Massage of the Prostate
George A. Holliday, in The American Journal of Dermatology, explains that by massage we endeavor to thoroughly empty the gland, ridding the ducts and the glands as well, of the retained inflammatory and irritating products which otherwise would not be discharged, and thus accomplish in intermittent drainage. Venous stasis is diminished, the arterial circulation increased, the lymphatics made more active—the nutrition of the gland thus improved—the absorption of the inflammatory exudates is aided, and the muscles and nerves stimulated.
Massage by the prostate can as a rule be easily accomplished with the patient in a mere stooping posture. The elbow-knee or leapfrog attitude is usually a satisfactory position, permitting easy access to the gland and counter-pressure over the abdomen with the fist. Some prefer the dorsal position which relaxes the muscles and permits the counter-pressure to be easily done.
If the upper border of the gland is not accessible the patient may be placed in the lithotomy position with exaggerated flexion of the thighs and legs upon the abdomen, or in the knee-chest position. In the elbow-knee posture the prostate is within reach of an index finger of ordinary length even in quite corpulent individuals, although an examination of the seminal vesicles may be accomplished with some difficulty.
The finger covered with a well oiled cot is carefully and slowly introduced, avoiding the anal hairs, and the gland at once outlined. This procedure is at first usually quite annoying and somewhat disagreeable to the patient and may be quite painful. The extreme sensitiveness of the gland may not allow of its palpation; some will cry out with pain; others will experience only a little unpleasantness or a burning sensation along the urethra to the head of the penis during firm pressure on the gland. During the treatment partial or complete erection of the penis may occur, and there is an inability to urinate for several minutes after.
No unnecessary force should be used in attempting the first massage of a gland, but the manipulation should be conducted as gently as possible, particularly where the patient makes complaint. The first treatment, if the pain is severe or the patient becomes faint, should be limited to a few seconds and a thorough expression not attempted. Succeeding treatments are less painful and soon the massage can, as a rule, be prolonged and sufficient force exerted to accomplish the desired result.
Pressure is made over the gland with the finger which is passed from the base to the apex (from above downward and inward), or a rotary movement of the ball of the finger is executed, or the finger may make lateral sweeps inward (from side to side toward the center). The last maneuver is often best tolerated by the patient.
Usually massage may be practiced for from two to five minutes every third or fourth day to good effect. It may be performed daily when the urine is cloudy with frequency of urination, and dull heavy sensation in the perineum. Where the gland is exquisitely tender, an effort should first be made to favorably influence the diseased process by other measures, particularly hot rectal irrigations, preparatory to this measure. Massage is useless in the hard contracted fibrous prostate and harmful in tubercular conditions.
To rid the gland of infection or irritating products must be accepted as a desirable result, and as massage is the most efficient means to this end at our command, it is adopted as the routine treatment, though the procedure is not always without ill effects.
By expression and dissemination of the infective materials, bacteriuria, cystitis, epididymitis, and gonorrheal rheumatism may be untoward results.
An acute exacerbation may be evoked, or by rupture of the retention cysts and diffusion of the contents the parenchyma of the gland may become infected and abscess be a possible result (evidently not a frequently observed effect). The production of gluteal and sciatic neuralgia from irritation of certain nerves of the sacral plexus has been observed, and harm can doubtless come from violent pressure upon the perineum, stretching of the anal canal, and bruising of the rectal mucous membrane. Massage should not be practiced where marked irritation follows its performance.
An effort should be made to prevent the occurrence of cystitis, bacteriuria, and epididymitis by the employment of copious irrigations preceding and following each treatment, the nature of the infection determining the solutions to be used. When the gonococcus is present the silver albuminates are the best; when secondary organisms, the mercurial salts; and when pus only is present (an aseptic catarrh) the nitrate of silver or copper sulphate.—Medical Standard.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.