What is Prostatitis?
Prostatitis is a term given to a set of symptoms that are caused by an infection or inflammation of the prostate.
This disease is different from an enlarged prostate or benign prostatic hyperplasia (BPH), which involves an increase in prostate cells. It’s also different from prostate cancer. This is when malignant cells form, multiply, and spread.
It’s a common condition that can affect men of any age and is generally prevalent among younger and middle-aged men. Common symptoms tend to include pain, discomfort, and problems with urine flow.
Due to the nature of the disease being complex, the symptoms depend on the cause and type. Thus, it’s crucial for doctors to know what the cause is for it to be effectively treated.
Types of Prostatitis
There are four main types of prostatitis, and each has its own set of causes and symptoms.
Acute prostatitis is an uncommon type of prostatitis that is caused by bacteria. It develops very quickly, and the infection can be severe. Therefore, it requires prompt treatment.
Men with this type often experience a high fever (above 38°C). There might be pain between the anus and testicles, along with the scrotum and penis.
Pain can also be felt on the muscles and joints of the pelvic area, thighs, and legs. Some experience frequent night-time urination and find it painful to urinate.
About 10% of cases experience acute urinary retention. This condition needs to be treated straight away, as it could lead to complications. A typical procedure is for the Doctor or nurse to pass a thin, flexible catheter from the penis into the bladder to drain the urine.
Acute bacterial prostatitis develops when certain types of bacteria get into the prostate. Some bacteria that typically thrive in the bowel may spread to the urethra and into the bladder and prostate. Microbes in the blood may also infect the prostate.
Chronic Bacterial Prostatitis
Chronic bacterial prostatitis involves a prostate infection that lasts at least three months. It also tends to come and go, causing flare-ups or episodes. Like the acute type, it isn’t common.
Bacterial infection also causes chronic bacterial prostatitis. It’s seen in men who’ve had frequent UTIs (urinary tract infections). The same microbe often causes each episode if the antibiotics were not successful in killing the previous infection.
This is why it’s essential to adhere to the treatment. Stopping it too early will lead to microbial resistance from drugs.
Chronic Non-bacterial Prostatitis (Chronic pelvic pain syndrome (CP/CPPS)
Chronic Prostatitis, also known as chronic pelvic pain syndrome (CPPS), is the most common type of prostatitis. About 9 in 10 men with an inflamed prostate have this type. It often leads to urinary symptoms such as urgency, frequency, and painful urination.
It’s important to note that because a bacterial infection does not cause this type of prostatitis, it cannot be treated with antibiotics.
Therefore, it is crucial to determine whether or not the prostatitis is bacterial or not. There is no single test to diagnose chronic prostatitis.
Your Doctor needs to rule out other possible causes of the symptoms to make a diagnosis. They will do this by asking about your symptoms, checking your medical history, and doing a physical exam.
A urine sample may be taken to determine whether or not you have a UTI. As it is a chronic condition, men often have symptoms for three months or longer.
Asymptomatic Prostatitis doesn’t have any symptoms and is often diagnosed by chance. Usually, doctors spot this condition when you’re having tests for other diseases, such as prostate cancer.
As the name indicates, symptoms of this type don’t exist as specific symptoms. Men do not often know they have this type of prostatitis. Regardless, some men who have this type have high PSA levels and white blood cells or pus cells in their urine. Some reports say that one-third of men with an elevated PSA level have asymptomatic prostatitis.
Symptoms of Prostatitis
The symptoms of prostatitis will vary in their severity, depending on the type you have. Here are some of the most common symptoms you may experience:
- Painful, difficult and/or frequent urinating
- Blood in the urine/ Cloudy urine
- Pain in the abdomen, groin or lower back
- Pain in the area between the scrotum and rectum (perineum)
- Pain or discomfort of the penis or testicles
- Fever, chills and body aches / flu-like symptoms
- Urethral discharge
- Painful ejaculation or sexual dysfunction
- Pain during sexual intercourse
Should I avoid having sex if I have Prostatitis?
A commonly asked question is, ‘can I have sex if I have prostatitis?’ Generally, having sex will not worsen your prostatitis.
However, as discussed above, some of the side effects can include painful ejaculation, pain during sexual intercourse, and sexual dysfunction. These side effects may affect your ability to have enjoyable sex.
There are several means to help manage pain, with quercetin and bee pollen being shown to help with pain management and inflammation.
You cannot spread prostatitis by having sex, but you can contract prostatitis through unprotected sexual activity, and in rarer cases, it can be transmitted sexually. If you have any signs of a sexually transmitted disease (STI), don’t have sex until you have consulted your Doctor.
What causes Prostatitis?
Prostatitis is a complicated condition, and the exact cause is difficult to uncover. The origins of prostatitis vary according to the type and are as follows:
Prostatitis acute is usually caused by the same bacteria that cause urinary tract infections (UTIs) or sexually transmitted diseases (STDs).
Bacteria that usually live in your bowel may spread to the tip of your penis and to the urethra (the tube men urinate and ejaculate through). From here, the bacteria might reach your prostate. This can be caused by a urine infection, a prostate biopsy, or possibly from regular use of a catheter.
Chronic Bacterial Prostatitis
A bacterial infection causes chronic bacterial prostatitis. It tends to affect men who’ve had lots of urine infections or an inflamed urethra (urethritis) in the past.
Each episode tends to be caused by the same bacteria, which also cause urine infections. It can develop from acute bacterial prostatitis if antibiotic therapy does not get rid of all the bacteria. This could be because the bacteria were resistant to antibiotics or because the treatment was stopped too early.
Chronic Non-bacterial Prostatitis (Chronic pelvic pain syndrome (CP/CPPS
The exact cause is unknown, unlike the other types which are caused by microbes. However, experts found that certain things trigger it. These include urine getting into the prostate, previous UTIs, and nerve dysfunction.
There is also some research indicating that CPPS may be linked to and triggered by other conditions such as stress, irritable bowel syndrome (IBS), and chronic fatigue syndrome.
The exact cause of asymptomatic inflammatory prostatitis is not known. However, one study claims that microbes from the semen can cause this. The research team looked at the semen of 37 men with asymptomatic prostatitis and found that the semen had about eight different types of bacteria. The bacterial count was also related to the high white blood cell count.
What are the risk factors for Prostatitis?
Factors that increase your risk of UTIs and sexually transmitted diseases (STDs) also increase your risk of having an inflamed prostate.
- Not drinking enough fluids
- Using a urinary catheter
- Multiple sexual partners
- Unprotected vaginal or anal intercourse
- Old age
- Recurring UTIs (urinary tract infection)
- Previous cases of prostatitis
- Having certain genes that can make you more prone to have prostatitis
- Pelvic injuries
- Inflamed testicles
- HIV/AIDS infection
- Stress and mental distress
Diagnosis of Prostatitis/ Tests for Prostatitis
If you are experiencing any of the symptoms of prostatitis, you should see your Doctor so that further tests can be taken to confirm whether you have prostatitis.
A urine test can be beneficial for diagnosing bacterial prostatitis. Bacteria and excessive white blood cells are found in the urine in people with bacterial prostatitis.
Blood PSA test
Most men with acute prostatitis experience a steep rise in PSA levels. So a PSA test in conjunction with other examinations may help diagnose bacterial prostatitis. In the vast majority of cases, this elevation is due to inflammation in the prostate.
Digital Rectal Exam
A Doctor/urologist may undergo a digital rectal exam (DRE) to assess whether your prostate is enlarged, swollen, or tender. Your Doctor can also rule out other severe prostate conditions during this examination.
Measuring post-void residual urine is useful for measuring bladder emptying capabilities.
Urinary retention can cause prostatitis if the urine is infected with bacteria. Therefore, the inability to empty your bladder may lead to prostate infection.
A post-void residual urine measurement provides useful information to determine whether a patient has incomplete bladder emptying. Urinary retention can cause recurrent urinary tract infections.
The UPOINT System
The UPOINT system is a method to clinically profile a patient’s symptoms into six categories, to allow a more individualized therapy.
The six categories include urinary signs, psychological dysfunction, organ-specific symptoms, infectious causes, neurological dysfunction, and tenderness of pelvic floor muscles.
Multiple clinical trials have externally validated the UPOINT system, and it is gaining increasing widespread use and effectiveness.
How common is Prostatitis (by age)?
Prostatitis can affect men at any age, but it’s most common in younger and middle-aged men, typically between 30 and 50.
For men over the age of 50, it is the third most common urinary tract issue. Prostatitis accounts for about two million visits to health care providers in the United States each year.
Are BPH and Prostatitis the same thing?
BPH (Benign Prostatic Hyperplasia) and Prostatitis are two common conditions that affect the prostate. They can both cause painful symptoms, such as difficulty urinating, but they have very different causes and are two distinct conditions.
Benign Prostatic Hypertrophy is called BPH for short. It is an enlargement of the prostate caused by the growth of prostate cells. Eventually, the increased size squeezes your urethra.
The body adapts by making the bladder walls thicker. The bladder weakens over time, which can lead to incontinence and the constant feeling that you have to urinate. A man with BPH often gets up in the middle of the night to urinate several times.
The symptoms of BPH and Prostatitis are similar.
Does Prostatitis increase your risk of Prostate Cancer?
According to a recent clinical study, there may be an increased risk of prostate cancer if you have prostatitis. The real answer is broad – and it’s based on the type of prostatitis you have.
The two types of prostatitis are clinical prostatitis, which is when you have symptoms and histological prostate inflammation. Histological prostatitis is where the cells of the prostate show inflammation underneath the microscope, but you don’t have symptoms.
Studies in the past have found that histological prostate inflammation is 4-5 times more common in men WITHOUT prostate cancer than those with cancer.
Doctors commonly think that having a history of clinical prostatitis increases prostate cancer risk, but histological prostatitis decreases the risk. However, doctors and researchers at the University of Miami Miller School of Medicine, Columbia University, and the Henry Ford Health System find different results.
These researchers examined the difference between histological prostatitis and clinical prostatitis – and cancer. First, they found that the proportion of men with histological prostatitis that developed clinical prostatitis varied by race. 28% of African American men developed symptoms of prostatitis compared to 17% in white men.
The researchers also revealed that there was no association between a history of clinical prostatitis and prostate cancer risk overall. However, when they separated their statistics by race, a different picture emerged.
In white males, the risk for cancer was elevated, although not statistically significant. It was only 2%. In African American men, those who had chronic prostatitis showed a significantly decreased risk of developing cancer.
In white men, a history of clinical prostatitis without laboratory confirmation of inflammation increased risk over three times for prostate cancer. And there’s more…
Elevated PSA is an established risk factor for prostate cancer. In this study’s sample of 978 men, those with a PSA >10 ng/ml had a 68% increased risk of prostate cancer. Those with a low PSA and a history of clinical prostatitis symptoms had almost a 3-fold increased risk for prostate cancer.
It appears that men with prostatitis get prostate cancer more often than men without the inflammatory condition. For now, however, no direct evidence having prostatitis increases a man’s risk of developing or eventually dying from prostate cancer.
Will Prostatitis resolve itself on its own?
To answer this question, we have to consider the cause of prostatitis and whether or not anything was done about it. Many cases of prostatitis can be blamed on microbes.
If you take an antibiotic, it may wipe out the specific bacteria causing your prostatitis right now. However, it’s also affecting the whole microbiome of probiotics living in your urinary tract. This could reduce the protective bacteria to seriously low numbers, leaving harmful fungi to grow – and potentially cause more chronic prostatitis.
The latest statistic I’ve seen is that one dose of an antibiotic is enough to kill 50% of the probiotics living in the gut. That means you’re in between a rock and a hard spot – do you take the antibiotic or not?
The answer may be that you could merely alter your microbiome with probiotics and fermented foods such as kefir milk (the best solution), homemade sauerkraut, yogurt, kimchee, miso, and kombucha tea. You could also try a probiotic supplement.
By influencing what is happening with your microbiome, you can increase your chances of prostatitis going away on its own. As you can see, there is a bit of work to do to get the remission to occur.
Another supplementary solution can be a series of colonic hydrotherapy sessions. This will “wash out” any overgrowth of waste matter in the colon and rectum, thus helping to restore the environment so the right probiotics can grow and protect your prostate.
I’ve found this to be quite useful in the past. Men’s symptoms for BPH and prostatitis decreased quickly with colonics or colon cleanses. One report by the Kellogg Clinic stated complete resolution of BPH with colonics.
How can you treat Prostatitis?
The treatment for an inflamed prostate depends on the type.
Acute Bacterial Prostatitis
Antibiotics are the primary treatment for this type of prostate disease. The duration of therapy is often 4-6 weeks.
It’s vital for you to finish the course of antibiotics. If not, it’s possible that the infection will recur, and the microbe will develop drug resistance.
Seek advice from your Doctor if the drugs are not working well. In severe cases, the Doctor will prescribe intravenous antibiotics, wherein the drugs will be passed through the blood for a much faster effect.
If a patient remains resistant to prolonged antibiotic therapy, the possibility of a prostatic abscess should be considered.
Chronic Bacterial Prostatitis
To treat this chronic condition, your doctor will prescribe antibiotic treatment for at least 4-6 weeks. Urine tests will be done to see if the infection is gone. In case the symptoms come back, the Doctor prescribes more antibiotics over an extended period.
However, the outcome of antibiotic treatment is not as simple as with chronic cases.
Chronic bacterial prostatitis involves prolonged and recurrent symptoms. It requires prolonged therapy with an antibiotic that penetrates the prostate. These antibiotics should be highly soluble in lipids, have a smaller molecular size and a low protein binding quality.
While antibiotics can cure the disease, they are still drugs that have certain side effects. However, an inflamed prostate can also be treated by natural means.
Chronic Non-bacterial Prostatitis (Chronic pelvic pain syndrome (CP/CPPS)
Treatment for chronic prostatitis varies from person to person. Though it won’t treat the cause, it can control its symptoms.
The doctor may prescribe drugs like alpha-blockers, 5-alpha reductase inhibitors, and pain relievers to help relieve painful symptoms. However, it is important to note that these medications can have side effects.
Long-term prostatitis can be a difficult condition to live with, and the painful flare-ups can make it hard to carry out everyday tasks. You may also experience feelings of stress and anxiety, which in turn may trigger chronic prostatitis.
To help, your Doctor may refer you to a counselor to help cope with the symptoms and to help manage pain. Physiotherapy and prostate massage may also be needed to treat problems with the pelvic floor muscles. In rare cases, surgery might be required.
As it doesn’t cause symptoms, it usually doesn’t need any treatment. However, antibiotics may be necessary if you have high levels of prostate-specific antigen (PSA) in the blood. Or, if you have a high white blood cell count in your urine or semen. How long the treatment lasts depends on these conditions but often takes around 4-6 weeks.
Prostatitis and antibiotics?
In most cases, if you have been diagnosed with prostatitis, your Doctors first course of action will be to prescribe antibiotics.
Antibiotics are prescribed in cases of bacterial prostatitis. However, some urologists will still prescribe antibiotics even in cases of non-bacterial prostatitis. This is to rule out the possibility of infection.
However, several studies have indicated excessive antibiotic use in men with prostatitis.
Antibiotics are not effective for the treatment of non- bacterial chronic prostatitis. As such, their use should be limited to individuals with confirmed positive cultures on expressed prostatic fluid or associated urinary tract infection. This is as excessive antibiotic use can lead to antibiotic resistance.
A study published in The American Journal of Medicine stated that despite evidence that antibiotics are not effective in the majority of men with chronic pelvic pain syndrome, they were prescribed in 69% of men with this diagnosis.
Overall the researchers concluded that improvement strategies to reduce unnecessary antibiotic use in men with chronic prostatitis is needed.
Commonly prescribed antibiotics include:
- IV Infusions
Alpha-blocking agents like tamsulosin (Flomax) and alfuzosin (Avodart) are sometimes used to reduce abnormal urinary symptoms in men with prostatitis.
These medications are used to help men who experience pain and discomfort when urinating. Although they may help to relieve symptoms, you should be aware of the potential side effects:
- Ejaculation And Orgasm Problems
- Peyronie’s Disease
- Blood Pressure Changes
- Blurred Vision
- Dizziness, Drowsiness and Falls
- Headache, Chest Pain and Back Pain
- Nausea, Diarrhea
- Fever, Chills and Flu symptoms
For certain types of prostatitis, such as bacterial prostatitis, antibiotic treatment will be necessary. However, it is essential to be aware of the potential side effects of antibiotics.
Fluoroquinolone drugs, in particular, can have severe side effects and have an FDA black box warning.
This warning states that these drugs can cause severe tendon damage and permanent peripheral neuropathy. This is a type of nerve damage that results in tingling, numbness, pain, and weakness.
A further issue with taking antibiotics is that while it kills harmful bacteria, it can also kill some of the good bacteria and microflora in your gut.
Your gut microflora modulates your immune system. The greater the number of good bacteria or probiotics you have in your gut, the fewer harmful bacteria that cause infection you’ll have.
This shows that antibiotic treatment alone is not adequate for many men. Probiotic supplementation can restore the loss of healthy bacteria in your gut microflora caused by antibiotic treatment. This would lower the risk of an infection recurrence.
Are there any natural treatments for Prostatitis?
Making changes to your lifestyle may help to alleviate prostatitis symptoms. Some of the following include:
In some cases, certain foods may cause your prostatitis to flare up; this could include spicy or foods or citrus. Keep a food diary and make a note of any foods that seem to irritate your bladder.
An analysis was undertaken to determine the effectiveness of dietary changes for the treatment of prostatitis in men and urethral syndrome in women. 2,385 patients 1710 men and 675 women with symptoms of prostatitis and the urethral syndrome were followed.
All patients were treated with a strict diet, eliminating caffeine, alcohol, and all hot and spicy food for 12 weeks. The results showed an 87% success in men and an 89% success rate in women. During the study, none of the patients received antibiotics or were treated with medications such as alpha blockers, 5-alpha reductase inhibitors, or phenazopyridine.
Food that causes allergies can also worsen the symptoms of the disease. So, you have to avoid food that causes vomiting, diarrhea, nausea, or abdominal pain.
It is also important to consume fruits and vegetables. They are high in vital nutrients, vitamins, and minerals and will help to fight infection and inflammation. It would help to drink 1.5 to 2 liters of water a day. Avoid drinks such as coffee, alcohol, and sodas, which can inflame your urinary tract.
Being active helps to maintain a healthy weight, which benefits your overall health. Aerobic exercises, in particular, have been shown to relieve prostatitis symptoms.
Italian researchers randomly assigned 231 men with prostatitis to do exercises three times a week for 18 weeks. One group participated in aerobic exercise, and the other group did non-aerobic exercise.
The researchers found that although both groups felt better, the group that had done aerobic exercise experienced significantly more significant improvements in CPPS pain levels, as well as improvements in anxiety and depression.
Pelvic floor exercises have also been shown to benefit some men with urinary symptoms. Experts estimate that pelvic tension and pelvic floor muscle disorders are responsible for pain in about 50% of CP/CPPS cases. Therefore, strengthening the pelvic floor muscles could help.
Following this, it is a good idea to avoid prolonged sitting. Sitting for long periods can put pressure on the prostate gland, eventually leading to inflammation over time. Sitting on a bike seat can have a similar effect, so it is also a good idea to limit cycling.
The benefits of probiotics for treating bacterial prostatitis have been demonstrated in human clinical research.
One study looked at the effects of supplementing with probiotics alongside antibiotics for treating chronic bacterial prostatitis. 210 men affected by chronic bacterial prostatitis were randomly allocated to receive a lactobacillus supplement with antibiotics or antibiotics alone for 30 days. At the end of the study, 27.6% of the group that received only antibiotics had a UTI recurrence, while only 7.8% of the combination group experienced a recurrence.
Probiotics can protect against harmful bacteria and restore the loss of healthy-supporting bacteria lost to antibiotic treatment. This makes probiotics one of the best treatments for bacterial prostatitis.
Curcumin is a potent bioactive constituent in the spice Turmeric. Turmeric is regularly used in India for cooking and in traditional medicine. Curcumin is well-known for its potent anti-inflammatory effects. Curcumin also has a very good safety profile, and it serves as a viable alternative to anti-inflammatory drugs.
The effects of curcumin alone on treating prostatitis are yet to be studied. However, using curcumin with other natural anti-inflammatory ingredients, such as quercetin and saw palmetto, can improve the symptoms of chronic non-bacterial prostatitis.
Quercetin is a flavonoid found in high concentrations in capers, and red onion. A human clinical showed that 1 gram of quercetin daily for four weeks significantly symptoms of chronic non-bacterial prostatitis.
For quercetin to be effective, you would require either a high dose (1 gram per day) or a lower dose when combined with other ingredients like curcumin and saw palmetto.
Pollen extract is another natural anti-inflammatory. Pollen extract reduced inflammation in rats induced with prostatitis.
In a human clinical study, patients given pollen extract reported more significant improvement in symptoms of chronic non-bacterial prostatitis and quality of life compared with men given a placebo.
Saw palmetto is regularly used to treat prostate enlargement. This is because of its ability to reduce DHT, which is a hormone that plays a vital role in prostate enlargement. Saw palmetto also has potent anti-inflammatory properties and may be useful for treating prostatitis.
Although prostatitis is not a life-threatening condition, it does have a debilitating effect on the quality of life. There are a number of natural ingredients for treating prostatitis. For anyone suffering from a form of bacterial prostatitis, it is very important that you supplement with probiotics.
A combination of saw palmetto, curcumin, and quercetin is clinically effective at reducing pain and should be used by men suffering from any form of prostatitis.
Using these natural supplements can also prevent you from having an unnecessary PSA test by reducing inflammation and PSA levels.
It takes a holistic approach that can benefit not just the prostate, but your entire body.