Prostatitis

Signs and Symptoms

Symptoms may include:

• Pain or burning when urinating
• Problems with urination
• Having to urinate frequently, especially at night
• Needing to urinate urgently
• Pain in the groin, lower back, abdomen, penis, or testicles
• Pain when ejaculating
• Premature ejaculation

Symptoms that are common with acute bacterial prostatitis include:

• High fever, chills
• Nausea

Symptoms that are common with chronic bacterial prostatitis include:

• Blood in semen or urine
• Frequent bladder infections

Symptoms that are common with chronic nonbacterial prostatitis are similar to those of chronic bacterial prostatitis, but without fever.

Asymptomatic inflammatory prostatitis has no symptoms and is usually discovered when undergoing tests for other problems.

What Causes It?

As its name suggests, bacterial prostatitis is caused by bacteria. Researchers are not sure what causes chronic nonbacterial prostatitis or asymptomatic prostatitis. Injury to the prostate, or problems with the immune or nervous systems, may contribute to chronic nonbacterial prostatitis. Men with prostate cancer often have prostatitis, benign prostatic hyperplasia (BPH), or both. Prostatitis interacts with BPH-increasing the risk of prostate cancer.

What to Expect at Your Doctor's Office

Your doctor will take a medical history and ask you about your symptoms. Your doctor will do a digital rectal exam, examining your prostate by inserting a lubricated finger into your rectum. You may need to provide a urine sample, semen sample, or get a blood test. Your doctor may suggest you see a urologist, a specialist who treats urinary tract problems.

Treatment Options

Drug Therapies

Bacterial prostatitis. Oral antibiotics, taken for several weeks. In severe cases, you may need intravenous (IV) antibiotics. Other medications may include stool softeners and pain relievers, such as ibuprofen (Advil).

Chronic nonbacterial prostatitis. In addition to pain relievers, alpha blockers, which help relax the bladder may help if you have trouble urinating. Alpha blockers include alfuzosin (Uroxatral) and doxazosin (Cardura). Side effects can include headaches and low blood pressure.

Surgical Procedures

Severe cases of bacterial prostatitis may require surgery.

Complementary and Alternative Therapies

Be sure to tell your doctors about any herbs or supplements you take, or any alternative therapies you use. Some herbs, supplements, and alternative therapies (CAM) may interfere with conventional medicine. Work with a doctor who is experienced in complementary and alternative therapies to find the combination of treatments that is right for you.

Drink plenty of water (48 oz. a day). Avoid alcohol, caffeine, and spicy foods. These supplements may help:

• Cernilton. An extract made from rye grass pollen. Preliminary studies suggest this pollen extract may help relieve symptoms of chronic nonbacterial prostatitis. More research is needed.
• Quercetin. An antioxidant that helps fight inflammation. May help reduce pain and symptoms of chronic nonbacterial prostatitis. In one study, combining quercetin with bromelain and papain produced even greater effects. Bromelain and papain help the body better absorb quercetin and they also have anti-inflammatory effects. Quercetin may interact with several common medications, so ask your doctor before taking it. Both bromelain and quercetin may increase the risk of bleeding, especially if you also take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Very high doses of quercetin have been associated with kidney damage. DO NOT take quercetin for more than 2 to 3 months without taking a break.
• Beta sitosterol. A naturally derived chemical found in various plants. Frequently used to treat prostatitis and is often included in prostate health formulas. Scientific support, however, is lacking. A few reports have linked taking beta sitosterol with low sex drive and erectile dysfunction.
• Zinc. There is evidence that zinc may reduce an enlarged prostate, but researchers do not know whether zinc helps prostatitis. A few preliminary studies suggest that taking zinc with antibiotics works better than antibiotics alone for reducing symptoms of prostatitis. High doses of zinc (more than 40 mg per day) can cause many negative side effects, including a copper deficiency. Work with your doctor to find the right dose of zinc for you.
• Vitamin C. Although researchers have not studied whether vitamin C is effective against bacterial prostatitis, some doctors recommend it. In test tubes, vitamin C stops the growth of E. coli, the most common bacteria involved in bacterial prostatitis.
• Omega-3 fatty acids. May help reduce inflammation over time. However, researchers have not studied how omega-3s affect prostatitis. Omega-3 fatty acids can increase the risk of bleeding, especially if you take blood thinners such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin). Talk to your doctor before taking omega-3 fatty acids.
• Pumpkin seeds. Used historically for a healthy prostate, but have not been studied for prostatitis.
• Probiotics. Preliminary studies suggest that taking an antibiotic followed by probiotics can help prevent the progression of prostatitis.

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. of herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

• African pygeum (Prunus africana). May help reduce urinary symptoms of BPH and both bacterial and nonbacterial prostatitis in men with mild-to-moderate urinary symptoms.
• Saw palmetto (Serenoa repens). Has been studied for its effects on BPH and used traditionally to treat nonbacterial prostatitis, but one preliminary scientific study found that it did not help. Saw palmetto can interact with some medications, including hormone replacement therapies and blood thinners. Ask your doctor before taking saw palmetto.
• Stinging nettle (Urtica dioca). Has shown some promise in helping maintain prostate health, but studies are mixed. Stinging nettle may interact with drugs taken to treat diabetes and high blood pressure. It may also interfere with lithium, and may reduce the effects of warfarin (Coumadin). It may not be safe for pregnant women.

Some of the most common remedies used for prostatitis are listed below. The usual dose is 3 to 5 pellets of a 12X - 30C remedy every 1 to 4 hours until your symptoms improve.

• Chimaphila umbellate. For retention of urine with an enlarged prostate.
• Pulsatilla. For pain after urination, especially involuntary urination.
• Pareira. For painful urination, especially with painful urging.
• Lycopodium. For painful urination with reddish sediment in the urine, especially with impotence.
• Thuja. Specifically if there is a forked stream of urine.

Kegel exercises improve pelvic muscle tone. They may help some men reduce urinary symptoms. These exercises involve tightening and relaxing the pelvic floor muscles. To identify the muscles, it may help to think of the muscles you use to stop and start a stream of urine, or to keep from passing gas. Tighten muscles for a count of 10, then relax for a count of 10. Repeat 10 times, and do 5 to 10 sets daily.

Contrast sitz baths. You will need two basins that you can sit in comfortably. Fill one basin with hot water, one with cold water. Sit in hot water for 3 minutes, then in cold water for 1 minute. Repeat this 3 times to complete 1 set. Do 1 to 2 sets a day, 3 to 4 days a week. Avoid sitz baths if you have acute bacterial prostatitis.

Acupuncture may improve urinary flow and decrease swelling and inflammation in some men with chronic nonbacterial prostatitis.

Following Up

Be sure you follow your doctor's instructions for treatment, and keep using the treatment as directed even if you start to feel better.

Special Considerations

Men should have a yearly prostate examination after age 40, even if they have no symptoms of prostate problems. In recurring cases, you may need ongoing treatment with periodic checkups.

Supporting Research

Bergman J, Zeitlan SI. Prostatitis and chronic prostatitis/chronic pelvic pain syndrome. Expert Rev Neurother. 2007;7(3):301-307.

Budia A, Palmero J, Broseta E, Tejadillos S, Benedicto A, Queipo JA, et al. Value of semen culture in the diagnosis of chronic bacterial prostatitis: A simplified method. Scand J Urol Nephrol. 2006;40(4):326-331.

Capodice JL, Bemis DL, Buttyan R, Kaplan SA, Katz AE. Complementary and alternative medicine for chronic prostatitis/chronic pelvic pain syndrome. Evid Based Complement Alternat Med. 2005 Dec;2(4):495-501.

Elist J. Effects of pollen extract preparation Prostat/Poltit on lower urinary tract symptoms in patients with chronic nonbacterial prostatitis/chronic pelvic pain syndrome: A randomized, double-blind, placebo-controlled study. Urology. 2006;67:60-63.

Ferri. Ferri's Clinical Advisor 2014, 1st ed. St. Louis, MO: Mosby. 2013.

Giubilei G, Mondaini N, Minervini A, Saieva C, Lapini A, Serni S, et al. Physical activity of men with chronic prostatitis/chronic pelvic pain syndrome not satisfied with conventional treatments -- could it represent a valid option? The physical activity and male pelvic pain trial: A double-blind, randomized study. J Urol. 2007;177(1):159-165.

Gujadhur R, Anng J. Careful assessment key in managing prostatitis. Practitioner. 2015; 259(1781):15-9,2.

Hochreiter WW, Weidner W. Prostatitis -- a frequently unrecognized disease. Ther Umsch. 2006;63(2):117-121.

Hung SC, et al. Synergistic interaction of benign prostatic hyperplasia and prostatitis on cancer risk. Br J Cancer. 2013;108(9):1778-1783.

Ismail M, Mackenzie K, Hashim H. Contemporary treatment options for chronic prostatitis/chronic pelvic pain syndrome. Drugs Today. 2013;49(7):457-462.

Kaplan SA, Volpe MA, Te AE. A prospective, 1-year trial using saw palmetto versus finasteride in the treatment of category III prostatitis/chronic pelvic pain syndrome. J Urol. 2004;171:284-288.

Kim JW, Oh MM, Bae JH, Kang SH, Park HS, Moon du G. Clinical and microbiological characteristics of spontaneous acute prostatitis and transrectal prostate biopsy-related acute prostatitis: Is transrectal prostate biopsy-related acute prostatitis a distinct acute prostatitis category? J Infect Chemother. 2015; 21(6):434-7.

Kucuk EV, Suceken FY, Bindayi A, Boylu U, Onol FF, Gumus E. Effectiveness of acupuncture on chronic prostatitis-chronic pelvic pain syndrome category IIIB patients: a prospective, randomized, nonblinded, clinical trial. Urology. 2015; 85(3):636-40.

Larsen EH, Frimodt-Moller C. Prostatitis -- pelvic pain syndrome. Ugeskr Laeger. 2007;169(20):1921-1923.

Lee JH, Lee SW. Relationship between premature ejaculation and chronic prostatitis/chroni pelvic pain syndrome. J Sex Med. 2015; 12(3):697-704.

Marx S, Cimniak U, Rutz M, Resch KL. Long-term effects of osteopathic treatment of chronic prostatitis with chronic pelvic pain syndrome: a 5-year follow up of a randomized controlled trial and considerations on the pathophysiological context. Urologe A. 2013;52(3):384-390.

Murphy AB, Macejko A, Taylor A, Nadler RB. Chronic prostatitis: management strategies. Drugs. 2009;69(1):71-84.

Nickel JC. Treatment of chronic prostatitis/chronic pelvic pain syndrome. Int J Antimicrob Agents. 2008 Feb;31 Suppl 1:S112-6.

Sun H, Wang H, Zhang A, et al. Berberine ameliorates nonbacterial prostatitis via multi-target metabolic network regulation. OMICS. 2015; 19(3):186-95.

Vicari E, La Vignera S, Castiglione R, Condorelli RA, Vicari LO, Calogero AE. Chronic bacterial prostatitis and irritable bowel syndrom: effectiveness of treatment with rifaximin followed by the probiotic VSL#3. Asian J Androl. 2014; 16(5):735-9.

Wagenlehner FM, Schneider H, Ludwig M, Schnitker J, Brähler E, Weidner W. 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. Eur Urol. 2009 Sep;56(3):544-551.

Zhang R, Sutcliffe S, Giovannucci E, et al. Lifestyle and risk of Chronic Prostatitis / Chronic Pelvic Pain Syndrome in a Cohort of United States Male Health Professionals. J Urol. 2015; 194(5):1295-300.