Treating chronic prostatitis

Depending on how you define the term, prostatitis affects 9% to 16% of men at some point in their lives. The term prostatitis, which means inflammation of the prostate, refers to a group of syndromes characterized by urinary problems such as burning or painful urination, urgency, and trouble voiding; difficult or painful ejaculation; and pain in the perineum or lower back. Although it causes some of the same symptoms as BPH and can occur at the same time, prostatitis is a separate condition.

Treating chronic prostatitis

If you have chronic prostatitis, treatment is highly individual and will depend on the type of symptoms that you have. Fortunately, there are many options, and with some trial and error, you may find one that works for you.

Antibiotics. The traditional view has been that unless there is evidence of bacterial infection, antibiotics are unlikely to be effective at treating chronic prostatitis. However, antibiotics sometimes work in men whose prostatitis had been preceded by a urinary tract infection. An antibiotic might be combined with an alpha blocker to get better relief from discomfort and voiding difficulties. But if a first course of antibiotics does not improve symptoms, then a second one is unlikely to work, so it's wise to explore other options.

Pain relievers. Hot baths or over-the-counter pain relievers can help when chronic prostatitis causes muscle tenderness or spasms. For some men, the best choice is a pain medication that also reduces inflammation, such as aspirin, ibuprofen, or another NSAID.

Anticholinergic drugs. These medications, which include tolterodine (Detrol) and oxybutynin (Ditropan), reduce the urge to urinate by decreasing bladder contractions. But men with enlarged prostates need to be aware that they can sometimes cause urinary retention.

Alpha blockers. These drugs relax the muscles at the neck of the bladder, easing the flow of urine. These drugs are most likely to work when the main symptom of chronic prostatitis is difficulty urinating. Choice of what alpha blocker to use may depend on side effects. Nonselective alpha blockers such as doxazosin (Cardura) and terazosin (Hytrin) must be used with care, because they can excessively lower blood pressure. Selective alpha blockers such as alfuzosin (Uroxatral) or tamsulosin (Flomax) are less likely to lower blood pressure.

Complementary therapies. Small studies suggest that some men with chronic prostatitis may find relief from complementary therapies such as myofascial trigger point release (a form of massage) and biofeedback (a technique that helps patients become more aware of their body's signals). Although the evidence is skimpy, many patients report that these therapies are beneficial, so they might be worth trying if all else fails. One challenge, however, might be finding an experienced and qualified provider in your area.

For more information on diseases of the prostate and other conditions afflicting men over the age of 50, buy A Guide to Men's Health Fifty and Forward, a Special Health Report from Harvard Medical School.

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