Prostatitis refers to one of a number of conditions in which the prostate becomes inflamed. Prostatitis is the most common urinary tract problem in men under the age of 50, but it can affect men of any age. In fact, approximately 25 percent of men experience one form of prostatitis in their lifetime. Men with asymptomatic inflammatory prostatitis, also known as category IV prostatitis, do not have any prostatitis symptoms and do not experience any complications and therefore do not require treatment.
Acute Bacterial Prostatitis Treatment
The primary treatment for acute bacterial prostatitis involves antibiotics. Once your urine and blood cultures have been taken and you test positive for ABP, you’ll likely be placed on an antibiotic such as a floroquinone (e.g. ciprofloxacin) that covers most of the bacteria that typically cause bacterial prostatitis. Antibiotics may be prescribed for two to six weeks depending on the severity of your symptoms.
You will also be encouraged to drink plenty of fluids to help flush bacteria out of the urinary tract and to avoid substances such as alcohol and caffeine that may irritate the bladder. Nonsteroidal anti-inflammatory drugs (NSAIDs) and warm sitz baths may be recommended for pain control. Stool softeners may be recommended to loosen stools such that bowel movements cause less discomfort.
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Chronic Bacterial Prostatitis Treatment
Like ABP, treatment for chronic bacterial prostatitis involves antibiotics but for a considerably longer course of therapy. Men with CBP may require anywhere from four to 12 weeks of antibiotics. Some urologists may prescribe low-dose antibiotics for as long as six months after treatment to prevent reoccurrence.
NSAIDs and sitz baths may be recommended for pain control. Stool softeners may help make bowel movements less uncomfortable. The duration of inflammation in CBP can lead to scar tissue formation in the urethra that may require surgical removal to aid urine flow. Alpha-adrenergic blockers may be needed to treat urinary retention symptoms. Doctors often advise avoiding activities such as bike riding or horseback riding that put pressure on the perineum (the area between your scrotum and rectum).
Chronic Prostatitis/Chronic Pelvic Pain Syndrome Treatment
Traditional treatment options for CPPS have involved antibiotics, NSAIDs, and alpha-adrenergic blockers. Antibiotics have been used based on the thought that bacteria might be present in the prostate tissue but difficult to detect. Some doctors will prescribe a single course of antibiotics to be taken for several weeks, but evidence shows that men who have already been prescribed antibiotics for their CPPS gain little from repeated courses. NSAIDs and other anti-inflammatory medications such as aspirin may be helpful as part of a multi-modal treatment approach but are rarely helpful alone.
Alpha-adrenergic blockers have proven to be effective first-line treatment options in many men with CPPS if taken for at least 6 weeks. 5alpha-reductase inhibitors such as finasteride have been used as treatment options; however, a large meta-analysis of clinical trials for CPPS therapies did not find them to be an effective treatment option in the general population (men with BPH may see some benefit).
More recent developments in CPPS treatment that are the subject of ongoing research are the medications silodosin and pregabalin as well as therapies such as biofeedback and a type of massage therapy called myofascial trigger release. Herbal supplements such as quercetin and saw palmetto, muscle relaxants, and steroids are all sometimes used as treatment, but research evaluating their efficacy is lacking.