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Prostatitis

Prostatitis is a general term for inflammation of the prostate gland — an organ about the size and shape of a walnut, located just below the bladder in males. The prostate gland's main function is to produce semen, the fluid that helps nourish and transport sperm. An inflamed prostate can cause a variety of symptoms, including a frequent and urgent need to urinate and pain or burning when urinating (dysuria) — often accompanied by pelvic, groin or low back pain.

Prostatitis can appear in several forms. The acute form is the least common, but is also the most severe. Symptoms are often sudden, and the condition may require hospitalization. Symptoms of chronic prostatitis tend to develop more slowly and aren't as severe as those of acute prostatitis.

It's not always possible to completely eliminate prostatitis, but in many cases your symptoms can be controlled. In addition to medication, treatments such as heat therapy, biofeedback and sometimes just drinking a lot of water or avoiding certain foods can provide relief.

• Back pain

Treatment

Once your doctor determines the kind of prostatitis you have, the two of you can work together on a plan for treating this condition. Your treatment plan may include medications as well as physical therapy and in rare cases, surgery. If you have acute prostatitis, you may need to be hospitalized for a few days to receive intravenous antibiotics.

Medications
Depending on the type of prostatitis you have, certain medications may help rid or control your symptoms. These medications include:

• Antibiotics. In general, antibiotics are the first line of treatment for all forms of bacterial prostatitis. Your doctor will likely start you with a drug that fights a broad spectrum of bacteria but may switch to a different medication once he or she has determined the type of bacteria causing your infection. How long you take antibiotics depends on how well you respond to the drug. If you have acute prostatitis, you may need medication for only a few weeks. Chronic bacterial prostatitis, on the other hand, is more resistant to antibiotics and takes longer to treat. You may need to continue taking medication for as long as six to 12 weeks. In some cases the infection may never be eliminated, and in others you may have a relapse as soon as the drug is withdrawn. If this happens, you may need to take a low-dose antibiotic indefinitely to combat the infection or try other measures. Although the cause of nonbacterial prostatitis is not an infection, some doctors may prescribe an antibiotic for a few weeks to see if symptoms improve. For unknown reasons, some men with nonbacterial prostatitis seem to benefit from a continuous low dose of an antibiotic.

• Alpha blockers. If you're having difficulty urinating, your doctor may prescribe an alpha blocker — an oral medication that helps relax the bladder neck and the muscle fibers where your prostate joins your bladder. This may help you urinate more easily and empty your bladder more completely.

• Pain relievers. Sometimes an over-the-counter pain reliever, such as aspirin or ibuprofen (Motrin, Advil, others), can make you more comfortable. Keep in mind, however, that taking too much of any of these medications can cause serious side effects including abdominal pain, intestinal bleeding or ulcers.

• Abdominal pain

• Back pain

Physical therapy
Special exercises and relaxation techniques can improve symptoms of prostatitis in some men, perhaps because tight or irritated muscles can contribute to the condition. Commonly used techniques include:

• Exercise. Stretching and relaxing the lower pelvic muscles — sometimes with the addition of heat to make the muscles more limber — may help relieve your symptoms. A physical therapist can show you which exercises will benefit you the most and how to perform them. You can then do the exercises yourself at home.

• Biofeedback. This technique teaches you how to control certain body responses, including relaxing your muscles. During a biofeedback session, a trained therapist applies electrodes and other sensors to various parts of your body. The electrodes are attached to a monitor that displays your heart rate, blood pressure and degree of muscle tension. You'll see changes on the monitor and learn to control these changes on your own.

• Sitz baths. From the German word sitzen, which means "to sit," this type of bath simply involves soaking the lower half of your body in a tub of warm water. Warm baths can relieve pain and relax the lower abdominal muscles. Few treatments are easier or as relaxing.

• Prostate massage. Some men have found that massaging the prostate helps relieve congestion by unplugging the tiny ducts blocked by inflammation. The massage is performed using a gloved finger, similar to what is done during a digital rectal exam. This procedure is performed less often today than it once was, however.

Surgical procedures
Most doctors prefer not to treat prostatitis surgically. But your doctor may recommend surgery to open blocked ducts if you have a bacterial form of the disease and antibiotics don't improve your symptoms or your fertility is severely affected. Surgery is not a treatment for nonbacterial prostatitis.

Other treatments
Finasteride (Propecia, Proscar), a drug that lowers hormone levels in the prostate, and microwave thermotherapy have been successful in treating some men, but scientific evidence to endorse these treatments is lacking.

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