Also known as inflammation of the prostate, prostatitis is a common and often frustrating problem, particularly when the cause is not obvious. Prostatitis can cause pain in the lower back and in the area between the scrotum and rectum (perineum) and may be accompanied by chills, fever, and a general feeling of malaise when caused by bacteria.
Several forms of prostatitis exist, but most men with the condition are believed to have the chronic nonbacterial form (also known as chronic prostatitis/chronic pelvic pain syndrome, or CP/CPPS). Chronic nonbacterial prostatitis may last for several weeks or longer, only to disappear and then flare up again.
Treatment of chronic prostatitis can be challenging. Some experts now believe that there are six subtypes, which are based on the presence of certain symptoms or characteristics. They propose that treatment or treatments (combination therapy is often required to obtain sufficient relief) be individualized based on the man’s particular subtype(s). These include:
Urinary symptoms. Pain on urination as well as a bothersome increase in urinary frequency and urgency and/or nighttime urination. Possible treatments include anticholinergic medications such as tolterodine (Detrol) and oxybutynin (Ditropan), alpha-blockers such as tamsulosin (Flomax) and alfuzosin (Uroxatral), and dietary changes such as cutting down on alcohol and, if they aggravate symptoms, caffeine and spicy foods.
Psychosocial symptoms. A history of anxiety, depression, stress, and/or a history of sexual abuse. Counseling, cognitive behavioral therapy, stress reduction techniques, and an antidepressant may be effective in this setting.
Organ-specific symptoms. Pain localized to the prostate or pain that is associated with filling and emptying the bladder. Therapies to address these symptoms include pentosan polysulfate (Elmiron), dimethyl sulfoxide (DMSO), and botulinum toxin (Botox) administered directly into the bladder. Alternative therapies such as quercetin, bee pollen, bromelain/papain, and saw palmetto (Permixon), as well as neuromodulation devices, also may be helpful.
Infection. Infection caused by organisms not typically associated with bacterial prostatitis. Ideally, the urine should be cultured to identify a causative organism and the infection treated with an antibiotic that the infectious organism is known to be sensitive to. However, if an antibiotic is prescribed before specific culture results are obtained and the patient does not respond to adequate therapy, an additional course of antimicrobial therapy is not warranted.
Neurological conditions. The presence of other pain-related neurologic or systemic conditions, such as irritable bowel syndrome or lower back and leg pain. Drugs, such as pregabalin (Lyrica), nortriptyline (Aventyl, Pamelor), and amitriptyline, as well as acupuncture, are potential therapies. Referral to a pain management clinic and stress reduction techniques also may be beneficial.
Skeletal muscle tenderness. The presence of spasms or trigger points in the abdomen or pelvis on examination by the doctor. Potential treatments for skeletal muscle tenderness include pelvic floor physical therapy, stress reduction, behavior modification (for example, sitting on a cushion when seated for a long period), oral antispasmodics, and neuromodulation.