DEAR DOCTOR K: I have chronic prostatitis. Antibiotics haven’t helped. What other treatment options are there?
DEAR READER: Prostatitis is an inflammation of the prostate. This walnut-sized gland secretes fluid into semen. Prostatitis is widespread and affects men of all ages.
The type of prostatitis you have – chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) – is the most common type. Yet we don’t know what causes it. Doctors have suspected that a bacterial infection causes the condition, but so far, no clear evidence of a bacterial cause has been found.
White blood cells, a sign of infection, are usually found in urine and prostate secretions. However, no bacteria are evident. Still, doctors often prescribe antibiotics in case there’s an undetected bacterial infection. But as in your case, such treatment is generally ineffective.
CP/CPPS may result from a cascade of events. The initial event may be an undetected infection (from some sort of microbe that we haven’t discovered yet), or a physical trauma that causes inflammation. Over time, the inflammation leads to heightened pain sensitivity. The condition may extend beyond the prostate. The chronic inflammation may affect the nerves near the prostate gland. This, in turn, could affect bowel, bladder and sexual function. These are all reasonable theories, but they are unproven.
Treatment aims to reduce discomfort. Pain medications that reduce inflammation – such as aspirin, ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs) – may help. So may hot baths.
Your doctor may prescribe one or more drugs. Anticholinergic drugs reduce urinary symptoms by decreasing bladder contractions. Alpha blockers relax the muscles at the neck of the bladder, easing the flow of urine. Pregabalin (Lyrica), a drug used to treat fibromyalgia, may reduce pain.
Myofascial trigger release, a form of massage, and biofeedback have been found in small studies to reduce pain and other symptoms. They might be worth a try.