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For many men with prostatitis, fatigue can be a daily companion, albeit an unwanted one. In fact, among the broad and diverse range of symptoms accompanying chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)—the most common type of prostatitis—fatigue, pain, and urinary problems can be the most debilitating.
But the adverse effects of chronic prostatitis often transcend the genitourinary realm, so much so that they can even damage a man’s psyche and his overall quality of life, an expert says.
“Prostatitis impacts on quality of life more than insulin-dependent diabetes, congestive heart failure, recent heart attack, and treated prostate cancer,” says J. Curtis Nickel, MD, President of the Canadian Urological Association and professor of urology at Queen’s University in Kingston, Ontario, Canada. “This has been proven in our clinical studies.”
In a minority of cases, prostatitis can be managed successfully and simply with antibiotics. More often than not, though, a multifaceted treatment approach is necessary to ease chronic prostatitis fatigue and other symptoms and help men cope with this troublesome disease.
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Prostatitis Symptoms and Types Vary
Of the four categories of prostatitis, the first two are caused by bacterial infections. With either acute or chronic bacterial prostatitis, you may experience fatigue, flu-like symptoms (e.g., fever and chills), and pain in the abdomen, lower back, or genitals. You also may experience pain when you urinate, ejaculate, or move your bowels, and you may have difficulty urinating and emptying your bladder completely.
These symptoms may develop rapidly with acute bacterial prostatitis or more gradually and less severely with the chronic form. Chronic bacterial prostatitis may cause recurrent urinary tract infections due to bacteria that linger in the prostate.
In either acute or chronic bacterial prostatitis, the treatment is straightforward: antibiotic therapy—up to eight weeks for acute bacterial prostatitis and up to 12 weeks or more for chronic forms. (Another form of prostatitis, acute asymptomatic inflammatory prostatitis, causes no symptoms and requires no treatment.)
Unfortunately, bacterial prostatitis accounts for only about one in 10 cases of prostatitis. Most men with the disease—and about 17 percent of all men in general—develop the more enigmatic chronic prostatitis/chronic pelvic pain syndrome (CPPS), characterized by prostatic inflammation with no discernible cause.
As with the bacterial forms of prostatitis, fatigue often accompanies CPPS. “Prostatitis fatigue is likely caused by central nervous system sensitization,” Dr. Nickel says. “This happens when patients develop neuropathic-type pain, which is associated with long-term, chronic CPPS.”
CPPS also causes urinary symptoms, pain in the prostate, bladder, or outside the pelvis and abdomen, muscle tenderness/spasm, neurological problems, and irritable bowel syndrome. And like other chronic pain conditions, CPPS can affect emotional and mental health, leading to stress, depression, and, in some cases, social isolation.
Multimodal Treatment for CPPS
Given the wide array of symptoms and complications that CPPS causes, doctors must employ an equally broad range of treatments that differ from patient to patient. While one man may experience only urinary symptoms or prostate pain, another might contend with chronic neuromuscular pain outside the pelvis that won’t respond to treatment aimed solely at the prostate.
The multimodal treatment strategy for CPPS includes a variety of medications to address urinary symptoms and bladder problems; quercetin (an antioxidant) and bee pollen to reduce inflammation and pain localized to the prostate; and neuroleptic drugs—amitriptyline, nortriptyline (Pamelor), and pregabalin (Lyrica) are examples—to treat chronic fatigue and pain outside the pelvis and abdomen. If you have tenderness and tightness in the pelvic floor muscles, your doctor may refer you for pelvic floor physical therapy from a trained therapist.
Also, to counter prostatitis fatigue, Dr. Nickel advises men to work with their physicians to follow a healthy, bladder-friendly diet, which limits spicy foods, alcohol, caffeine, and other bothersome foods and beverages listed by the Interstitial Cystitis Association. He also recommends psychotherapy, such as cognitive behavioral therapy, to help men manage anxiety, reduce stress, and avoid ruminating about their CPPS.
“Treatment of a single symptom has been shown not to be effective in a majority of patients,” Dr. Nickel says. “All domains of a patient’s CPPS experience must be addressed for overall improvement.
“From both the physician’s and patient’s perspective, the goal of therapy for CPPS is not necessarily cure,” he continues. “Rather, it’s amelioration of symptoms and improvement in activities and quality of life.”