Introduction:

Prostatitis is inflammation of the prostate gland. It is actually a group of conditions that affect the prostate, a walnut-sized gland found just under the bladder in men. The prostate produces part of seminal fluid, the fluid that helps carry sperm out of the body when men ejaculate. Prostatitis can cause pain and problems urinating. There are four major types of prostatitis:

• Acute bacterial prostatitis
• Chronic bacterial prostatitis
• Chronic prostatitis/chronic pelvic pain
• Asymptomatic inflammatory prostatitis

Symptoms and treatment vary depending on what type of prostatitis you have.

Signs and Symptoms:

In general, 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

In addition, specific types of prostatitis can cause these symptoms:

Acute bacterial prostatitis:

• High fever, chills
• Nausea

Chronic bacterial prostatitis:

• Blood in semen or urine
• Frequent bladder infections

Chronic nonbacterial prostatitis:

Similar to chronic bacterial prostatitis, but without fever

Asymptomatic inflammatory prostatitis:

No symptoms; usually discovered when undergoing tests for other problems

What Causes It?:

As its name suggests, bacterial prostatitis is caused by bacteria. Researchers aren' t sure what causes chronic nonbacterial prostatitis or asymptomatic prostatitis. Trauma or injury to the prostate, or problems with the immune or nervous systems, may contribute to chronic nonbacterial prostatitis.

What to Expect at Your Provider's Office:

Your doctor will take a medical history and ask you about your symptoms. Your doctor will perform a digital rectal exam, examining your prostate by inserting a lubricated finger into your rectum. Lab tests, including urinalysis, semen sample, or blood cultures, may be ordered. Your doctor may suggest you see a urologist (a specialist who treats urinary tract disorders).

Treatment Options:

Drug Therapies

Bacterial prostatitis -- oral antibiotics, taken for several weeks. In some 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 such as ibuprofen (Advil), 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

In severe cases of bacterial prostatitis, you may need surgery.

Complementary and Alternative Therapies

Be sure to let all of your doctors know about any herbs or supplements you take, or any alternative therapies you use. Some herbs, supplements, and alternative therapies may interfere with conventional medical therapies. Work with a doctor who is experienced in complementary and alternative therapies to find the right mix of treatments for you.

Nutrition and Supplements

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

• Cernilton, a flower pollen extract (500 - 1,000 mg two to three times a day) -- A few preliminary studies have found that this pollen extract may help relieve symptoms of chronic nonbacterial prostatitis. More research is needed.
• Quercetin (500 mg two times per day), an antioxidant flavonoid that fights inflammation, may help reduce pain and symptoms of chronic nonbacterial prostatitis. In one study, quercetin was combined with bromelain and papain, showing even greater effects. Bromelain and papain help the body better absorb quercetin and they also have anti-inflammatory effects.
• Beta sitosterol (20 mg per day), a naturally derived chemical found in various plants, is frequently used to treat prostatitis and is often included in prostate health formulas. However, scientific studies are lacking.
• Zinc -- There is evidence that zinc may reduce an enlarged prostate, but researchers don't know whether zinc helps prostatitis. A few preliminary studies suggest that when zinc is taken with antibiotics, it may work better than antibiotics alone for reducing some symptoms of prostatitis. Taking zinc supplements may cause you to have a copper deficiency, so be sure to work with your doctor to find the right dose of zinc for you.
• Vitamin C (500 mg per day) -- Although no studies have been done to see 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 (1,000 - 1,500 mg one to two times a day), over time, may help reduce inflammation, although they have not been studied for prostatitis. Omega-3 fatty acids can increase the risk of bleeding, especially if you take blood thinning medications such as aspirin or warfarin (Coumadin). Talk to your doctor before taking omega-3 fatty acids.
• Pumpkin seeds have been used historically for a healthy prostate, but have not been studied for prostatitis.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, 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 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink two to four cups per day. You may use tinctures alone or in combination as noted.

• Saw palmetto (Serenoa repens, 160 mg in capsule form two times per day) has been studied for its effects on benign prostatic hyperplasia (BPH), and used traditionally to treat nonbacterial prostatitis, although studies for prostatitis are lacking. An extract standardized for 85 - 95% of fatty acids and sterols is recommended.
• African pygeum (Prunus africana, 75 - 200 mg per day) -- Several studies suggest that pygeum 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, 160 mg in capsule form two times per day, standardized for 85 - 95% of fatty acids and sterols) has been studied for its effects on benign prostatic hyperplasia (BPH), and used traditionally to treat nonbacterial prostatitis. But there are no scientific studies using it for prostatitis. Saw palmetto can interact with some medications including hormone replacement therapies. Ask your doctor before taking saw palmetto.
• Stinging nettle (Urtica dioca, 80 mg per day) has shown some promise in helping maintain prostate health, but studies are mixed.

Herbs traditionally used for prostatitis (but lacking scientific studies) include:

• Pau d'arco (Tabebuia impetiginosa) -- This herb can be toxic in large doses. Do not use pau d'arco unless your doctor tells you to. Let your doctor determine the safe dose for you.
• Horsetail (Equisetum arvense) -- Do not take horsetail if you have high blood pressure or heart disease, and take it only under the supervision of a doctor.

Homeopathy

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

• Chimaphila umbellata -- 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

Physical Medicine

Kegel exercises increase 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 or 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 - 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 three times to complete one set. Do one to two sets a day, 3 - 4 days a week. Avoid sitz baths if you have acute bacterial prostatitis.

Acupuncture

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

Following Up:

Be sure you follow your health care provider'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.

Alternative Names:

Prostate infection