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Prostatitis

Also indexed as: Acute Bacterial Prostatitis, Chronic Abacterial Prostatitis, Chronic Bacterial Prostatitis, Chronic Nonbacterial Prostatitis, Prostadynia

Illustration

Prostate inflammation can lead to daily discomfort. Learn more about the four forms of prostatitis, and find relief for symptoms. According to research or other evidence, the following self-care steps may be helpful:

What you need to know

  • Discover quercetin
  • Reduce symptoms of chronic prostatitis with the anti-inflammatory and antioxidant effects of this beneficial flavonoid; take 1,000 mg a day
  • Get relief from flower pollen
  • Take two tablets of flower pollen extract twice a day to improve symptoms of chronic prostatitis
  • Flush your urethra
  • Help prevent infectious prostatitis with frequent urination and ejaculation
  • Make time for a checkup
  • See your healthcare provider to determine the specific cause of your condition

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full prostatitis article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About prostatitis

Prostatitis is an inflammation of the prostate gland. It is a term that encompasses four disorders of the prostate: acute bacterial prostatitis, chronic bacterial prostatitis, chronic nonbacterial prostatitis, and prostadynia.

Chronic nonbacterial prostatitis (NBP), also called chronic abacterial prostatitis (CAP), is the most common form of prostatitis. NBP is usually caused by infectious agents such as fungi, mycoplasma, or viruses.1 Prostadynia (PD), also called chronic pelvic pain syndrome, is a noninfectious form of prostatitis. Although the cause is unknown, it has been proposed that PD may be a neuromuscular condition, causing pain of the pelvic floor muscles.2 Acute bacterial prostatitis (ABP) results from a urinary tract infection (usually from E. coli bacteria) that has spread to the prostate. Chronic bacterial prostatitis (CBP) is usually the result of a partial blockage of the male urinary tract, such as occurs with benign prostatic hyperplasia (BPH). Such blockages promote the harboring of bacteria from a previous infection and reduce circulation, thereby preventing both the body’s natural immune mechanisms and medication from getting to the site.

Product ratings for prostatitis

Science Ratings Nutritional Supplements Herbs
3Stars

Quercetin (NBP, PD)

 
2Stars

Bromelain (NBP, PD)

Flower Pollen (not bee pollen) (NBP, PD)

 
1Star

Vitamin C (ABP, CBP)

Zinc (CBP, NBP)

Pau d’arco

Pygeum (CBP, NBP)

Saw palmetto (NBP)

3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Men with prostatitis may have symptoms including pain or discomfort in the lower abdomen, testicles, and penis; discomfort during ejaculation or urination; or a weak urinary stream with dribbling. Advanced cases may also have fever, chills, frequent urge to urinate, burning urination, blood passed in the urine, and pain in the joints and muscles.

Medical options

Over-the-counter pain medications, such as aspirin (Bayer®, Ecotrin®, Bufferin®), ibuprofen (Motrin IB®, Advil®), naproxen (Aleve®), and acetaminophen (Tylenol®), may be beneficial. Stool softeners, such as docusate (Colace®, Surfak®), might be recommended.

Prescription drug treatment primarily includes fluoroquinolone antibiotics, such as ciprofloxacin (Cipro®), norfloxacin (Noroxin®), oflaoxacin (Floxin®), and levofloxacin (Levaquin®), which are often taken for 4 to 12 weeks.

Health care practitioners may recommend bed rest and plenty of fluids.

Lifestyle changes that may be helpful

Urination and ejaculation may provide defense against prostatic infection by flushing the urethra. The prostate also secretes an antibacterial substance known as “prostatic antibacterial factor” into the seminal fluid (semen), which helps to fight infection.3 In one preliminary study, unmarried men with NBP who had avoided sexual activity for personal or religious reasons and who had not responded to medication, were encouraged to masturbate at least twice a week for six months. Out of 18 men, 78% experienced moderate to complete relief of symptoms.4

Use of tobacco, especially by smoking, reduces the zinc content of prostatic fluid, and may therefore reduce natural immunity to prostate infection.5 No research, however, has investigated the effect of smoking cessation on the prevention of prostatitis.

Vitamins that may be helpful

Quercetin, a flavonoid with anti-inflammatory and antioxidant effects, has recently been reported to improve symptoms of NBP and PD. An uncontrolled study reported that 500 mg of quercetin twice daily for at least two weeks significantly improved symptoms in 59% of men with chronic prostatitis.6 These results were confirmed in a double-blind study, in which similar treatment with quercetin for one month improved symptoms in 67% of men with NBP or PD.7 Another uncontrolled study combined 1,000 mg per day of quercetin with the enzymes bromelain and papain, resulting in significant improvement of symptoms.8 Bromelain and papain promote absorption of quercetin and have anti-inflammatory effects as well.9

An extract of flower pollen, derived primarily from rye, may improve symptoms of chronic prostatitis and prostadynia. In a small, uncontrolled trial, men with chronic NBP or prostadynia given two tablets of flower pollen extract twice daily for up to 18 months reported complete or marked improvement in symptoms.10 In a larger, uncontrolled trial, one tablet three times daily for six months produced a favorable response in 80% of the men based on symptoms, laboratory tests, and doctor evaluations.11 Men who did not respond in this study were found to have structural abnormalities of the urinary tract, suggesting that uncomplicated prostate conditions are more likely to respond to flower pollen. Additional uncontrolled studies support the effectiveness of flower pollen extract,12 13 14 but no controlled research has been published.

In healthy men, prostatic secretions contain a significant amount of zinc, which has antibacterial activity and is a key factor in the natural resistance of the male urinary tract infection.15 16 In CBP17 18 19 20 and NBP21 these zinc levels are significantly reduced; however, it is not clear whether this indicates a predisposition to, or is the result of, prostatic infection.22 23 Zinc supplements increased semen levels of zinc in men with NBP in one study,24 but not in another.25 While zinc supplements have been associated with improvement of benign prostatic hyperplasia (BPH), according to one preliminary report,26 no research has examined their effectiveness for prostatitis. Nonetheless, many doctors of natural medicine recommend zinc for this condition.

Test tube studies have shown that vitamin C inhibits the growth of E.coli,27 the most common cause of ABP and CBP. Results from preliminary human studies indicate vitamin C supplementation can cause changes in urine composition that may inhibit the growth of urinary E. coli.28 29 Although vitamin C has not been studied in bacterial prostatitis, the association of this condition with urinary tract infections leads many nutritionally oriented doctors to recommend its use, in the form of ascorbic acid, for bacterial prostatitis due to E. coli infection.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Saw palmetto, known more for its use in BPH, has also been used historically for symptoms of prostatitis.30 According to laboratory studies, saw palmetto contains constituents that act to reduce swelling and inflammation.31 However, there is no scientific research evaluating the effects of saw palmetto in men with prostatitis.

In a small preliminary trial, men with chronic prostatitis or BPH were given 200 mg per day of pygeum extract for 60 days, resulting in some improvement of symptoms and laboratory evaluation of the prostate and urinary tract.32 The extract used in this study was standardized to contain 14% beta-sitosterol and 0.5% n-docosanol. Other preliminary trials have also reported improvement of prostatitis symptoms with pygeum.33

Pau d’arco extract has been used traditionally for prostatitis.34 According to test tube studies, pau d’arco exerts antibacterial activity against E.coli,35 which suggests a possible mechanism for this claim. However, no scientific studies of the effectiveness of pau d’arco for preventing or treating prostatitis have been done.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Holistic approaches that may be helpful

Acupuncture may be helpful for chronic prostatitis according to one small, uncontrolled study.36 Seventeen patients with chronic prostatitis that was unresponsive to conventional therapy were treated with electroacupuncture (acupuncture with electrical stimulation). The effectiveness of electroacupuncture therapy was reported to be moderate in 70% and excellent in 30% of the patients treated.

Prostatic massage through the rectum was once a common treatment for CBP and NBP, and is still prescribed by some practitioners. Prostatic massage is thought to promote circulation and drainage of infected areas.37 While little scientific research has been done to evaluate the effectiveness of this treatment, some physicians and their patients have reported symptomatic improvement.38 Prostatic massage should be conducted only by a trained specialist. Prostatic massage should be avoided in ABP because it is painful and could spread the infection.39 Also avoid this therapy in the presence of prostatic calculi (stones), a condition common in elderly men in which small calcifications develop in the prostate.

Controlled studies indicate psychological factors, such as anxiety and depression, occur more frequently in men with NBP and PD.40 41 42 This may be because psychological factors contribute to the development of NBP and PD, or perhaps they occur as a result of prostatitis. Nonetheless, some practitioners believe psychotherapy may help reduce symptoms in these cases.43

Some researchers have reported that certain cases of chronic prostatitis are helped by biofeedback (using simple electronic devices to measure and report information about a person’s biological system) and other treatments aimed at reducing chronic pain.44 This suggests that some of the causes of PD, and possibly NBP, may be neuromuscular. In support of this idea, smooth muscle relaxing medications are reported to reduce symptoms in men with CBP, NBP, and PD, and to reduce the recurrence rate of CBP.45 However, no controlled research has explored the effectiveness of biofeedback or alternative neuromuscular therapies for prostatitis.

A sitz bath is the immersion of the pelvic region (up to the navel) in water. Sitz baths are reported to provide temporary relief of symptoms in men with chronic prostatitis, although no controlled research has evaluated these claims.46 47 This therapy is not recommended in ABP, as it may worsen the infection.48 In chronic prostatitis, doctors of natural medicine recommend “contrast sitz baths,” a series of alternating hot and cold baths, requiring two tubs (or a bathtub and adequately sized basin), one for each temperature. The hot sitz bath is taken first with the water at a temperature of 105–115ºF for 3 minutes. This is immediately followed by the cold sitz bath at 55–85º F for 30 seconds. This process is repeated two more times, for a total of six baths (three hot and three cold) per treatment.49

References:

1. Tanner MA, Shoskes D, Shahed A, Pace NR. Prevalence of corynebacterial 16S rRNA sequences in patients with bacterial and “nonbacterial” prostatitis. J Clin Microbiol 1999;37:1863–70.

2. Zermann DH, Ishigooka M, Doggweiler R, Schmidt RA. Chronic prostatitis: A myofascial pain syndrome? Infect Urol 1999;12:84–8,92.

3. Lipsky BA. Prostatitis and urinary tract infection in men: what’s new; what’s true? Am J Med 1999;106:327–34 [review].

4. Yavascaoglu I, Oktay B, Simsek U, Ozyurt M. Role of ejaculation in the treatment of chronic non-bacterial prostatitis. Int J Urol 1999;6:130–4.

5. Pakrashi A, Chatterjee S. Effect of tobacco consumption on the function of male accessory sex glands. Int J Androl 1995;18:232–6.

6. Shoskes DA. Use of the bioflavonoid quercetin in patients with longstanding chronic prostatitis. JANA 1999;2:36–9.

7. Shoskes DA, Zeitlin SI, Shahed A, Rajfer J. Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial. Urology 1999; 54:960–3.

8. Shoskes DA, Zeitlin SI, Shahed A, Rajfer J. Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial. Urology 1999; 54:960–3.

9. Izaka K, Yamada M, Kawano T, Suyama T. Gastrointestinal absorption and anti-inflammatory effect of bromelain. Jpn J Pharmacol 1972;22:519–34.

10. Buck AC, Rees RW, Ebeling L. Treatment of chronic prostatitis and prostatodynia with pollen extract. Br J Urol 1989;64:496–9.

11. Rugendorff EW, Weidner W, Ebeling L, Buck AC. Results of treatment with pollen extract (Cernilton N) in chronic prostatitis and prostatodynia. Br J Urol 1993;71:433–8.

12. Jodai A, Maruta N, Shimomae E, et al. A long-term therapeutic experience with Cernilton in chronic prostatitis. Hinyokika Kiyo 1988;34:561–8 [in Japanese].

13. Suzuki T, Kurokawa K, Mashimo T, et al. Clinical effect of Cernilton in chronic prostatitis. Hinyokika Kiyo 1992;38:489–94 [in Japanese].

14. Ohkoshi M, Kawamura N, Nagakubo I. Clinical evaluation of Cernilton in chronic prostatitis. Jpn J Clin Urol 1967;21:73–6.

15. Colleen S, Mardh PA, Schytz A. Magnesium and zinc in seminal fluid of healthy males and patients with non-acute prostatitis with and without gonorrhoea. Scand J Urol Nephrol 1975;9:192–7.

16. Fair WR, Parrish RF. Antibacterial substances in prostatic fluid. Prog Clin Biol Res 1981;75A:247–64.

17. Lipsky BA. Prostatitis and urinary tract infection in men: what’s new; what’s true? Am J Med 1999;106:327–34 [review].

18. Colleen S, Mardh PA, Schytz A. Magnesium and zinc in seminal fluid of healthy males and patients with non-acute prostatitis with and without gonorrhoea. Scand J Urol Nephrol 1975;9:192–7.

19. Fair WR, Couch J, Wehner N. Prostatic antibacterial factor. Identity and significance. Urology 1976;7:169–77.

20. Kavanagh JP, Darby C, Costello CB. The response of seven prostatic fluid components to prostatic disease. Int J Androl 1982;5:487–96.

21. Marmar JL, Katz S, Praiss DE, DeBenedictis TJ. Semen zinc levels in infertile and postvasectomy patients and patients with prostatitis. Fertil Steril 1975;26:1057–63.

22. Lipsky BA. Prostatitis and urinary tract infection in men: what’s new; what’s true? Am J Med 1999;106:327–34 [review].

23. Neal DE Jr, Kaack MB, Fussell EN, Roberts JA. Changes in seminal fluid zinc during experimental prostatitis. Urol Res 1993;21:71–4.

24. Marmar JL, Katz S, Praiss DE, DeBenedictis TJ. Semen zinc levels in infertile and postvasectomy patients and patients with prostatitis. Fertil Steril 1975;26:1057–63.

25. Fair WR, Couch J, Wehner N. Prostatic antibacterial factor. Identity and significance. Urology 1976;7:169–77.

26. Bush IM, Berman E, Nourkayhan S, et al. Zinc and the prostate. Presented at the annual meeting of the American Medical Association Chicago, 1974.

27. Sirsi M. Antimicrobial action of vitamin C on M.tuberculosis and some other pathogenic organisms. Indian J Med Sci 1952;6:252–5.

28. Axelrod DR. Ascorbic acid and urinary pH. JAMA 1985;254:1310–1 [letter].

29. Lundberg JO, Carlsson S, Engstrand L, et al. Urinary nitrite: more than a marker of infection. Urology 1997;50:189–91.

30. Felter HW, Lloyd JU. Kings American Dispensatory, Vol II. Portland, OR: Eclectic Medical Publications, 1983, 1751–2.

31. Breu W, Hagenlocher M, Redl K, et al. [Anti-inflammatory activity of sabal fruit extracts prepared with supercritical carbon dioxide. In vitro antagonists of cyclooxygenase and 5-lipoxygenase metabolism]. Arzneimittelforschung 1992;42:547–51 [in German].

32. Carani C, Salvioli V, Scuteri A, et al. Urological and sexual evaluation of treatment of benign prostatic disease using Pygeum africanum at high doses. Arch Ital Urol Nefrol Androl 1991;63:341–5 [in Italian].

33. Menchini-Fabris GF, Giorgi P, Andreini F, et al. New perspectives on treatment of prostato-vesicular pathologies with Pygeum Africanum. Arch It Urol 1988;LX:313–22 [in Italian].

34. Pizzorno JE, Murray MT. A Textbook of Natural Medicine, 2nd ed.. New York: Churchill Livingstone, 1999, 968.

35. Anesini C, Perez C. Screening of plants used in Argentine folk medicine for antimicrobial activity. J Ethnopharmacol 1993;39:119–28.

36. Ikeuchi T, Iguchi H. Clinical studies on chronic prostatitis and prostatitis-like syndrome (7). Electric acupuncture therapy for intractable cases of chronic prostatitis-like syndrome. Hinyokika Kiyo 1994;40:587–91 [in Japanese].

37. Evans D. Treatment of chronic abacterial prostatitis: A review. Int J STD AIDS 1994;5:157–64 [review].

38. Nickel JC, Alexander R, Anderson R, et al. Prostatitis unplugged? Prostatic massage revisited. Tech Urol 1999;5:1–7 [review].

39. Lipsky BA. Prostatitis and urinary tract infection in men: what’s new; what’s true? Am J Med 1999;106:327–34 [review].

40. Wenninger K, Heiman JR, Rothman I, et al. Sickness impact of chronic nonbacterial prostatitis and its correlates. J Urol 1996;155:965–8.

41. Berghuis JP, Heiman JR, Rothman I, Berger RE. Psychological and physical factors involved in chronic idiopathic prostatitis. J Psychosom Res 1996;41:313–25.

42. Smart CJ, Jenkins JD, Lloyd RS. The painful prostate. Br J Urol 1976;47:861–9.

43. Evans D. Treatment of chronic abacterial prostatitis: A review. Int J STD AIDS 1994;5:157–64 [review].

44. Zermann DH, Ishigooka M, Doggweiler R, Schmidt RA. Chronic prostatitis: A myofascial pain syndrome? Infect Urol 1999;12:84–8,92.

45. Barbalias GA, Nikiforidis G, Liatsikos EN. Alpha-blockers for the treatment of chronic prostatitis in combination with antibiotics. J Urol 1998;159:883–7.

46. Evans D. Treatment of chronic abacterial prostatitis: A review. Int J STD AIDS 1994;5:157–64 [review].

47. Drach GW. Prostatitis: Man’s hidden infection. Urol Clin North Am 1975;2:499–520 [review].

48. Pizzorno JE, Murray MT. A Textbook of Natural Medicine, 2nd ed. New York: Churchill Livingstone, 1999, 353–4.

49. Pizzorno JE, Murray MT. A Textbook of Natural Medicine, 2nd ed. New York: Churchill Livingstone, 1999, 353–4.

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