Dear Dr. Roach: My son was diagnosed with pelvic floor dysfunction (PFD) by a urologist. He went to another doctor who never found anything conclusive. My son has complained of stinging and burning in his urethra, as well as an uncomfortable feeling when trying to sit. He’s on his feet most of the time.
He quit his job because of the problems that he encountered with this condition. He’s had two MRIs, a cystoscopy and an ultrasound. The problem persists. He uses a hot tub, which offers some relief but not much. According to his current doctor, the tests are inconclusive without a diagnosis. Should he seek a new doctor?
— Anon.
Dear Anon.: Chronic pelvic pain is found in both men and women, and the diagnosis is frequently delayed for both as well. Patients can suffer for a long time, and both men and women can also be misdiagnosed.
The underlying cause can be a wide variety of issues, so a thoughtful diagnostic approach is wise. Only a few physicians have the expertise to do a careful physical exam of the pelvic floor, so I refer my patients to specialized pelvic pain referral centers. For men, these centers’ experts may include urologists, surgeons, physiatrists, gastroenterologists and physical therapists.
I can’t speculate on what’s causing his pain. It’s likely that he’s had an evaluation for prostate problems, which is a frequent cause of male pelvic pain. Often, a variety of treatments are recommended simultaneously, like pelvic floor physical therapy. Even in men without clear prostate problems, a trial of alpha blockers (a common treatment for an enlarged prostate) can sometimes yield pain relief.
However, my experience with my few male patients with PFD has shown that a skilled pelvic floor physical therapist provides the most benefit in helping relieve symptoms.
Dear Dr. Roach: My general practitioner has a problem with helping me relieve my student loan debt. I’ve had a diagnosis of AIDS since 1990, having tested positive in 1988. My accumulation of comorbidities brings an absolute picture to my current condition. Why is it that sometimes doctors take things so personally? The questions on the form from the federal education department specifically ask, “Will this condition last for five years or more?” I don’t know if my practitioner’s worried that he’ll be put in jail.
— Anon.
Dear Anon.: I write many letters for patients, the vast majority of which don’t pose a moral or legal dilemma. Once in a while, a patient asks me to do something I’m not comfortable with. I have two rules: The first is never to commit fraud. The second is to do what I can to help my patient without breaking the first rule.
Jail time for physicians is possible but rare; however, fines and suspension or the loss of a license aren’t rare for those who get convicted of writing fraudulent letters. In your case, it’s absolutely clear that your condition will last for five years or more. We still don’t have the ability to cure most people of the virus. (There are a handful of cases of cures through bone marrow transplants from a person with a mutation in the CCR5 gene.)
I don’t have all the details of your case or what your doctor’s being asked to write, but if you’re unable to work because of your HIV-related medical conditions, it sounds like he should be able to write a letter that helps you get into the debt forgiveness program — without a fear of committing fraud.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.
This article originally appeared on The Detroit News: Dr. Roach: Pelvic floor dysfunction persists in man without much relief
Reporting by Dr. Keith Roach, To Your Health / The Detroit News
USA TODAY Network via Reuters Connect
By Dr. Keith Roach, To Your Health | USA TODAY Network
