A guide to the causes of chronic prostatitis with solutions
I am post-doctoral scientist working in autoimmunity in the UK and have recovered from likely autoimmune prostatitis, now it is in remission, but I still need to avoid certain things. I wanted to make a thread that has a lot of information in one place from this forum and from papers written in a fairly scientific way for people to get help from. Many people are confused about what to do if the antibiotics do not work and the urologist cannot help.
This is not supposed to be a substitute for professional medical advice. If you decide to try supplements it is best to inform your doctor, and any information here is for educational purposes only.
1. Bacteria
Prostatitis may be caused by infection usually by intercourse with variety of bacteria. The best course of action is usually to find an urologist who does one of the following; the expressed prostatitic excretion test (EPS) (Ref1), semen analysis, or the four glass test. Since prostate infection occurs inside the prostate, urine analysis has limited use so it is best to test material from the source of the potential infection. These tests can identify candidate strains the infection is caused by, and then the appropriate antibiotics can be used. I will avoid a discussion of which antibiotics are best, that is really up to the urologist. Note, it may be a good idea to try a course of antibiotics regardless of whether you get a test or not.
If an infection is proving very hard to get rid of, there is a doctor in New York, Dr. Attila Toth, who does intra prostate injections. There is also another urologist Dr. Duke Bahn, based in Ventura, California, who will do these. There is some scientific support for this method working, although it isn't widely accepted (Ref4). Some users have reported benefit from these injections in combination with follow up antibiotics (
viewtopic.php?f=2&t=1267), but reports are mixed.
Prostate massage is often used in combination with antibiotics or alone, and there is some support of this again in the literature (Ref5). It seems worth a try. There is a user on this forum, ihateprostatitis, who has been cured through this method (
viewtopic.php?t=197). Some urologists will offer this as part of a treatment package.
2. Muscle/fascia tension/pelvic alignment issues
It is apparent that many cases of nonbacterial prostatitis may be related to muscle or fascia tensions around the prostate region (Ref2). In these cases a specialised physiotherapist may be able to suggest exercises and provide myofascial release techniques to treat and sometimes cure these issues. There have been a variety of posters on the forum who have found relief through this kind of approach e.g. UKSufferer (
viewtopic.php?f=2&t=494&start=25). There is the book, headache in the pelvis, which is probably worth a read. Additionally, mindfulness based approaches and or CBT may help reduce related stress that either causes the problem, or makes it worse. Finally, pelvic alignment may be responsible for some types of prostatitis, e.g. David88 (
viewtopic.php?f=2&t=385). A chiropractor may be worth a visit. Magnesium is known to help relax muscles and is a common and safe supplement.
3. Related digestive problems, supplements, and lifestyle changes
It seems many of us suffer digestive issues that in many cases are related to the prostatitis in more complex cases. Leaky gut, small intestine overgrowth (SIBO), and general gut dysbiosis (e.g. IBS) are all serious problems and are related to autoimmune problems, normal medical doctors sometimes ignore these problems or give poor quality advice. There is a poster on this forum bill_johnstl who has found prostatitis relief through treating his diagnosed SIBO through treatment with Rifaximin, an antibiotic (
viewtopic.php?f=2&t=1011). There is a paper that supports this treatment approach (Ref3). You could consult with a sensible naturopath or Western herbalist for testing and treatment. Note: Bad gut health is related to a lot of other problems like Rheumatoid arthritis so it is really worth sorting out sooner rather than later.
Definitely, diet plays a big role in treating prostatitis and related gut problems. Aim towards a plant-based diet without processed foods, refined sugar, white bread, etc. Chilli peppers, tomatoes, alcohol, and caffeine are big prostatitis triggers in many of us. There are also reports that gluten sensitivity may underlie some cases of prostatitis, so an elimination diet is an option. Reducing or eliminating diary, grains, sugars, and processed foods in the diet may help resolve gut issues. I partially agree with the Paleo diet, but it is pretty extreme and consumption of red meat is linked to inflammation and cancer (Ref14). I found red meat made my inflammation worse. There is also the keto diet which is along similar lines. With every diet, the individual will have to work on modifying it for their own body until they find everything is working better. Sugar is related to increased inflammation so please try and reduce that along with overeating which is bad for gut issues and associated problems.
Many autoimmune diseases you don't want to get (e.g. MS) may be related to vitamin D deficiency/ lack of sunlight (Ref6). Vitamin D is deficient in most people so it is worth supplementing with unless you are out in the open sun a lot. A multivitamin with vitamin D may be beneficial.
Anybody with inflammatory conditions, unless eating a lot of oily fish (salmon and tuna for example) should consider supplementing with Omega3 (Ref7). Omega3 often comes packaged with omega6 which is pro-inflammatory, so don't get this. Pure omega3 is the best with a combined amount of EPA plus DHA of 1000mg, clinical trials of omega3 usually use this high dose form.
Urologists will normally encourage ejaculation (Ref17), although it is clear from this forum that some individuals will benefit from this and others it will just make the pain worse. Additionally, completely avoid any activities that put a lot of pressure on the prostate region like cycling.
4. Prostatitis specific supplements
There are a variety of prostatitis specific supplements available online. Two with scientific credibility for prostatitis are Quercetin (Ref8) and Cernilton/Graminex (rye grass pollen extract) (Ref9), both of which have been demonstrated to help patients in double-blind placebo controlled studies. Dr. Daniel Shoskes headed the Quercetin trial and then was involved in creating a Quercetin containing product called ProstaQ which is sold by Farrlabs. These are probably worth a try as they contain natural anti-inflammatories probably better for you then NSAIDs.
5. Other supplements
There are also various supplements and herbs for reducing inflammation, immune stimulation, relaxing tense muscles, and reducing neuropathic pain around that haven't been tested for prostatitis, but may be helpful and have differing degrees of scientific support. Check Examine for fairly unbias information.
To stimulate the immune system to fight infections, herbalists sometimes use astragalus, reishi, and echinacea. For inflammation, common herbs are turmeric and boswellia. The adaptogens from Ayurveda and TCM are herbs that relax the nervous system and may also reduce inflammation, common options include; ashwagandha, reishi, gotu kola, holy basil, panax ginseng, astragalus, and cordyceps.
6. Pain clinics
Drugs like Lyrica (Ref10) and amitriptyline can be effective in treating chronic pelvic pain and additionally may help related sleep problems. NSAIDs like naproxen reduce the inflammation, although will likely cause problems in the long term. Ibuprofen is a bit safer.
7. Other options
Working with a traditional Chinese (or Indian or Western) herbalist could help (Ref20) (
viewtopic.php?f=2&t=1322). Another option is homeopathy (Ref18) (
viewtopic.php?f=2&t=1878).
I believe the answers are out there... try to remain optimistic.
Remember many cases of chronic prostatitis will resolve or get better on their own, but it may take some time. I waited one year and I was improved a great deal.
Good luck.
Chris
Ref1. Schaeffer, A. J., Knauss, J. S., Landis, J. R., Propert, K. J., Alexander, R. B., Litwin, M. S., ... & Shoskes, D. A. (2002). Leukocyte and bacterial counts do not correlate with severity of symptoms in men with chronic prostatitis: the National Institutes of Health Chronic Prostatitis Cohort Study. The Journal of urology, 168(3), 1048-1053.
Ref2. Anderson, R. U., Wise, D., Sawyer, T., Glowe, P., & Orenberg, E. K. (2011). 6-day intensive treatment protocol for refractory chronic prostatitis/chronic pelvic pain syndrome using myofascial release and paradoxical relaxation training. The Journal of urology, 185(4), 1294-1299.
Ref3. Weinstock, L. B., Geng, B., & Brandes, S. B. (2011). Chronic prostatitis and small intestinal bacterial overgrowth: effect of rifaximin. Canadian Journal of Urology, 18(4), 5826.
Ref4. Yamamoto, M., Hibi, H., Satoshi, K., & Miyake, K. (1996). Chronic bacterial prostatitis treated with intraprostatic injection of antibiotics. Scandinavian journal of urology and nephrology, 30(3), 199-202.
Ref5. Shoskes, D. A., & Zeitlin, S. I. (1999). Use of prostatic massage in combination with antibiotics in the treatment of chronic prostatitis. Prostate Cancer & Prostatic Diseases, 2(3).
Ref6. Baeke, F., Takiishi, T., Korf, H., Gysemans, C., & Mathieu, C. (2010). Vitamin D: modulator of the immune system. Current opinion in pharmacology, 10(4), 482-496.
Ref7. Simopoulos, A. P. (2002). Omega-3 fatty acids in inflammation and autoimmune diseases. Journal of the American College of Nutrition, 21(6), 495-505.
Ref8. Shoskes, D. A., Zeitlin, S. I., Shahed, A., & Rajfer, J. (1999). Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial. Urology, 54(6), 960-963.
Ref9. Wagenlehner, F. M., Schneider, H., Ludwig, M., Schnitker, J., Brähler, E., & Weidner, W. (2009). A pollen extract (Cernilton) in patients with inflammatory chronic prostatitis–chronic pelvic pain syndrome: a multicentre, randomised, prospective, double-blind, placebo-controlled phase 3 study. European urology, 56(3), 544-551.
Ref10. Pontari, M. A., Krieger, J. N., Litwin, M. S., White, P. C., Anderson, R. U., McNaughton-Collins, M., ... & Zeitlin, S. (2010). Pregabalin for the treatment of men with chronic prostatitis/chronic pelvic pain syndrome: a randomized controlled trial. Archives of internal medicine, 170(17), 1586-1593.
Ref11. Irwin, M., McClintick, J., Costlow, C., Fortner, M., White, J., & Gillin, J. C. (1996). Partial night sleep deprivation reduces natural killer and cellular immune responses in humans. The FASEB journal, 10(5), 643-653.
Ref12. Branco, J., Atalaia, A., & Paiva, T. (1994). Sleep cycles and alpha-delta sleep in fibromyalgia syndrome. The Journal of rheumatology, 21(6), 1113-1117.
Ref13. Vicari, E., La Vignera, S., Castiglione, R., Condorelli, R. A., Vicari, L. O., & Calogero, A. E. (2014). Chronic bacterial prostatitis and irritable bowel syndrome: effectiveness of treatment with rifaximin followed by the probiotic VSL# 3. Asian journal of andrology, 16(5), 735.
Ref14. Azadbakht, L., & Esmaillzadeh, A. (2009). Red meat intake is associated with metabolic syndrome and the plasma C-reactive protein concentration in women. The Journal of nutrition, 139(2), 335-339.
Ref15. Esposito, K., Marfella, R., Ciotola, M., Di Palo, C., Giugliano, F., Giugliano, G., ... & Giugliano, D. (2004). Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. Jama, 292(12), 1440-1446.
Ref16. Birrell, M. A., McCluskie, K., Wong, S., Donnelly, L. E., Barnes, P. J., & Belvisi, M. G. (2005). Resveratrol, an extract of red wine, inhibits lipopolysaccharide induced airway neutrophilia and inflammatory mediators through an NF-κB-independent mechanism. The FASEB journal, 19(7), 840-841.
Ref17. YAVAŞÇAOĞLU, Į., OKTAY, B., ŞIMŞEK, Ü., & ÖZYURT, M. (1999). Role of ejaculation in the treatment of chronic non‐bacterial prostatitis. International Journal of Urology, 6(3), 130-134.
Ref18. Linde, K., Clausius, N., Ramirez, G., Melchart, D., Eitel, F., Hedges, L. V., & Jonas, W. B. (1997). Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials. The Lancet, 350(9081), 834-843.
Ref19. Rutten, A. L. B., & Stolper, C. F. (2008). The 2005 meta-analysis of homeopathy: the importance of post-publication data. Homeopathy, 97(4), 169-177.
Chicago
Ref20. Chen, R., & Nickel, J. C. (2003). Acupuncture ameliorates symptoms in men with chronic prostatitis/chronic pelvic pain syndrome. Urology, 61(6), 1156-1159.
Ref21. Joseph, S., Sabulal, B., George, V., Smina, T. P., & Janardhanan, K. K. (2009). Antioxidative and antiinflammatory activities of the chloroform extract of Ganoderma lucidum found in South India. Scientia Pharmaceutica, 77(1), 111-122.
Ref22. Kimmatkar, N., et al. "Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee–a randomized double blind placebo controlled trial." Phytomedicine 10.1 (2003): 3-7.
Ref23. Riehemann, Kristina, Bert Behnke, and Klaus Schulze-Osthoff. "Plant extracts from stinging nettle (Urtica dioica), an antirheumatic remedy, inhibit the proinflammatory transcription factor NF-κB." FEBS letters 442.1 (1999): 89-94.
Ref24. Chandran, Binu, and Ajay Goel. "A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis." Phytotherapy research 26.11 (2012): 1719-1725.
Ref25. Schwalfenberg, Gerry K. "The alkaline diet: is there evidence that an alkaline pH diet benefits health?." Journal of Environmental and Public Health 2012 (2011).