Prostatic Congestion

Prostatic congestion is exactly what the name describes – it is congestion of fluid within the prostate gland that isn’t released through ejaculation.  This congestion causes the prostate, and even the seminal vesicles, to swell with fluid.  The area that becomes most congested is often the peripheral zone of the prostate where prostatic fluid is produced.   In some cases, prostatic congestion may be the same disease as non-bacterial prostatitis with simply more congestive symptoms rather than pain symptoms.

This is an often overlooked disorder that can go unnoticed in men that are sexually active or men who masturbate frequently since frequent ejaculation oftentimes relieves congestive symptoms.  For this reason, men who rely on wet dreams for ejaculation often can manifest with symptoms more easily.  In fact, men who suddenly become sexually inactive or stop masturbating may be the most symptomatic.  For this reason, prostatic congestion can often be a major roadblock in men trying to overcome a masturbation and/or pornography addiction.  The role of prostatic congestion in men with masturbation and/or pornography addiction is discussed HERE.

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Symptoms of prostatic congestion consist largely of a man feeling “full” in the prostate and/or seminal vesicles and feeling the need to ejaculate, even when not sexually aroused.  This can sometimes feel like sexual fluid being backed up behind the penis in the pubic hair area.  Some men feel this in the prostate area (often described as "deep inside" or on the perineum (where they sit on a bike) that my feel congested or even "buzz".  Symptoms of needing to ejaculate or feeling congested can increase during the night or early morning after experiencing nocturnal erections.  This often results in men ejaculating more frequently.  In men who are not sexually active, this can increase masturbation frequency and those who do masturbate frequently may actually "mask" their symptoms.  In men who do not masturbate for moral or religious reasons, this can also be highly distressing emotionally since the temptation to masturbate is typically extremely high.  In fact, these sexually inactive/non-masturbating men often experience more symptoms then men who ejaculate regularly.  This often leads to extremely frequent wet dreams or repeated failed wet dream attempts and severe congestion.  In many some cases, this can ultimately result in the individual giving in to the temptation and masturbating against their personal/religious beliefs to relieve congestion which can be emotionally and/or spiritually devastating in some cases.

Sometimes a man may also notice prostate fluid released without ejaculation.  This can occur when the prostate gland is congested and full and a bowel movement can press prostate fluid into the urethra where it then “oozes” out or is flushed out by urine.  This is called prostatorrhea and can be mistaken for thick urine because it typically isn’t white in color like semen (it’s often a clear to light yellow thick and sticky fluid).  This occurs because the peripheral (outside) zone of the prostate becomes engorged with fluid). 

Because of this increased fluid backup, men may also notice that semen volumes may be larger and they may notice that they ejaculate longer in order to release the excess fluid.  Men who are not sexually active may notice heavy wet dreams in which their underwear is completely soaked through.  They may also notice more frequent wet dreams (or attempts by the body to have a wet dream) as the body tries to relieve itself of excess congestion. 

 

Other symptoms may mimic those of benign prostatic hypertrophy (BPH) usually seen in older men.  These BPH symptoms can include having to urinate frequently, getting up in the night to use the bathroom (sometimes multiple times), dribbling after urination, always feeling like you need to go to the bathroom, or a weaker stream of urine.  BPH often occurs as men age, so these types of symptoms in younger men may have more to do with prostatic congestion than BPH.

 

However, BPH and prostatic congestion have swelling that focuses in different areas of the prostate.  BPH is caused by continuous growth of prostate tissue, usually in the transition zone of the prostate near the urethra and next to the bladder – hence all of the urinary symptoms.  Prostatic congestion on the other hand tends to be swelling caused by overproduction and/or backup of fluid in the peripheral zone on the sides and towards the bottom of the prostate.  So the prostate tissue can still swell and affect the flow of urine in prostatic congestion, but it often just feels more “full”.  Hence the reason many of these men have the sensation that ejaculation would be “relieving” (very much the same way a man would feel that emptying his bladder when it’s full would be relieving).  Image below copyrighted by DNA Illustrations and used by permission.

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Diagnosis

Diagnosis can be made by a healthcare provider.  This often is based on the symptoms mentioned above.  The provider may also do a digital rectal exam to feel the prostate (see pages 438-439).  They can often notice on examination that the prostate feels boggy (soft and mushy), especially towards the outer edges.  However, a digital exam only can feel the rear side of the prostate.  Since a large portion of the peripheral zone is on the front of the prostate, this engorgement can’t be felt on rectal exam.  So basing a diagnosis on symptoms can sometimes trump the findings found on exam.

 

 

Causes

There can be one or more causes for prostatic congestion.  The first cause of prostatic congestion can be prostatitis.  If there is an infection in the prostate, the prostate may produce more fluid as a defense mechanism (think of your nose creating more mucus when you have a sinus infection).  These infections as well as inflammation and edema in the prostate can cause more prostate fluid to be produced, thus creating congestion if it’s not released.  In addition, prostatitis may thicken prostate fluid thus inhibiting the appropriate release through the prostatic ducts into the urethra.  This prevents the prostate from releasing as much fluid as it should during ejaculation.

 

The second cause is due to pelvic tension disorder.  Pelvic tension can cause semen to “back up” or not empty completely during ejaculation.  This can cause congestion in the prostate gland and even other glands as the sexual fluids are not able to empty.  This can be worsened in men with prostatitis as ejaculation may be painful and muscle tension may skyrocket during emission and before ejaculation, thus causing fluid to back up even more.

The third cause is sexual denial.  Sexual denial is when a man is sexually stimulated and does not ejaculate.  During sexual stimulation, more than half of the sexual fluid that will be ejaculated as semen will be produced by the male reproductive glands.  Think of this like the salivary glands.  During eating, more saliva is produced.  Same with sexual activity, more sexual fluids are produced during sexual arousal and stimulation.  This can occur when a man is sexually stimulated but does not complete to ejaculation.  Although this rarely occurs in men who are sexually active, men who are trying to stop masturbating can run into this problem.  This would occur if they began masturbating then changed their mind and stopped manual stimulation before ejaculation.  This can also occur in men who view pornography.  Sexual images and stimulation can lead to production of seminal fluids and if ejaculation does not occur, then these fluids can cause congestion.  Another form of sexual denial could occur in sexually inactive men who may have a wet dream process start while they are sleeping but not ejaculate if they awaken prior to ejaculating.  These “failed” wet dreams cause a backup of additional fluid that is not released, thus leading to congestion.

 

Finally, prostatic congestion may be caused by zinc deficiency.  Zinc is a slight inhibitor of 5-alpha reductase.  As we mentioned previously, 5-alpha reductase causes testosterone to turn into DHT – a potent form of testosterone that causes more sexual fluid to be produced.  Low zinc levels can cause more DHT than normal to be produced and thus more fluid production.  Zinc also allows excess fluids to be reabsorbed back into the body more easily.  Not every bit of prostate fluid men make will be ejaculated – the body has a way of absorbing excess fluids back into the body.  A decrease in zinc can cause the prostate to build up fluid more quickly without being resorbed, thus making an individual feel more full and congested. 

 

 

Treatments

The treatments for prostatic congestion, like pelvic tension disorder, can involve both medications and non-drug therapies. 

 

Medication Therapy

  • Zinc can often be used over-the-counter to reduce fluid production and help the body resorb excess fluid.  Zinc 25mg (half a 50mg tablet) at bedtime is safest since 50mg of zinc can sometimes lead to too much zinc which has its own set of side effects.  25mg of zinc can be especially helpful in men who are not sexually active since it helps them resorb excess sexual fluids more easily and it can increase testosterone which increases the chances of having a wet dream to clear things out naturally.

  • 5-alpha reductase inhibitors like finasteride may be prescribed in severe cases to reduce the amount of sexual fluid being produced.  Again, this is only an option in adult men who have fully completed puberty and is not an option in pubescent, younger men.  In addition, it should not be used in men whose spouse is pregnant or desiring to become pregnant.

 

Non-Drug Therapy

  • Behavioral modifications can also be made.  For example reducing sexual stimulation time as much as possible can be helpful.  For sexually active men, it may involve avoiding prolonged sexual stimulation (foreplay) during intimacy.  It’s often helpful for men to avoid activities that cause prolonged erections (such as long make out sessions, delaying ejaculation while masturbating, viewing pornography, etc.).  In fact, it isn’t uncommon for men with pornography/masturbation addictions to develop this disorder.  Treatment of the pornography/masturbation addiction is essential in overcoming the physical symptoms associated with the disorder.

  • Treating underlying prostatitis and pelvic tension disorder is critical in men who have these conditions and prostatic congestion.  For men with pelvic tension disorder, aggressive treatment of the pelvic tension disorder is often necessary in order for there to be any progress with prostatic congestion since muscle contractions during ejaculation can further congests the prostate rather than relieving it. 

 

  • Regular/scheduled ejaculation often helps relieve the prostate (and seminal vesicles) of congested fluids.  For men who are sexually active, ejaculating two to three times a week is often helpful.  In men who are not sexually active and only have wet dreams, wet dreams may become more frequent or heavy as the body tries to resolve the fluid backup naturally.​​​

  • Limiting Ejaculation - Many men with prostatitc congestion also have pelvic tension disorder.  In the pelvic tension section we discussed limiting ejaculation in men with pelvic tension.  So in men that have both conditions, ejaculation may need to be balanced against effects on pelvic tension.  Frequency may vary from one man to the next depending on symptoms.  Some men will feel more tense than congested and may need to ejaculate less often.  Other men who have more congestion than tension may benefit from ejaculating more regularly (occasionally twice in the same day if congestion is particularly bothersome).  Ejaculation after pelvic floor treatments can be more productive than ejaculation when the pelvic floor muscles are tight.  In fact, some men with pelvic tension and prostatic congestion who aren’t sexually active (and don’t masturbate) may find that wet dreams are more likely after having pelvic floor treatments.

  • Prescribed Ejaculation - In some cases, providers may prescribe  masturbation in some sexually inactive men to relieve congestion, especially in men who fail to have wet dreams (oftentimes where the body attempts to have a wet dream and the natural process is interrupted by premature waking).  The evidence for using prescribed masturbation stems from the close association between prostatic congestion and chronic non-bacterial prostatitis (in many cases they may be the same disease).  In the prostatitis section, a study on reducing prostate symptoms in non-masturbating, sexually inactive men by prescribing masturbation 2-3 times per week was studied and found to reduce symptoms.  This can create a dilemma in men who don’t masturbate for personal or religious reasons.  In these men, prescribed ejaculation is often reserved for men who have failed all other treatments.  

    • Men with religious or personal views against masturbation should not infer from what has been said here that they should masturbate to relieve congestive symptoms or to finish off failed wet dreams.  Speaking with a religious counselor or leader after seeking professional treatment for underlying concerns can be very beneficial.  In some cases, they may have suggestions that allow these men to continue to abstain from masturbation, deal with high temptation situations to ejaculation, and seek medical help to relieve their symptoms in other ways. In other cases, they may agree that masturbation for medical reasons is warranted.  Having the input of trusted religious leaders can often eliminate second guessing and guilt; however, gaining personal confirmation on sensitive matters such as these is always prudent.

Images on this page from top to bottom include:

  1. Kateryna Kon/Shutterstock.com

  2. copyrighted by DNA Illustrations and used by permission.