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:
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Chills
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Fever
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Frequent
urination |
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Incomplete
emptying of bladder |
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Joint pain (arthralgia)
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Lower back
pain |
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Muscle pain (myalgia)
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Pain in
penis, testicles, and area between the scrotum and the
rectum (perineum) |
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Painful
ejaculation |
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Painful
urination (dysuria) |
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Sensation of
having to urinate immediately, often accompanied by
bladder pain
or spasm (urgency) |
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Tender,
swollen prostate |
Symptoms of chronic bacterial prostatitis (CBP)
and nonbacterial prostatitis are generally less severe than
those of ABP and include the following:
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Blood in
semen (hematospermia) |
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Discomfort in
genital area and perineum |
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Dysuria
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Fever
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Lower back
pain |
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Pain in lower
abdomen |
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Painful
ejaculation |
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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:
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Collection of
pus (abscess) |
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Acute urinary
retention |
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Chronic
bacterial prostatitis |
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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:
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Diarrhea
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Dizziness
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Headache
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Nausea
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Stomach pain
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Vomiting
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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:
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Damage to the
kidneys caused by urine backing up
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Frequent
urinary tract infections |
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Inability to
urinate |
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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:
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avoid heavy
lifting, driving, or operating machinery;
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drink plenty
of water to flush the bladder; |
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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 ½ 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:
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Bromelain (proteolytic
enzymes)-Take 400 mg 3 times daily away from meals. |
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Proteolytic
enzymes have anti-inflammatory properties and can
potentize the effectiveness of antibiotics.
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Vitamin
C-Take 500-1000 mg 3 times daily.
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Vitamin
E-Take 400 IUs daily. |
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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. |
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Probiotics-If
antibiotics are taken, supplement with probiotics, such as
acidophilus, to replenish the beneficial gut flora.
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Quercetin-Has
anti-inflammatory properties. · |
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Selenium-Is
an antioxidant. May be more effective when taken with
vitamin E. |
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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:
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Bearberry (Arctostaphylos
uva ursi)-Acts as a diuretic and antiseptic for the
urinary tract system. |
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Echinacea and
goldenseal-Used to treat infections due to their antiviral
and antibacterial properties. |
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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. |
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Pellitory of
the Wall (Parietaria diffusa)-Has anti-inflammatory action
in the urinary tract. |
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Saw palmetto
(Serenoa repens)-Provides a tonic effect on the prostate
and the urinary tract. |
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