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Prostatitis

Prostatitis is a catch-all term used for most acute and chronic pelvic pain in men (women don’t have a prostate). It is characterized by an inflammation of the prostate gland and/or the surrounding pelvic structures, and is often accompanied by short and infrequent but excruciatingly painful flare-ups.

Prostatitis Symptoms

The inflammation itself can cause pain in and around the area of the prostate, as well as referred pain to other areas around the pelvis. It can also cause enlargement of the prostate gland which can weaken urination and ejaculation. The most common symptoms of prostatitis include:

Pain in the prostate, perineum (“taint”), testicles, anus, abdomen, or low back

Pain in any of these areas especially after ejaculation or a bowel movement

Pain in the urethra or penis during or after urination

Difficulty urinating

Frequent or urgent need to urinate

Types of Prostatitis

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), there are 4 classifications of prostatitis:

Category 1 – Acute bacterial prostatitis. This form of prostatitis is characterized by symptoms of systemic infection, including body aches, fever, and chills. It also causes burning or painful urination as well as increased urinary frequency and urgency. White blood cells and bacteria in the urine indicate acute bacterial prostatitis and it is usually treated with a course of antibiotics.

Category 2 – Chronic bacterial prostatitis. This form of prostatitis is the least common – occurring in only about 5% of cases – and is typically asymptomatic. Chronic bacterial prostatitis is caused by a bacterial infection that can be treated by a 4-8 week course of prostate-penetrating antibiotics. If left untreated, chronic bacterial prostatitis can lead to abnormalities in semen quality and infertility.

Category 3 – Chronic prostatitis/chronic pelvic pain. This form of prostatitis is also known as chronic non-bacterial prostatitis and is the most prevalent form of the condition (representing about 90-95% of cases). Unfortunately, it is also the least understood and the most difficult to treat. Diagnosis of chronic prostatitis is by exclusion of the other types of the condition (i.e., there is no bacterial infection present).

Category 4 – Asymptomatic inflammatory prostatitis. This form of prostatitis is asymptomatic and is usually found by chance during tests for other conditions or during a routine prostate exam. A prostate-specific antigen (PSA) test is useful in screening for prostatitis as well as prostate cancer.

What To Do

If you think you might have prostatitis, you should make an appointment with your doctor to diagnose the type and severity. You can prepare for your visit and help with the diagnosis by answering the following questions in advance:

What symptoms are you experiencing?
Where are you experiencing symptoms? (Be as specific as possible)
What causes them or when do they commonly occur?
When did your symptoms begin?
How severe are your symptoms?
Were you recently diagnosed with a urinary tract infection?
Have you had frequent urinary tract infections?
Have you had any recent injury to the groin?
Does anything, such as pain medication, improve your symptoms?
Have you recently experienced any major stress or life changes?
What medications and supplements are you taking?

Managing and Treating Prostatitis

Eliminate bacterial infections. Both acute and chronic bacterial prostatitis (Types I and II) can be treated with antibiotics. Your health care provider will know if this is the right course of treatment for you.

Reduce inflammation. Since prostatitis is an inflammatory condition, reducing systemic (whole body) inflammation should help reduce its painful effects. An anti-inflammatory diet includes plenty of fruits, vegetables, and healthy fats. Potent anti-inflammatory supplements include fish oil, curcumin, boswellia, and cat’s claw.

Supplements and nutrients. Quercetin and flower pollen extract have both been shown to be effective treatments for chronic prostatitis (Type III). Antibiotics may be recommended for bacterial prostatitis.

Optimize androgen:estrogen ratio. This can be accomplished by increasing low testosterone, reducing elevated estrogens, or both.

Chronic pain therapy. The goal of these therapies is to reduce the incidence and intensity of painful flare-ups. Chronic pain therapies include the following:

Myofascial trigger point release
Active and progressive relaxation of the pelvic floor muscles
Biofeedback
Cognitive-behavioral therapy
Acupuncture
Stress and anxiety management

References

Anderson, R.U., et al., Sexual Dysfunction in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Improvement After Trigger Point Release and Paradoxical Relaxation Training. The Journal of Urology, 2006. 176(4): p. 1534-1539.Anderson, R.U., et al., Psychometric Profiles and Hypothalamic-Pituitary-Adrenal Axis Function in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome. The Journal of Urology, 2008. 179(3): p. 956-960.

Anderson, R.U., et al., Painful Myofascial Trigger Points and Pain Sites in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome. The Journal of Urology, 2009. 182(6): p. 2753-2758.

Heather, J.L., et al., An investigation of the relationship between sex-steroid levels and urological symptoms: results from the Boston Area Community Health survey. BJU International, 2007. 100(2): p. 321-326.

Ku, J.H., S.W. Kim, and J.-S. Paick, Quality of life and psychological factors in chronic prostatitis/chronic pelvic pain syndrome. Urology, 2005. 66(4): p. 693-701.

Lee, S.W.H., et al., Acupuncture versus Sham Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain. The American Journal of Medicine, 2008. 121(1): p. 79.e1-79.e7.

Li, X. and N. Rahman, Estrogens and bladder outlet obstruction. The Journal of Steroid Biochemistry and Molecular Biology. 118(4-5): p. 257-263.

Nickel, J.C., L.M. Nyberg, and M. Hennenfent, Research guidelines for chronic prostatitis: consensus report from the First National Institutes of Health International Prostatitis Collaborative Network. Urology, 1999. 54(2): p. 229-233.

Potts, J.M., Alternative Approaches to the Management of Prostatitis: Biofeedback, Progressive Relaxation and the Concept of Functional Somatic Syndromes. European Urology Supplements, 2003. 2(2): p. 34-37.

Shoskes, D.A., et al., Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial. Urology, 1999. 54(6): p. 960-963.

Wagenlehner, F.M.E., et al., A Pollen Extract (Cernilton) in Patients with Inflammatory Chronic Prostatitis-Chronic Pelvic Pain Syndrome: A Multicentre, Randomised, Prospective, Double-Blind, Placebo-Controlled Phase 3 Study. European Urology, 2009. 56(3): p. 544-551.

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