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Prostatitis
Overview
Prostatitis is a term used to describe inflammatory conditions of the prostate gland. It is thought that most cases of prostatitis result from bacterial infection, but evidence of infection is not always found. An infected or inflamed prostate can cause painful urination and ejaculation, and if left untreated, serious complications.
Incidence and Prevalence
Prostatitis can affect men of any age and it is estimated that 50% of men experience the disorder during their lifetime. Prostatitis is the most common urological disorder in men over the age of 50 and the third most common disorder in men younger than 50.
According to the National Institutes of Health, prostatitis accounts for 25% of all office visits involving the genitourinary system by young and middle-aged men.
Nonbacterial prostatitis and prostatodynia, which is also called chronic pelvic pain syndrome (CPPS), are the most common diagnoses. Bacterial prostatitis (acute and chronic) accounts for less than 5–10% of cases. Acute bacterial prostatitis occurs most often in men under age 35, and chronic bacterial prostatitis primarily affects men between the ages of 40 and 70.
Anatomy
The prostate is a walnut-sized gland located below the bladder and in front of the rectum. It secretes seminal fluid, a milky substance that combines with sperm to form semen. During sexual climax, muscles in the prostate propel the semen through the urethra and out through the penis.
Types
There are four types of prostatitis: acute bacterial prostatitis, chronic bacterial prostatitis, nonbacterial prostatitis, and prostatodynia.
Acute bacterial prostatitis (ABP) is inflammation of the prostate gland caused by bacteria such as Escherichia coli and Klebsiella. Severe complications may develop if not promptly treated. ABP can be fatal if the bacterial infection is untreated and travels to the bloodstream (sepsis).
Chronic bacterial prostatitis (CBP) is a recurrent infection and inflammation of the prostate and urinary tract. Symptoms are less severe than those associated with acute bacterial prostatitis.
Nonbacterial prostatitis is an inflamed prostate without bacterial infection.
Prostatodynia, sometimes called chronic pelvic pain syndrome (CPPS), is the occurrence of prostatitis symptoms, without inflammation or bacterial infection.
Risk Factors
Risk factors include bladder outlet obstruction (e.g., stone, tumor, BPH), diabetes mellitus, a suppressed immune system, and urethral catheterization (i.e., small tube inserted into the bladder through the urethra to drain urine). Some sexually transmitted diseases (STDs; e.g., nongonnococcal urethritis, gonorrhea) increase the risk for developing bacterial prostatatis. Unprotected anal and vaginal intercourse can allow bacteria to enter the urethra and travel to the prostate.
Causes
Bacterial prostatitis is caused by the growth of bacteria that are normally found in prostatic fluid, such as Escherichia coli and Klebsiella. Urine that flows back into the urethra (urine reflux) that enters the prostate can also cause the condition. There is no known cause for nonbacterial prostatitis or prostatodynia, but atypical organisms (e.g., viruses, chlamydial organisms) have recently been suggested.
Signs and Symptoms
Symptoms of acute bacterial prostatitis (ABP) are usually sudden and include the following:
• Chills
• Fever
• Frequent urination
• Incomplete emptying of bladder
• Joint pain (arthralgia)
• Lower back pain
• Muscle pain (myalgia)
• Pain in penis, testicles, and area between the scrotum and the rectum (perineum)
• Painful ejaculation
• Painful urination (dysuria)
• Sensation of having to urinate immediately, often accompanied by bladder pain or spasm (urgency)
• Tender, swollen prostate
Symptoms of chronic bacterial prostatitis (CBP) and nonbacterial prostatitis are generally less severe than those of ABP and include the following:
• Blood in semen (hematospermia)
• Discomfort in genital area and perineum
• Dysuria
• Fever
• Lower back pain
• Pain in lower abdomen
• Painful ejaculation
• Recurring urinary tract infection (UTI)
Patients with prostatodynia have symptoms of prostatitis but there is no evidence of infection or inflammation.
Complications
Complications of acute bacterial prostatitis (ABP) include the following:
• Collection of pus (abscess)
• Acute urinary retention
• Chronic bacterial prostatitis
• Infection in bloodstream (sepsis)
Diagnosis
A digital rectal exam (DRE) is used to determine if the prostate gland is tender or swollen. To perform a DRE, the physician inserts a lubricated, gloved finger into the patient’s rectum to feel the surface of the prostate gland through the rectal wall and assess its size, shape, and consistency.
A three-part urinalysis is the standard diagnostic tool. Two urine specimens are collected and analyzed, followed by prostate massage and a third urine sample that contains prostatic fluid.
During prostate massage, the physician inserts a lubricated, gloved finger into the rectum to massage the surface of each lobe of the prostate gland, resulting in the release of prostate fluids. Prostate massage should not be used if ABP is suspected because massage may encourage the spread of bacteria.
Urinalysis determines the presence of white blood cells (leukocytes) in the urine. Leukocytes help the body to fight infection; a high number indicates a bacterial infection. A urine culture is performed to identify bacteria.
Nonbacterial prostatitis is diagnosed when tests reveal no bacteria in the urine or prostatic secretions. There is no test to diagnose prostatodynia; it is diagnosed after eliminating other probable causes (e.g., kidney stones, interstitial cystitis, urethral cancer).
Treatment
Medication
Acute bacterial prostatitis is treated with antibiotics such as flouroquinolones (e.g., Avelox®, Levaquin®) and trimethoprim-sulfamethoxazole (e.g., Bactrim®, Cotrim®) administered intravenously, followed by a course of oral antibiotics. Side effects include the following:
• Diarrhea
• Dizziness
• Headache
• Nausea
• Stomach pain
• Vomiting
Analgesics and warm baths are recommended to alleviate symptoms of prostatodynia and nonbacterial prostatitis. Treating the underlying cause (e.g., stones) relieves prostatitis symptoms.
Surgery
In cases of chronic bacterial prostatitis or prostatodynia, surgery to remove part of the prostate is a treatment option. It is recommended for patients who experience chronic pain and serious complications, such as the following:
• Damage to the kidneys caused by urine backing up
• Frequent urinary tract infections
• Inability to urinate
• Stones in the bladder
TURP Transurethral resection of the prostate (TURP) is performed under general or regional anesthesia and takes less than 90 minutes. The surgeon inserts an instrument called a resectoscope into the penis through the urethra. The resectoscope is about 12 inches long and one-half inch in diameter. It contains a light, valves for controlling irrigating fluid, and an electrical loop to remove the obstructing tissue and seal blood vessels. The surgeon removes the obstructing tissue and the irrigating fluids carry the tissue to the bladder. This debris is removed by irrigation and any remaining debris is eliminated in the urine over time.
Patients usually stay in the hospital for about 3 days, during which time a catheter is used to drain urine. Most men are able to return to work within a month. During the recovery period, patients are advised to
• avoid heavy lifting, driving, or operating machinery;
• drink plenty of water to flush the bladder;
• eat a balanced diet;
• use a laxative if necessary to prevent constipation and straining during bowel movements.
Complications
Blood in the urine (hematuria) is common after TURP surgery and usually resolves by the time the patient is discharged. Bleeding also may result from straining or activity. Postsurgical bleeding should be reported to the urologist immediately.
Some patients have initial discomfort, a sense of urgency to urinate, or short-term difficulty controlling urination. These conditions improve as recovery progresses, but the longer the urinary problems existed before surgery, the longer it takes to regain full and normal bladder function after surgery.
Up to 30% of men who undergo TURP experience problems with sexual function. Complete recovery of sexual function may take up to 1 year. The most common, long-term side effect of prostate surgery is dry climax (retrograde ejaculation), which results when the muscle that closes the bladder neck during ejaculation is removed along with the prostate tissue. Semen enters the wider opening to the bladder instead of being expelled through the penis, causing sterility but not affecting the man’s ability to experience sexual pleasure.
Prostatectomy Surgical removal of the prostate (prostatectomy) is very rarely indicated for treatment of prostatitis. Severe symptoms that do not improve after all other methods of treatment have been tried may be treated using this procedure.
Prevention
Avoiding unprotected sex can help prevent acute bacterial prostatitis.
Naturopathic Treatment
Prostatitis can be difficult to treat. Acute, chronic, or nonbacterial prostatitis are inflammatory and/or infectious conditions that can be treated naturally with lifestyle changes, nutritional support, and herbal medicine, in some cases. The key to this approach is the elimination of inflammatory agents from the diet while supplementing with anti-inflammatory nutrients, foods, and herbs. Naturopathic methods may be applied with antibiotics and may even improve their effectiveness.
Nutrition
• Eat whole, fresh, unrefined, and unprocessed foods. Include fruits, vegetables, whole grains, soy, beans, seeds, nuts, olive oil, and cold-water fish (salmon, tuna, sardines, halibut, and mackerel). Eating organic food helps reduce exposure to pesticides, herbicides, and hormones.
• Avoid sugar, dairy products, refined foods, fried foods, junk foods, and caffeine.
• Eliminate food sensitivities. Use an elimination and challenge diet to determine food sensitivities.
• Drink ? of your body weight in ounces of water daily (e.g., if you weigh 150 lbs, drink 75 oz of water daily).
Supplements
Supplements are intended to provide nutritional support. Because a supplement or a recommended dose may not be appropriate for all persons, a physician (e.g., a licensed naturopathic physician or holistic MD or DO) should be consulted before using any product. Recommended doses follow:
• Bromelain (proteolytic enzymes)-Take 400 mg 3 times daily away from meals. Proteolytic enzymes have anti-inflammatory properties and can potentize the effectiveness of antibiotics.
• Vitamin C-Take 500-1000 mg 3 times daily.
• Vitamin E-Take 400 IUs daily.
• Flaxseed meal-Grind 2-4 tablespoons daily. Flaxseed meal is a better choice due to its fiber, lignan, and vitamin content, but flaxseed oil (1 tbsp daily) can be substituted.
• Probiotics-If antibiotics are taken, supplement with probiotics, such as acidophilus, to replenish the beneficial gut flora.
• Quercetin-Has anti-inflammatory properties. ·
• Selenium-Is an antioxidant. May be more effective when taken with vitamin E.
• Zinc-Take 30 mg daily. Zinc is vital to the health of the prostate, which concentrates and secretes zinc. Zinc also prevents infections.
Herbal Medicine
Herbal medicines usually do not have side effects when used appropriately and at suggested doses. Occasionally, an herb at the prescribed dose causes stomach upset or a headache. This may reflect the purity of the preparation or added ingredients, such as synthetic binders or fillers. For this reason, it is recommended that only high-quality products be used. As with all medications, more is not better and overdosing can lead to serious illness and death.
These herbs may be used to treat prostatitis and associated urinary tract infections:
• Bearberry (Arctostaphylos uva ursi)-Acts as a diuretic and antiseptic for the urinary tract system.
• Echinacea and goldenseal-Used to treat infections due to their antiviral and antibacterial properties.
• Flower pollen extract-Follow product directions. It has been used in Europe for over 25 years to treat prostatitis. Flower pollen is not the same as bee pollen.
• Pellitory of the Wall (Parietaria diffusa)-Has anti-inflammatory action in the urinary tract.
• Saw palmetto (Serenoa repens)-Provides a tonic effect on the prostate and the urinary tract.
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