Prostatitis is characterized by irritative voiding symptoms and perineal or suprapubic discomfort. It may be the most common genitourinary ailment in men younger than age 50, resulting in an estimated 2 million visits to physicians each year. The bacterial form of prostatitis most often occurs in men ages 70 and older. The four subtypes are:

• Acute bacterial prostatitis—the least common form; often associated with bacteriuria; usually caused by enteric gram-negative bacilli
• Chronic bacterial prostatitis—a relatively uncommon disorder sometimes associated with an underlying defect in the prostate
• Nonbacterial prostatitis—the most common form; causes unknown
• Prostatodynia—symptoms similar to nonbacterial prostatitis; no objective findings, such as the presence of infection-fighting cells

Infection by a bacterial pathogen is the most common factor in the etiology of prostatitis; the etiology of nonbacterial prostatitis and prostatodynia is unknown.

• Recent urinary tract infection
• Prior sexually transmitted disease, such as gonorrhea or chlamydia.
• Smoking
• Excess alcohol consumption

Signs and symptoms may vary depending on subtype; some patients are asymptomatic. Common symptoms include:

• Recurrent urinary tract infections
• Urinary frequency and urgency
• Dysuria
• Nocturia
• Fever
• Chills
• Generalized malaise
• Bladder outlet obstruction
• Painful ejaculation, bloody semen, or sexual dysfunction
• Pain localized to lower back (sacral), pelvis, or perineum

• Chronic urethritis
• Cystitis
• Anal disease

Although often not definitive, a physical examination may find the prostate tender, swollen, and indurate; may be warm to palpitating finger in rectum; hardness and nodules may indicate a malignancy.

Urine and blood cultures to detect infection or cancerous cells. In the case of nonbacterial prostatitis, cultures are negative but increased numbers of leukocytes are seen on prostatic secretions.

Enteric gram-negative organisms are the most commonly found bacterial pathogens in prostatitis; gram-negative organisms (e.g., Enterococcus) are sometimes associated with acute and chronic forms.

In most cases, imaging tests are not required. However, pelvic radiographs and transrectal ultrasound may help detect prostatic calculi.

• Clinician interview and physical examination: Take medical history and conduct prostate exam.
• Conduct a cytoscopic examination of the urethra, prostate, and bladder in cases of nonbacterial prostatitis to rule out interstitial cystitis.

Antibiotics are the treatment of choice, either intravenously or orally. Symptomatic relief is achieved with pain relievers, stool softeners, anti-inflammatory agents, and hot sitz baths. Periodic prostatic massage may also relieve symptoms, but an acutely inflamed prostate gland should not be massaged until antibacterial agent has established adequate blood levels. Surgery (transurethral resection or drainage) is indicated if calculi are detected or fever and pain persist; side effects of resection include retrograde ejaculation and some cases of impotence or incontinence.

Several antibiotics are recommended for treating prostatitis, depending on the subtype. They include:

• Ampicillin and aminoglycoside (parenteral) is recommended initially until organisms' sensitivities are determined in acute bacterial prostatitis; oral antibiotics such as trimethoprim-sulfamethoxazole or quinolones are then used to complete a four-to-six-week regimen.
• Trimethoprim-sulfamethoxazole is associated with successful cure rates in chronic prostatitis; also effective are carbenicillin, erythromycin, cephalexin, and quinolones; therapy duration is controversial but usually lasts from 6 to 12 weeks.
• Erythromycin (250 mg qid) is recommended for nonbacterial prostatitis to treat ureaplasma, mycoplasma, or chlamydia; recommended duration is 14 days to be continued for four to six weeks if response is favorable; oxybutynin (5 mg orally tid), propantheline (15 mg orally tid), and diazepam (2 mg orally tid) are also recommended treatments.

Various therapies can be effective during acute infection. With chronic or nonbacterial prostatitis, these therapies may have much to offer. A combination of herbs and nutrition can be effective. Homeopathy may offer significant symptomatic relief.

• Vitamin C (1,000 mg tid to qid)
• Zinc (60 mg/day) has been shown to reduce the size of the prostate.
• Selenium (200 mcg/day) is an antioxidant concentrated in the prostate.
• Essential fatty acids (1,000 to 1,500 mg one to two times/day) are anti-inflammatory; for optimum prostaglandin concentrations.
• Pumpkin seeds have been used historically to help maintain a healthy prostate.
• Diet: Avoid simple sugars, alcohol (especially beer), and coffee; consume plenty of water (48 oz. per day).

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to ascertain a diagnosis before pursuing treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, or 10 to 20 minutes for roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as noted.

Saw palmetto (Serenoa repens): Studies show this could possibly be as effective as prescribed antimicrobial therapy. Dose of 160 mg bid is difficult to achieve in tea or tincture; extract standardized for 85% to 95% of fatty acids and sterols is recommended.

Cernilton, a flower pollen extract (500 to 1,000 mg bid to tid), has been used extensively in Europe to treat prostatitis due to inflammation or infection. It also has a contractile effect on the bladder and relaxes the urethra.

• Bearberry (Arctostaphylos uva ursi): diuretic, urinary antiseptic
• Goldenseal (Hydrastis canadensis): diuretic, antiseptic, antimicrobial
• Coneflower (Echinacea purpurea): improves immune function
• Corn silk (Zea mays): diuretic, soothing demulcent

Take a combination of the above herbs, 1 cup tea or 60 drops tincture tid.

An experienced homeopath should assess individual constitutional types and severity of disease to select the correct remedy and potency. For acute prescribing, use 3 to 5 pellets of a 12X to 30C remedy every one to four hours until acute symptoms resolve.

• Chimaphila umbellata for retention of urine with an enlarged prostate
• Pulsatilla for pain after urination, especially with involuntary urination
• Pareira for painful urination, especially with painful urging or pain in the bladder
• Lycopodium for painful urination with reddish sediment in the urine, especially with impotence
• Thuja for urethritis, prostatitis, specifically if there is a forked stream of urine or genital condyloma

Kegel exercises increase pelvic circulation and improve muscle tone.

Contrast sitz baths may relieve symptoms and promote circulation, relieving pelvic vascular congestion. You will need two basins that can be comfortably sat in. Fill one basin with hot water, one with cold water. Sit in hot water for three minutes, then in cold water for one minute. Repeat this three times to complete one set. Do one to two sets per day, three to four days per week.

May improve urinary flow and decrease edema and inflammation of prostatic tissues.

May help reduce symptoms, especially with chronic or recurring prostatitis. Focus may be on the lower abdominal area, lower back, and around the sacrum.

Men should have a yearly prostate examination after age 40, even if they have no symptoms of prostate problems.

Warm sitz baths, increased water consumption, and avoidance of prolonged bicycle riding, horseback riding, and other exercises that irritate the region below the prostate may help prevent recurrence. Sexual activity may reduce the chances of prostatitis and reduce the likelihood of recurrence by easing fluid congestion in the prostate. However, sexual intercourse during infection may further irritate prostate and hinder recovery.

Infection may spread to testicles and epididymis. Chronic form may cause destruction of gland, bladder neck scarring, and stricture formation. Impotence may develop in some cases.

Antimicrobial therapy is usually effective, and recurrence is variable. Chronic prostatitis is more difficult to cure; suppressive antibiotic therapy may be used to prevent symptoms and recurrent urinary tract infections. Recurrent symptoms are common in nonbacterial prostatitis; serious sequelae do not usually result.

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:52, 128, 203.

Berkow R, ed. The Merck Manual of Diagnosis and Therapy. 16th ed. Rahway, NJ: The Merck Publishing Group; 1992.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:75, 201.

Buck AC, Rees RWM, Ebeling L. Treatment of chronic prostatitis and prostadynia with pollen extract. Br J Urol. 1989;64:496-499.

Conn RB, Borere WZ, Snyder JW, eds. Current Diagnosis 9. Philadelphia, Pa: WB Saunders Co; 1996.

Driscoll CE, Bope ET, Smith CW JR, Carter BL, eds. The Family Practice Desk Reference. 3rd ed. St. Louis, Mo: Mosby-Year Book; 1996.

Gruenwald J, Brendler T, Jaenicke C, et al., eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Co; 1998:817, 1229.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:119, 228-231, 341, 388-389.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin, Calif: Prima Publishing; 1998:480-486.

Tierney LM Jr, McPhee SJ, Papadakis MA, eds. Current Medical Diagnosis & Treatment 1999. 38th ed. Stamford, Conn: Appleton & Lange; 1999.

Werbach, M. Nutritional Influences on Illness. New Canaan, Conn: Keats Publishing; 1988:82-84.