Prostatitis FAQ

Prostatitis is a disease that causes swelling and inflammation of the prostate gland, resulting in difficult urination and pain. The prostate gland is just below the bladder and has functions for nourishing sperm, regulating pH, and transporting sperm.

Prostatitis can be divided into acute prostatitis and chronic prostatitis that lasts more than three months. Most acute cases are caused by bacterial infection. There is a possibility that chronic prostatitis may be caused by bacterial infection, but only a small percentage (about 10%). Most cases are chronic prostatitis not related to bacterial infection, and the cause has not been identified.

Symptoms of prostatitis include difficulty urinating, pain when urinating, pain in genital, frequent urination, and pain in the lower abdomen. Even teenagers or twenties can have chronic prostatitis, but men in the ages between 35 to 50 are particularly susceptible. It is a frequent disease, affecting 10% to 15% of men. 

Treatment consists mainly of antibiotics and symptomatic therapy. Symptoms often improve after the treatment, but some patients become refractory and have prolonged symptoms. 

Symptoms of prostatitis include:

• Frequent urination, urinary urgency (need to urinate immediately)
• Frequent urination at night
• Strong pain when urinating
• Difficulty in urinating, especially at the onset of urination
• Back pain
• Constipation
• Lower abdominal pain
• Pain or numbness at the base of the leg or thigh
• Blood in urine
• Sensation of residual urine
• Pain during erection
• Discomfort 
• Pain in the area between the testicles and anus

In addition to the above symptoms, prostatitis caused by bacterial infection can cause flu-like symptoms such as feeling chilly and fever.

Bacterial prostatitis is caused by retrograde infection from the urinary tract (bacteria enter through the urethra and travel in the opposite direction of urine). Treatment with antibiotics is effective but can cause recurrence and chronicity if not properly treated.

The cause of noninfectious prostatitis, which is not related to bacterial infection, is not yet known in detail. There are various hypotheses, some of which consider it an autoimmune reaction to the prostate gland, others that the prostate gland is inflamed by the contents of urine, and still others that the surrounding nerves and muscles are dysfunctional.

Risk factors for prostatitis (you are more likely to have prostatitis if these items apply to you) include,

• Young or middle-aged people
• Prostatitis in the past
• Urethritis or cystitis in the past
• Pelvic injuries due to biking, horseback riding, etc.
• Previous urethral catheterization
• Previous prostate biopsy

You will be asked about your history and symptoms during a medical consultation. In addition, the following tests will be performed to differentiate prostatitis from other diseases and to diagnose the type of prostatitis. 

Urinalysis
If prostatitis due to bacterial infection is suspected, a urinalysis will be performed to confirm the presence of pyuria or bacteriuria.

Blood test
Inflammation markers will be checked to determine whether the disease is acute or chronic. A tumor marker called PSA is also measured. PSA is also elevated in prostatitis, but it decreases with treatment, so it can be distinguished from prostate cancer.

Rectal Examination
If necessary, a rectal examination is performed. Rectal examination is a manual examination in which the doctor puts on gloves, inserts his fingers into the rectum, and compresses the prostate from the rectal side to see if it is swollen and if the compression causes pain or discomfort.

Imaging Examination
MRI, ultrasound, and CT scans may be performed as imaging tests.
An MRI scan provides an overall view of the pelvic area. It can also detect signal changes due to prostate cancer or inflammation in the prostate.

By performing the above tests, we can divide the patient into the following four types.

1. Acute bacterial prostatitis
It develops suddenly with cold-like symptoms. It is characterized by fever, chills, nausea, and vomiting.

2. Chronic bacterial prostatitis
When the bacteria that caused prostatitis are not adequately treated with antibiotics, the infection may recur or become intractable. If the disease becomes chronic, there may be periods of strong symptoms, while others may be asymptomatic or cause only mild symptoms.

3. Chronic prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)
This type of prostatitis is the most common of all prostatitis, with a chronic course that does not involve bacterial infection. Often the cause cannot be identified. Symptoms often persist with equal intensity over a long period of time and, in some cases, improve and worsen repeatedly.

4. Asymptomatic inflammatory prostatitis
This type does not have any symptoms and is found by the presence of white blood cells in a urine test by chance. It does not require any specific treatment.

The first treatment prescribed for prostatitis is 500 mg of fluoroquinolone antibiotic (product name: Cravit), taken once daily for 2-4 weeks or 6 weeks at longest. This treatment is effective enough for acute bacterial prostatitis, and even for chronic prostatitis, about half of patients with chronic prostatitis report improvement in their symptoms.

However, chronic prostatitis may not improve with antibiotics, and a combination of several medications may be considered depending on the symptoms. Harnal may be prescribed as an alpha blocker to improve urinary tract symptoms such as frequent urination. In addition to NSAIDs such as Loxonin, a pain reliever called Tramal may be prescribed, as well as an anti-anxiety medication such as Depas. Myonal, a muscle relaxant, may also be prescribed to reduce muscle overstrain. Cymbalta, an antidepressant, is also sometimes prescribed.

A plant-derived medicine called Cernilton may also be prescrived to reduce inflammation of the prostate gland. It is made from an extract of a Western-developed plant pollen mixture (thymus, corn, rye, hazel, pussy willow, boxelder, frangipani, and pine) and is taken two tablets two to three times a day. 

In addition to the above oral treatment, lifestyle modification, stretching of pelvic floor muscles, physiotherapy therapy, psychotherapy, and prostate massage. Surgery is also available but is less common. 

Recently, in cases you have an inflammation of the prostate, a new treatment method called catheterization is available to reduce the number of problem blood vessels created by the inflammation. 

When prostatitis becomes chronic, the sensitivity spills over to adjacent organs in the pelvic region. The possible areas of spillover include the testicles, anus, bladder, sacral region, lumbar region, and sciatic nerve. This may result in constipation, back pain, and numbness.

This is common for people with pelvic pain, including bladder and anal pain, as well as for prostatitis, but when people often experience prolonged discomfort or pain in one area, it can cause pain and sensitivity to spill over into the surrounding areas. Fundamentally, curing prostatitis often improves the surrounding symptoms that were spilling over.

Generally, other diseases are ruled out when diagnosing prostatitis, so it is unlikely to be another disease, but diseases that present with similar symptoms include the following.

Some conditions that have similar symptoms to prostatitis include prostate cancer, bladder stones, and musculoskeletal disorders.

In prostate cancer, urethral symptoms and sexual pain are common. Blood tests and MRI are useful for differentiation.

Bladder stones also cause similar symptoms and lower abdominal pain during urination. Diagnosis is made by ultrasound or CT to confirm the presence or absence of stones.

Also, musculoskeletal conditions such as low back pain, hip pain, and pubic symphysis can cause similar symptoms.

These should not be self-diagnosed, and if you are concerned you should seek a professional medical institution. 

In prostatitis, the pelvic floor muscles are thought to be in a state of hypertonia. Hypertonia can also be described as a state in which muscle output (exertion of force) is not working properly. Squatting is an effective way to improve this condition of the pelvic floor muscles. It is a moderate full-body exercise and relaxes the overstretched pelvic floor muscle groups.

■ Squats

Pease follow the below procedures.

1. Stand with your feet shoulder-width apart. Your toes and knees should be facing in the same direction. 
2. Slowly bend knees. Imagine there is a chair behind you and bend your knees as if you were sitting on the chair. Once your hips are as low as your knees, slowly extend your hip and knee joints.

- Stand with your feet shoulder-width apart.
- Your toes and knees should be facing in the same direction. 

- Slowly bend knees. 
- Imagine there is a chair behind you and bend your knees as if you were sitting on the chair. 

Bad examples of squats

- The knee plate should not point outward more than the toes.

The following stretches are also recommended. 
To loosen the overstretched pelvic floor muscles, it is a good idea to stretch the abdominal muscles and hip adductor muscles which are connected to the pelvis floor muscles. 

■Stretching the abdominal muscles

1. Lie on your stomach.
2. Keeping your pelvis on the floor, bend your upper body back. Your abdominal muscles will be stretched. Keep the posture for 15 seconds. Do this 3-5 times a day.

- Lie on your stomach

- Keeping your pelvis on the floor, bend your upper body back.

- Use your hand to support your body for a better stretching.
- Avoid doing this if you feel any pain

■Stretching the hip adductor muscles (inner thigh muscles)

1. Sit on the floor. Place both soles together and open your hip joints. 
2. From this position, lean your body forward. Be careful not to round your back. 
3. Keep the posture for 15 seconds. 

This will stretch the inner thigh muscles. Do these 3 to 5 times a day.

- Place both soles together and open your hip joints.

- Lean your body forward

- Be careful not to round your back. 

There is a relationship between symptoms of prostatitis and stress.

The symptoms of prostatitis are pain and discomfort, but not only prostatitis, but pain and discomfort in general are amplified in situations of increased stress.

The reason for this is that our body usually sends various signals of pain and discomfort to the brain, but if we had to feel every single one of these signals, it would interfere with the things we need to concentrate on, equivalent to work in the modern world, to survive. Our brain is equipped with a function to ignore weak pain signals, like noise cancellation, but this function is weakened by stress. When stress increases, the secretion of serotonin and noradrenaline in the brainstem decreases. These substances are not able to play their role of ignoring pain signals as noise, and the pain signals are amplified and felt more intense.

For example, when workload increases and stress increases, the symptoms of prostatitis may become more intense.

Also, in prostatitis caused by bacterial infection, stress is relevant here as well since the weakening of the immune system due to continued stress can lead to allowing bacteria to invade the body.

The following should be avoided as they may cause or aggravate prostatitis

■Physical pressure
Since the prostate gland is located deep between the penis and anus, working at a desk or driving for long periods of time (especially bicycling) can cause prolonged pressure on the prostate gland as well. You can lighten the load on the prostate by taking breaks or taking time to stand up once an hour when working at a desk or driving for long periods of time.
If you cannot take a break, you should find and use a cushion that suits you, such as a cushion with an open center, as this may reduce the pressure on the prostate.

■ Special Sexual Practices
Some sexual acts and sexual services place physical or functional strain on the prostate gland. Repeated stimulation of the prostate through the anus or stopping just before ejaculation can put physical or functional stress on the prostate. This can cause or aggravate prostatitis, so you must be very careful. Also, many people develop bacterial prostatitis triggered by a sexually transmitted infection, which then becomes chronic. Please be as careful as possible.

■Excessive alcohol consumption, eating or drinking excessive salt or stimulants
Excessive alcohol consumption, salt, and stimulants such as pepper, horseradish, and hot pepper can cause swelling of the prostate gland, decrease contraction of the bladder, and stimulate inflammation. Try not to take these. 

There are several Chinese herbal medicines that have been reported to be effective in the treatment of prostatitis, including Gentian Liver-Purging Decoction(竜胆潟肝湯), Lotus Seed Combination(清心蓮子飲), Bupleurum & Hoelen Combination (柴苓湯) and Cinnamon Twig and Poria Pill(桂枝茯苓丸). For more information, please visit a specialized medical institution.

The basic treatment for prostatitis is antibiotics, but most over-the-counter medications are made from herbal preparations or herbal medicine ingredients. No antibiotic or antibacterial preparations are available. Therefore, to improve prostatitis with over-the-counter drugs, the symptoms are suppressed with herbal or herbal medicine ingredients.

Specifically, over-the-counter Chinese herbal preparations available include Gosha-jinki-gan (牛車腎気丸), Gentian Liver-Purging Decoction(竜胆潟肝湯), Rehmannia Eight Formula(八味地黄丸), Ulinar b based on Lotus Seed Combination(清心蓮子飲), and Urination pain medicine called Bokoren in Japanese. 

The first step is diet. Dietary therapy includes avoiding food with a lot of spices, citrus fruits to reduce the irritation of urine passing through the urethra. 

Psychotherapy has also been reported to be effective, as stress and psychological factors can also amplify pain and discomfort. Psychotherapy includes reducing daily stress such as through counseling as well as cognitive behavioral therapy.

In addition, improvement of pelvic floor muscle function may also be effective. Surgery is also used in some situations but is not very common. Transcatheter embolization has recently been developed to improve prostatitis. 

Acute prostatitis caused by a bacterial infection generally requires 2-4 weeks of oral antibiotic medication, 6 weeks in the long case.
Also even with chronic prostatitis, it is reported that approximately half people have experienced of improvement or disappearance of symptoms after 6 weeks of Cravit therapy. On the other hand, there are many cases in which the above treatment does not improve. In these cases, it is very difficult to predict or estimate the duration of the treatment. This is because the treatment is symptomatic, and it takes time to reach a level of improvement that does not interfere with daily life. 

Acute prostatitis has an obvious bacterial infection and develops rapidly. It is characterized by symptoms similar to those seen with influenza, such as fever, feeling chilly and vomiting in addition to prostate symptoms. 
If there is an intense bacterial infection of the prostate that does not respond to oral medications, intravenous antibiotics may be used. 

Chronic prostatitis lasts for more than three months and its mostly unrelated to bacterial infection and is called Chronic Prostatitis/ Chronic Pelvic Pain Syndrome (CP/CPPS).

If there are no bacteria present, sexual activity is not a problem. In the case of prostatitis caused by chlamydia infection, it is necessary to make sure that the chlamydia has disappeared with treatment. Also, in both cases, masturbation is not a problem.

Pubic pain tends to be prolonged in case of prostatitis. You can relieve the pain in several ways, including below. 

First, you can review your lifestyle. Since sitting at a desk for long periods of time puts a strain on the prostate gland. Try to avoid sitting for long periods of time by getting up from your seat every 30 minutes to an hour. Also, avoid using a bicycle, especially one with a seat that digs into your hips, such as a road bike. It is recommended to avoid using bicycles as much as possible. Drinking alcohol and smoking are known to increase inflammation of the prostate gland and they should be avoided.

If the MRI shows evidence of inflammation in the prostate, catheterization as described in our website is recommended.

In treating prostatitis, there is a possibility of recurrence. First of all, if you did not take antibiotics for a long enough period of time during the initial treatment, you should resume taking them. If there is still no improvement, we will address the problem with the other treatments listed above and lifestyle modifications.