Prostatitis is inflammation of the prostate gland. It is actually a group of conditions that affect the prostate, a walnut-sized gland found just under the bladder in men. The prostate produces part of seminal fluid, the fluid that helps carry sperm out of the body when men ejaculate. Prostatitis can cause pain and problems urinating. There are four major types of prostatitis:

• Acute bacterial prostatitis
• Chronic bacterial prostatitis
• Chronic prostatitis/chronic pelvic pain
• Asymptomatic inflammatory prostatitis

Symptoms and treatment vary depending on what type of prostatitis you have.

In general, symptoms may include:

• Pain or burning when urinating
• Problems with urination
• Having to urinate frequently, especially at night
• Needing to urinate urgently
• Pain in the groin, lower back, abdomen, penis, or testicles
• Pain when ejaculating

In addition, specific types of prostatitis can cause these symptoms:

Acute bacterial prostatitis:

• High fever, chills
• Nausea

Chronic bacterial prostatitis:

• Blood in semen or urine
• Frequent bladder infections

Chronic nonbacterial prostatitis:

Similar to chronic bacterial prostatitis, but without fever.

Asymptomatic inflammatory prostatitis:

No symptoms; usually discovered when undergoing tests for other problems.

As its name suggests, bacterial prostatitis is caused by bacteria. Researchers aren’t sure what causes chronic nonbacterial prostatitis or asymptomatic prostatitis. Injury to the prostate, or problems with the immune or nervous systems, may contribute to chronic nonbacterial prostatitis.

Your doctor will take a medical history and ask you about your symptoms. Your doctor will do a digital rectal exam, examining your prostate by inserting a lubricated finger into your rectum. Lab tests, including urinalysis, semen sample, or blood cultures, may be ordered. Your doctor may suggest you see a urologist, a specialist who treats urinary tract problems.

Drug Therapies

Bacterial prostatitis -- oral antibiotics, taken for several weeks. In some severe cases, you may need intravenous (IV) antibiotics. Other medications may include stool softeners and pain relievers such as ibuprofen (Advil).

Chronic nonbacterial prostatitis -- In addition to pain relievers, alpha blockers, which help relax the bladder may help if you have trouble urinating. Alpha blockers include alfuzosin (Uroxatral) and doxazosin (Cardura). Side effects can include headaches and low blood pressure.

Surgical Procedures

In severe cases of bacterial prostatitis, you may need surgery.

Complementary and Alternative Therapies

Be sure to let all of your doctors know about any herbs or supplements you take, or any alternative therapies you use. Some herbs, supplements, and alternative therapies may interfere with conventional medicine. Work with a doctor who is experienced in complementary and alternative therapies to find the right mix of treatments for you.

Nutrition and Supplements

Drink plenty of water (48 oz. a day). Avoid alcohol, caffeine, and spicy foods. These supplements may help:

• Cernilton, an extract made from rye grass pollen -- A few preliminary studies have found that this pollen extract may help relieve symptoms of chronic nonbacterial prostatitis. More research is needed.
• Quercetin, an antioxidant flavonoid that fights inflammation, may help reduce pain and symptoms of chronic nonbacterial prostatitis. In one study, quercetin was combined with bromelain and papain, showing even greater effects. Bromelain and papain help the body better absorb quercetin and they also have anti-inflammatory effects. Quercetin may interact with a number of common medications, so ask your doctor before taking it. Both bromelain and quercetin may increase the risk of bleeding, especially if you also take blood-thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Very high doses of quercetin have been associated with kidney damage. Don't take quercetin for more than 2 - 3 months without taking a break.
• Beta sitosterol, a naturally derived chemical found in various plants, is frequently used to treat prostatitis and is often included in prostate health formulas. However, there aren't any scientific studies about whether it works. A few reports have linked taking beta sitosterol with low sex drive and erectile dysfunction.
• Zinc -- There is evidence that zinc may reduce an enlarged prostate, but researchers don't know whether zinc helps prostatitis. A few preliminary studies suggest that when zinc is taken with antibiotics, it may work better than antibiotics alone for reducing some symptoms of prostatitis. High doses of zinc (more than 40 mg per day) can cause many negative side effects. Taking zinc supplements may cause you to have a copper deficiency, so be sure to work with your doctor to find the right dose of zinc for you.
• Vitamin C -- Although no studies have been done to see whether vitamin C is effective against bacterial prostatitis, some doctors recommend it. In test tubes, vitamin C stops the growth of E. coli, the most common bacteria involved in bacterial prostatitis.
• Omega-3 fatty acids, over time, may help reduce inflammation, although they have not been studied for prostatitis. Omega-3 fatty acids can increase the risk of bleeding, especially if you take blood-thinners such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin). Talk to your doctor before taking omega-3 fatty acids.
• Pumpkin seeds have been used historically for a healthy prostate, but have not been studied for prostatitis.

Herbs

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. of herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink two to four cups per day. You may use tinctures alone or in combination as noted.

• African pygeum (Prunus africana) -- Several studies suggest that pygeum may help reduce urinary symptoms of BPH and both bacterial and nonbacterial prostatitis in men with mild to moderate urinary symptoms.
• Saw palmetto (Serenoa repens) has been studied for its effects on benign prostatic hyperplasia (BPH), and used traditionally to treat nonbacterial prostatitis. But one preliminary scientific study found that it didn't help. Saw palmetto can interact with some medications including hormone replacement therapies and blood-thinners. Ask your doctor before taking saw palmetto.
• Stinging nettle (Urtica dioca) has shown some promise in helping maintain prostate health, but studies are mixed. Stinging nettle may interact with drugs taken to treat diabetes and high blood pressure. It may also interfere with lithium and may reduce the effects of warfarin (Coumadin). It may not be safe for pregnant women.

Homeopathy

Some of the most common remedies used for prostatitis are listed below. The usual dose is three to five pellets of a 12X to 30C remedy every 1 - 4 hours until your symptoms improve.

• Chimaphila umbellata -- for retention of urine with an enlarged prostate
• Pulsatilla -- for pain after urination, especially involuntary urination
• Pareira -- for painful urination, especially with painful urging
• Lycopodium -- for painful urination with reddish sediment in the urine, especially with impotence
• Thuja -- specifically if there is a forked stream of urine

Physical Medicine

Kegel exercises increase improve pelvic muscle tone. They may help some men reduce urinary symptoms. These exercises involve tightening and relaxing the pelvic floor muscles. To identify the muscles, it may help to think of the muscles you use to stop and start a stream of urine, or to keep from passing gas. Tighten muscles for a count of 10, then relax for a count of 10. Repeat 10 times, and do 5 - 10 sets daily.

Contrast sitz baths: You will need two basins that you can sit in comfortably. Fill one basin with hot water, one with cold water. Sit in hot water for 3 minutes, then in cold water for 1 minute. Repeat this three times to complete one set. Do one to two sets a day, 3 - 4 days a week. Avoid sitz baths if you have acute bacterial prostatitis.

Acupuncture

Acupuncture may improve urinary flow and decrease swelling and inflammation in some men with chronic nonbacterial prostatitis.

Be sure you follow your health care provider's instructions for treatment, and keep using the treatment as directed even if you start to feel better.

Men should have a yearly prostate examination after age 40, even if they have no symptoms of prostate problems. In recurring cases, you may need ongoing treatment with periodic checkups.

Bergman J, Zeitlan SI. Prostatitis and chronic prostatitis/chronic pelvic pain syndrome. Expert Rev Neurother. 2007;7(3):301-7.

Budia A, Palmero J, Broseta E, Tejadillos S, Benedicto A, Queipo JA, et al. Value of semen culture in the diagnosis of chronic bacterial prostatitis: A simplified method. Scand J Urol Nephrol. 2006;40(4):326-31.

Capodice JL, Bemis DL, Buttyan R, Kaplan SA, Katz AE. Complementary and alternative medicine for chronic prostatitis/chronic pelvic pain syndrome. Evid Based Complement Alternat Med. 2005 Dec;2(4):495-501.

Elist J. Effects of pollen extract preparation Prostat/Poltit on lower urinary tract symptoms in patients with chronic nonbacterial prostatitis/chronic pelvic pain syndrome: A randomized, double-blind, placebo-controlled study. Urology. 2006;67:60-3.

Giubilei G, Mondaini N, Minervini A, Saieva C, Lapini A, Serni S, et al. Physical activity of men with chronic prostatitis/chronic pelvic pain syndrome not satisfied with conventional treatments -- could it represent a valid option? The physical activity and male pelvic pain trial: A double-blind, randomized study. J Urol. 2007;177(1):159-65.

Hochreiter WW, Weidner W. Prostatitis -- a frequently unrecognized disease. Ther Umsch. 2006;63(2):117-21.

Kaplan SA, Volpe MA, Te AE. A prospective, 1-year trial using saw palmetto versus finasteride in the treatment of category III prostatitis/chronic pelvic pain syndrome. J Urol. 2004;171:284-88.

Larsen EH, Frimodt-Moller C. Prostatitis -- pelvic pain syndrome. Ugeskr Laeger. 2007;169(20):1921-3.

Murphy AB, Macejko A, Taylor A, Nadler RB. Chronic prostatitis: management strategies. Drugs. 2009;69(1):71-84.

Nickel JC. Treatment of chronic prostatitis/chronic pelvic pain syndrome. Int J Antimicrob Agents. 2008 Feb;31 Suppl 1:S112-6.

Wagenlehner FM, Schneider H, Ludwig M, Schnitker J, Brähler E, Weidner W. A pollen extract (Cernilton) in patients with inflammatory chronic prostatitis-chronic pelvic pain syndrome: a multicentre, randomised, prospective, double-blind, placebo-controlled phase 3 study. Eur Urol. 2009 Sep;56(3):544-51.