vessels to regrow while avoiding the activity
(bicycling, sitting) that cause the injury

- oral steroids, anti inflammatory (palliative more than treatment)

Put another way, if excessive bicycling on a narrow seat caused problems
(numbness, or urinary or erectile) then don't bicycle.  Maybe even sit less.
Walk.  You'll get better, though it may take months.

The freak side of the neurological approach claims the pain is the result of an
"entrapped" nerve -- not just injured, but stuck between ligaments that are
grinding it making it worse.  It's not proven that the pudendal nerve is EVER
entrapped and what a lot of the PNE crowd considers their "gross abnormality"
is something they somehow lived with without pain for years.  Can you say
QUACK?!

The tests that "prove" entrapment are crackers.  Pudendal nerve blocks cure no
one, and a serious percentage (over 25% on my extremely informal and
unscientific test) get permanently worse.  And IMO they have no diagnostic
value re: "entrapment".  And the "cure" for entrapment -- surgery -- has NO
statistics despite years of operations.

[4] ANATOMICAL

There are many structural reasons that can explain your symptoms (whatever they
are).  They can include:

- a spinal injury or cyst

- testicular or prostate cyst or tumor

- a urinary stricture which causes "urinary reflux" (chemical inflammation)

Now try and find a doctor who will methodically test you for all the
possibilities!

[5]  EVERYTHING ELSE

I've seen chiropractors who claim to have made progress treating this stuff.

Oh, and herbal -- that's a big one.  Many men (at least with enlarged prostates
that appear not to have cancer or bacterial infection) are helped by Quercetin,
or Saw Palmetto, etc., etc.

For pain that is sitting-specific (in other words, no accompanying urinary,
prostate or epididymal symptoms) there may be other nonbacterial infections
(Google "Bursitis")

MANY medical theories

- an autoimmune disease (the inflammation is a body reaction, not an external
agent)
- an allergy (same as autoimmune reaction?)

When substantive treatment fails, try pain management.

Oh, and something about hormones.  This guy is a great resource for all of
this:

  GENERALLY http://www.geocities.com/bill3320/

   HORMONE THEORY  http://www.geocities.com/bill3320/hormones.html