Prostatitis

Prostatitis is a term used to describe any inflammatory condition of the prostate gland. It is extremely common, with up to half of all men developing symptoms of it at some stage during their life.

Microscopic features of prostatitis

Types of prostatitis

Bacterial prostatitis occurs if a urinary infection secondarily infects the prostate. If it is successfully treated within a few days it is known as acute but if it persists it becomes chronic.

Non-bacterial prostatitis describes inflammation within a prostate gland without any evidence of bacterial infection (usually because it has been successfully treated, but despite this the inflammation persists).

Prostatodynia means ‘painful prostate’ and is characterised by the symptoms of prostatic inflammation but without evidence of inflammation or bacterial infection. It is also known as chronic pelvic pain syndrome (CPPS).

Symptoms of Prostatitis

Acute

	Fever and chills.
	Frequent, urgent and painful urination.
	Joint, muscle and back ache.
	Pain in penis, testicles and area between the scrotum and the rectum (perineum).
	Painful ejaculation.

Chronic

	Painful urination.
	Recurring urinary infections.
	Discomfort in genitals and perineum.
	Back ache and abdominal pain.
	Painful ejaculation.
	Blood in semen.

Complications of prostatitis

	Prostatic abscess – a serious condition, in which a collection of pus can cause severe pain, fever and a rapid deterioration in health. It is only relieved by drainage of the abscess bursting or if it bursts.
	Acute urinary retention – the inability to pass any urine, which needs to be relieved by inserting a catheter (tube) to drain the bladder.
	Chronic prostatitis.
	Septicaemia (blood poisoning).

Investigations for Prostatitis

	Digital rectal exam (DRE) to determine if the prostate gland is tender or swollen.
	Blood tests to measure inflammatory markers, the health of the urinary system and PSA.
	Urine culture.
	Prostate massage, following which the first urine sample, which contains the expressed prostatic secretions, is cultured for infection.
	Prostate biopsy to determine whether inflammation truly exists in the prostate.
	Flow rate and bladder ultrasound to investigate obstructive bladder symptoms.
	Cystoscopy to investigate irritative bladder symptoms.
	CT scan of abdomen and pelvis to ensure the health of other organ systems, if all tests are negative for prostatitis.

Nonbacterial prostatitis is diagnosed when tests reveal no bacteria in the urine or prostatic secretions. There is no test to diagnose prostatodynia; which is diagnosed after eliminating other probable causes.

Treatment of Prostatitis

Warm baths.

Medication

	painkillers.
	antibiotics – it is important to use an antibiotic which penetrates the prostate well (most don’t) for a sufficient length of time (usually 6 weeks). The quinolone family of antibiotics is best for this, such as ciprofloxacin and norfloxacin.
	anti-inflammatory drugs – such as Brufen and Neurofen.
	antidepressant drugs – effective in many patient with neurogenic (nerve-mediated) pain. Prescribed and supervised by an expert in chronic pain relief, such as Dr Christopher Siefert.
	prostate block – long-acting local anaesthetic administered under ultrasound guidance around the prostate to block the nerves subserving pain either as a diagnostic manoeuvre or as treatment.

Surgery

In cases of chronic bacterial prostatitis or prostatodynia, surgery to remove part or all of the prostate is a treatment option. It is only recommended for patients who experience chronic, debilitating pain despite medication and importantly does not guarantee a resolution of the problem.

	TURP.
	laparoscopic prostatectomy.

Alternative treatments for Prostatitis

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 more fruit, vegetables, whole grains, soy, beans, seeds, nuts, olive oil, and cold-water fish (salmon, tuna, sardines, halibut, and mackerel).
	Eat less dairy products, refined food, fried foods, hydrogenated oils, alcohol and caffeine.
	Increase fluid intake until urine always looks dilute (pale yellow).

Supplements

	Bromelain - 400 mg 3 times daily away from meals. Proteolytic enzymes have anti-inflammatory properties and can potentiate the effectiveness of antibiotics.
	Vitamin C - 500-1000 mg daily.
	Vitamin E - 400 IUs daily.
	Flaxseed meal - grind and eat 2-4 tbsp daily. An alternative is to take 1 tbsp of flaxseed oil daily. Flaxseed oil is also a good source of the essential fatty acid alpha-linolenic acid (an omega-3 fatty acid).
	Probiotics - If antibiotics are taken probiotics, such as acidophilus, replenish the beneficial gut flora.
	Quercetin - has anti-inflammatory properties.
	Selenium - an antioxidant. May be more effective when taken with vitamin E.
	Zinc - 30 mg daily. Zinc is vital to the health of the prostate, which concentrates and secretes zinc. Zinc also prevents infections.

Herbs

	bearberry - 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 - used in Europe for over 25 years to treat prostatitis. Flower pollen is not the same as bee pollen.
	pellitory of the wall – has anti-inflammatory activity in the urinary tract.
	saw palmetto – reduces the size of the prostate via its oestrogenic effect and so relieves symptoms of BPH. Recommended dosage is 320 mg of extract a day.