The National Institutes of Health (NIH) has recognized and defined recognized prostatitis as one of four syndromes as follows:
I – Acute bacterial prostatitis – typically the patient experiences a fever here and urine analysis is positive for bacteria. About 80% of the times the bacteria responsible is Escherichia coli (E.coli) approximately 5% of patients presenting with acute bacterial prostatitis develop chronic bacterial prostatitis which accounts for approximately 5–10% of all cases
II – Chronic bacterial prostatitis – here despite there being an infection shown from a urine analysis the person may or may not have symptoms
III – Chronic prostatitis and chronic pelvic pain syndrome (CPPS; further classified as inflammatory or noninflammatory) This is 90 TO 95% of cases where there’s a negative urine analysis but the patient has associated symptoms
IV – Asymptomatic inflammatory prostatitis – this is from an incidental finding, maybe a prostate biopsy, that shows inflammation but the person has no symptoms
How do I Know if I have Prostatitis?
The guy with prostatitis often has two things going on:
- Pain, discomfort, achiness in the perineum area (between the scrotum and anus), around the testicles, lower abdominal area and/or on the penis. Pain is often worse after urinating or ejaculating.
- Urinary problems, typically urgency and frequency.
Again, both symptoms, pain around the pelvic area and urinary problems have to be present for it to be prostatitis. If there’s only one out of the two, it is something else.
The type of prostatitis you may have is category III. And this is the type Henry from the BBC news article has. Henry got relief from reading a book, Teach Us To Sit Still describes how the author, Tim Parks his own form of CPPS through Vipassana meditation.
Despite feeling better, Henry underwent a prostate biopsy from an elevated PSA. He does not discuss what that PSA value was or the results of the prostate biopsy in the article. However, while I do not know essential details of Henry’s case, i.e., family history of prostate cancer, if nodule found on the physical exam, patients with prostatitis should NOT undergo a prostate biopsy even if PSA is “elevated” chronic inflammation can cause false PSA increase.
Like many of the patients I see, Parks concluded that the pain was “produced by tension: anxiety is often stored in muscles, and pelvic musculature is particularly vulnerable as it is intertwined with nerves. The solution lay in calming a restless mind, “ writes Henry.
At the end of the BBC article, Henry calls his condition, “a blessing” as he is more capable of managing physical life challenges as he approaches his 60”s.
“A blessing!?” – I have never heard that before from any person living with prostatitis. Heard it many times from prostate cancer patients but never, ever from a CP/CPPS patient.
Other Facts About Prostatitis
- Prostatitis is one of the most common diseases seen in urology practices in the United States, accounting for nearly 2 million outpatient visits per year.
- Most sufferers are much younger than Henry from the BBC article, typically mid-twenties or thirties. The youngest I’ve seen clinically is fifteen-years-old.
- Across the globe, areas with widespread sexually transmitted disease (STD) rates and prostitution have a higher incidence of acute bacterial prostatitis. STD is often not the cause, at least in my clinical experience.
- The first line of therapy is antibiotics, even when urinary cultures show no bacteria. E.coli is the most common type of bacteria when urine culture is positive.
Dr. Geo’s Take and Method to Treating Prostatitis
The first thing to know is that prostatitis does NOT improve by treating the prostate, the person with the prostate must be treated.
Secondly, category III prostatitis, CP/CPPS, is not likely to be an organ-specific problem, but a prostate/bladder/pelvic problem. The symptoms are very similar to Interstitial Cystitis and Overactive Bladder.
The cause may begin with an infection or autoimmune reaction causing inflammation or neurological damage in and around the prostate (pelvic floor, bladder, perineum, etc.). If not adequately treated in the early stage, peripheral and then central sensitization could occur.
Once the central nervous system is “pissed off” (pun unintended), the nerves continue to persistently fire away at the pelvic region causing pain and discomfort around the pelvic area.
As a result depression, anxiety, and frustration sets in worsening the symptoms.
The other important point here is that antibiotic therapy is the WORSE approach for prostatitis, particularly the non-bacterial type.
That’s right! This treatment method, while life-saving for some infections, is horrific for prostatitis even though some people feel better initially after treatment to then get symptoms again shortly after the end of the antibiotic course.
And that is FRUSTRATING!
The primary form of antibiotics used for prostatitis are fluoroquinolones, i.e., Ciprofloxacin (Cipro, Cipro XR, Proquin XR), Levofloxacin (Levaquin) typically for 4 to 6 weeks. Not only can fluoroquinolones cause Achilles tendon rupture or tendinitis
Also, fluoroquinolones cause mitochondrial dysfunction of the pancreas where insulin is made called the beta cells leading to low blood sugar (hypoglycemia). Yikes!
But that’s not all.
Misuse or overuse of antibiotics in patients with CP/CPPS can have a direct effect on the gut microbiome, killing off good bacterial flora important for health. The prolong and overuse of antibiotics also contribute to Irritable Bowel Syndrome (IBS) likely by killing off the healthy flora.
Here is the kicker; IBS is common among prostatitis sufferers and treating IBS is a major component for treating prostatitis.
So not only are antibiotics causing all sorts of undesired side effects but likely making the disease worse by causing IBS. (I’m shaking my head)
My treatment approach for treating Prostatitis
I’m privileged of seeing many prostatitis cases at my clinic, likely more than any functional/naturopathic doctor in the nation. While still imperfect, the treatment approach I deliver has worked for many patients.
I believe prostatitis is a neuropathic dysfunction of the urogenital system.
What does all that jargon mean?
Prostatitis is caused by the excess firing of the nerves through the urological system that includes your bladder, prostate, scrotum, and penis. That’s why the burning and achy sensation is felt in those areas after peeing, ejaculating or from doing nothing.
The term “prostatitis” is often a diagnosis of exclusion and just a diagnosis to connect an ICD-10 code number to it for billing purposes. But the real problem is hyperactivity and hypersensitivity of the nerves innervating the urological and digestive system. That is why treating gut related issues help with prostatitis as well – the two are connected via the nervous system.
OK, so how do we do treat the cause.
- Listen to the patient with empathy. Prostatitis patients have been through the mill with their social life and by seeing many urologists, some of whom are likely as frustrated as the patient from seeing these cases with very little results. Listening to prostatitis patients does not only offer some therapeutic solutions but also shows you care – and listening with care is therapeutic in and by itself.
- Calm the nervous system. There are many ways of achieving this. One is to learn how to meditate like our guy Henry from the BBC article. There are numerous books that teach Mindful Based Stress Reduction (MBSR) and have a calming effect on the parasympathetic system is stimulated from the practice. These books I recommend.
I teach patients how to breathe diaphragmatically and that is calming as well.
- Acupuncture – a systemic review study in looking at over 470 subjects show efficacy in acupuncture treatment for prostatitis. I attest to it works as I have seen it do wonders for some patients clinically.
- Botanicals – I use many herbs, too many to mention here as every case I see requires a different protocol – it is not a “one size fits all” approach. A formula packet I use is APS. This formula packet is loaded with ingredients including :
Immune stimulant – Mushrooms, Beta 1,3 glucan, arabinogalactan, Diindolylmethane (DIM), Astragalus, Elderberry, Andrographis, allspice, garlic, basil, sage, Acerola, echinacea,
Anti-inflammatory –Curcumin, quercetin,
Anti-microbial– Astragalus, garlic, goldenseal, clove, Allspice
The reason these botanicals help is that it stimulates the immune system against hidden bacteria often not found in the urinary testing currently available to physicians, there are anti-microbial that are strong but work gently in the body, and herbs to reduce inflammation.
Rye Pollen extract, not included in APS has shown to help men with prostatitis in studies.
5. Heal the gut. This is done by eliminating foods like gluten and dairy. There might be others a functional medicine or naturopathic doctor can detect but gluten and dairy is a good start. Also, the typical “prostatitis inducing foods” like coffee and spicy food may or may not cause symptoms – everyone case is different.
6. See a physical therapist specializing in pelvic dysfunction. They can help by relaxing tight muscles in the pelvis that contribute to pain and discomfort.
Lastly, If you have prostatitis I assure you that you are not crazy. The symptoms are real. However, after suffering for a long time with an achy pelvis and the urge and frequency to pee, the mind becomes hypersensitive to the pelvic area even when under normal circumstances, the feeling is a mild itch or twitch down there.
In other words, every guy feels strange things around their scrotum, penis or perineal area at any given time, that’s common, but the person who has never had prostatitis ignores it. The guy with a history of prostatitis often catastrophizes (not sure if this is a real word) with such familiar sensations and symptoms worsen form the anxiety provoked.
If you do not know where to start, begin like Henry and meditate.
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The CaPLESS Retreat is coming in September to help prostate cancer (CaP) thrivers live their best life by implementing science-based lifestyle practices. I to connect with you there. There is limited space.