The prostate gland is a small, doughnut-shaped organ this is located between the urinary bladder and the penis. The urine has to pass through a hole in the middle. The entire gland weights about 10-15 grams and is about the size of a walnut.
When the prostate gland becomes inflamed or infected, the condition is called prostatitis. Infections reach the prostate by traveling through the penis into the prostatic ducts. Prostatitis is a very common medical disorder which causes two million physician office visits each year. The average age for prostatitis is about 43 years old.
The most common presenting complaint is pelvic pain or discomfort usually lasting three months or more, but prostatitis can produce a wide variety of symptoms including the following:
The function of the prostate gland is to produce a secretion that forms about 60% of the fluid in the semen. The purpose of this portion of the semen is to protect the sperm and neutralize the normal acidity of the vagina, which would otherwise kill all the sperm before fertilization could take place. The prostatic fluid is therefore alkaline (antacid) in nature. The prostate gland is the only organ in the body whose sole function is to produce an alkaline secretion. Therefore, its chemical makeup is different from the tissues of the other glands and organs. For this reason, antibiotics that work well for sore throats infected ears and fingers, will not function well in the prostate gland. The prostatic ducts, where the bacteria like to hide, are separated from the main blood supply by additional prostate tissue and membranes. This makes treating prostate infections particularly difficult.
Antibiotics
Initial treatment of prostatitis usually involved antibiotics. Most antibiotics cannot chemically penetrate well into the prostate gland or ducts; so only those, few which have good penetration, should be used. Even those antibiotics, which penetrate well, require long courses of therapy to be effective. Inadequate treatment of a prostate infection usually results in a rapid recurrence. The most effective antibiotics for prostatitis currently available belong to a drug class called quinolones and include the first five medications listed below. While effective, quinolones tend to be quite expensive costing about ten dollars a day.
The most effective oral antibiotics for prostatitis are:
A minimum of a six-week course of antibiotics is necessary and twelve weeks is usually recommended. Antibiotic therapy should continue for as long necessary to eliminate all traces of infection, inflammation and irritation from the prostate. As long as a particular antibiotic appears to be effective, we do not recommend changing to a different antibiotic. When one antibiotic no longer appears to be helping, then another antibiotic is chosen and treatment begins again. In some cases, continuous low dose antibiotic therapy is needed to adequately control the symptoms of prostatitis.
Many cases of prostatitis do not involve germs or bacteria at all. It’s believed tat no more than 30% and possible as few as 51 of patients with prostatitis actually have true infections. The rest have pain and inflammation caused by other factors, such as immune system disorders, and antibiotics alone will not help these cases of prostatic pain and discomfort.
Other Therapies
A hot sitz bath is extremely helpful in alleviating discomfort and promoting healing. The patient must sit in a tub of very hot water 6-8 inches deep for about 10 minutes at a times, two or even three times a day. The heat from the hot water will penetrate deeply into the prostate and open up the blood vessels improving circulation. This will reduce soreness, irritation and inflammation while speeding healing. It is important that the water be as hot as possible without burning and that the treatment be ongoing. This hot bath treatment is recommended for everyone will prostatitis regardless of other therapies because it always helps. The more often the hot sitz bath treatment can be repeated, the better it seems to work. The patient is also advised to avoid sitting on anything hard or cold for long periods of time. A soft doughnut cushion is recommended for prostatitis patients who need to sit for long periods of time.
Alpha blockers (Hytrin, Cardura and Flomax) are commonly used to reduce muscle tension in the prostate and cause relaxation. They can improve urinary flow and help relieve other symptoms. These medications tend to be moderately expensive, need to be taken indefinitely in relatively high doses, often have significant side effects and cannot cure the underlying problem or prevent recurrences.
Anti-inflammatory agents (Motrin, Advil Aleve) help relieve pain and reduce inflammation but they do not cure the disease and effect wears off rapidly. They are best used in combination with hot sitz baths. Various other medications such as Valium and Ditropan can be used for irritative voiding symptoms. Anitriptyline (Elavil) has been helpful in various chronic pain conditions including prostatitis.
Finasteride (Proscar) can shrink prostate tissue, but there is little evidence that it helps most cases of prostatitis. Allopurinaol (Zyloprim), a drug that reduces uric acid levels in the body, has been used to treat prostatitis based on the theory that uric acid crystals may form inside the prostate and cause inflammation. In practice, most clinicians report disappointing results from allopurinol therapy.
Prostatic massage has been advocated by some practitioners for prostatitis. This involved vigorous massage of the prostate by digital rectal examination on a regular basis with the intention of causing evacuation and drainage of he prostatic ducts. This is usually combined with antibiotic therapy. While this technique has been used for years, there is little reliable data to support its use and it causes fairly intense pain and discomfort at the time of the massage. While it may sometimes help a few carefully selected patients, we generally do not routinely recommend this unpleasant treatment. One of the more promising and effective therapies for pain relief in prostatitis is biofeedback. This involves a highly trained technician and specialized equipment to assist the patient in pelvic muscle rehabilitation and pain reduction techniques. There are no medicines, side effects or complications and biofeedback well with other therapies. It requires a series of one-hour weekly treatments. A full course of therapy usually lasts two or sometimes three month. We can provide biofeedback therapy in our office to those patients who are interested and wish to try it.
Regular sexual activity and ejaculation will help empty the prostate ducts where the infection tends to settle. Prostate disease or infection cannot be transmitted to a sexual partner. Behavioral therapy, referral to a pain clinic and psychological treatment has all been recommended for patients with prostatitis and occasionally offer some relief to selected individuals.
Nutritional Therapies
Certain foods are known to cause difficulty with prostatic inflammation and irritation. Liquids containing large amounts of caffeine such as colas, coffee and tea should be avoided. These liquids tend to reduce the blood supply to the prostate and prolong healing. For many patients, “hot” or spicy foods also seem to aggravate any inflammation of the prostate. Too much vitamin C appears to be irritating to the prostate in some people. Nutrasweet is another possible irritant to the prostate, which should probably be avoided by people with prostatitis
Natural herbal remedies are among the most promising new treatments available for prostatitis. They have been used extensively in Asia and Europe but are only now becoming popular in America. While usually recommended for prostate enlargement, there is growing evidence that they may be quite effective for prostatitis when used in the right combinations. These products appear to be quite safe and have no known side effect or drug interactions. Saw Palmetto is the most popular plant product used for prostate problems in the world. It seems that an extract from this plant is somehow able to reduce prostatic inflammation and swelling as well improve many bothersome urinary symptoms. Pygeum africanum is made from the bark of an African evergreen tree. It appears to work as an anti-inflammatory agent. It improved urinary symptoms in 66% of patients tested in several European studies.
Selenium has been shown to reduce the incidence of prostate cancer by up to 66% in various studies. This theoretically occurs because of an improvement in the general health and immunity of the prostate. A Finnish study showed that Vitamin E reduced prostate cancer by 32%.
Combining these remedies along with other herbal products, vitamins anti-oxidants and amino acids seems to improve the overall benefit and effect especially for prostatitis. For example, Vitamin E and Selenium together are able to stimulate the immune system to work better to protect and heal the prostate. Zinc may need substantial amounts of Vitamin E and Selenium as well as other nutrients to be able to effectively enter and treat the prostate. Zinc has been linked to the prevention of prostate cancer and an improved prostatic immune system. It also exerts an anti-inflammatory effect on the prostate.
Perhaps the most promising combination product developed so far is called PEENUTS (PEENUTS is an acronym for Power to Empty Every time while Never Voiding Too Soon and stands for normal urinary function and prostatic health) This particular combination product contains all the natural remedies known to improve prostate health in a unique formula which seems to be particularly effective in treating both male urinary symptoms and especially prostatitis. Preliminary double blinded clinical studies using "PEENUTS" in over 300 male patients showed substantial improvement in at least some abnormal urinary symptoms in every single patient tested with the first tow months of therapy! The PSA level dropped by 50-70% in ninety-five percent of all men tested within 3 to 6 months of using the product. There were no side effects or drug interactions noted during these tests. If these early findings were confirmed by additional research, it would mean, "PEENUTS" could be a significant medical breakthrough in the treatment of prostatitis and other prostate disorders. No prescription is required to obtain this product and the cost is reasonable. Contact our office for more information on PEENUTS and other nutritional therapies.
Some cases of prostatitis may actually be an unusual type of bladder disorder called interstitial cystitis. This condition is found most often in women and is characterized by pelvic and bladder pain as well as urinary frequency and urgency. The bladder capacity is usually reduced to about half the normal volume. Interstitial cystitis is often triggered by certain foods especially those high in potassium. It is thought to be cause by a loss of the protective mucus layer that normally lines the bladder. Treatment consists of Elmiron (a medication that helps restore the missing mucus layer), dietary modifications, biofeedback, medicated bladder irrigations and a variety of other remedies. It is now believed that at least some cases of chronic prostatitis, especially those that are resistant to stand therapies, may actually be interstitial cystitis and should respond to appropriate treatment.
When all other treatments fail, surgery may be considered. This usually involves a procedure called a transurethral resection of the prostate or "TURP". This procedure involves the surgical removal of as much prostate tissue as possible. It is usually performed for prostate enlargement that significantly blocks the urinary channel in middle aged or elderly men. When this surgery is done for intractable prostatitis, it seems to help about one third of the patients receiving it and has little effect on the rest. The vast majority of patients is successfully treated by other means and never requires surgery for their prostatitis. Prostate surgery is recommended only when all other treatments fail.
Prostatitis is a common and potentially serious medical condition which can cause serve pain, impotence, urinary difficulties and even blood poisoning in rare cases. Thorough, continuing treatment is necessary to ensure complete resolution of the problem. For more information on prostatitis, call our office at 440.985.9898