Prostatitis is an inflammation of the prostate gland. It is a term that encompasses four disorders of the prostate: acute bacterial prostatitis, chronic bacterial prostatitis, chronic nonbacterial prostatitis, and prostadynia.
Chronic nonbacterial prostatitis (NBP), also called chronic abacterial prostatitis (CAP), is the most common form of prostatitis. NBP is usually caused by infectious agents such as fungi, mycoplasma, or viruses.1 Prostadynia (PD), also called chronic pelvic pain syndrome, is a noninfectious form of prostatitis. Although the cause is unknown, it has been proposed that PD may be a neuromuscular condition, causing pain of the pelvic floor muscles.2 Acute bacterial prostatitis (ABP) results from a urinary tract infection (usually from E. coli bacteria) that has spread to the prostate. Chronic bacterial prostatitis (CBP) is usually the result of a partial blockage of the male urinary tract, such as occurs with benign prostatic hyperplasia (BPH). Such blockages promote the harboring of bacteria from a previous infection and reduce circulation, thereby preventing both the body’s natural immune mechanisms and medication from getting to the site.
What are the symptoms of prostatitis?
Men with prostatitis may have symptoms including pain or discomfort in the lower abdomen, testicles, and penis; discomfort during ejaculation or urination; or a weak urinary stream with dribbling. Advanced cases may also have fever, chills, frequent urge to urinate, burning urination, blood passed in the urine, and pain in the joints and muscles.
Lifestyle changes that may be helpful for prostatitis
Urination and ejaculation may provide defense against prostatic infection by flushing the urethra. The prostate also secretes an antibacterial substance known as “prostatic antibacterial factor” into the seminal fluid (semen), which helps to fight infection.3 In one preliminary study, unmarried men with NBP who had avoided sexual activity for personal or religious reasons and who had not responded to medication, were encouraged to masturbate at least twice a week for six months. Out of 18 men, 78% experienced moderate to complete relief of symptoms.4
Use of tobacco, especially by smoking, reduces the zinc content of prostatic fluid, and may therefore reduce natural immunity to prostate infection.5 No research, however, has investigated the effect of smoking cessation on the prevention of prostatitis.
Nutritional supplements that may be helpful for prostatitis
Quercetin, a flavonoid with anti-inflammatory and antioxidant effects, has recently been reported to improve symptoms of NBP and PD. An uncontrolled study reported that 500 mg of quercetin twice daily for at least two weeks significantly improved symptoms in 59% of men with chronic prostatitis.6 These results were confirmed in a double-blind study, in which similar treatment with quercetin for one month improved symptoms in 67% of men with NBP or PD.7 Another uncontrolled study combined 1,000 mg per day of quercetin with the enzymes bromelain and papain, resulting in significant improvement of symptoms.8 Bromelain and papain promote absorption of quercetin and have anti-inflammatory effects as well.9
An extract of flower pollen, derived primarily from rye, may improve symptoms of chronic prostatitis and prostadynia. In a small, uncontrolled trial, men with chronic NBP or prostadynia given two tablets of flower pollen extract twice daily for up to 18 months reported complete or marked improvement in symptoms.10 In a larger, uncontrolled trial, one tablet three times daily for six months produced a favorable response in 80% of the men based on symptoms, laboratory tests, and doctor evaluations.11 Men who did not respond in this study were found to have structural abnormalities of the urinary tract, suggesting that uncomplicated prostate conditions are more likely to respond to flower pollen. Additional uncontrolled studies support the effectiveness of flower pollen extract,12 13 14 but no controlled research has been published.
In healthy men, prostatic secretions contain a significant amount of zinc, which has antibacterial activity and is a key factor in the natural resistance of the male urinary tract infection.15 16 In CBP17 18 19 20 and NBP21 these zinc levels are significantly reduced; however, it is not clear whether this indicates a predisposition to, or is the result of, prostatic infection.22 23 Zinc supplements increased semen levels of zinc in men with NBP in one study,24 but not in another.25 While zinc supplements have been associated with improvement of benign prostatic hyperplasia (BPH), according to one preliminary report,26 no research has examined their effectiveness for prostatitis. Nonetheless, many doctors of natural medicine recommend zinc for this condition.
Test tube studies have shown that vitamin C inhibits the growth of E.coli,27 the most common cause of ABP and CBP. Results from preliminary human studies indicate vitamin C supplementation can cause changes in urine composition that may inhibit the growth of urinary E. coli.28 29 Although vitamin C has not been studied in bacterial prostatitis, the association of this condition with urinary tract infections leads many nutritionally oriented doctors to recommend its use, in the form of ascorbic acid, for bacterial prostatitis due to E. coli infection.
Are there any side effects or interactions with prostatitis?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful for prostatitis
Saw palmetto, known more for its use in BPH, has also been used historically for symptoms of prostatitis.30 According to laboratory studies, saw palmetto contains constituents that act to reduce swelling and inflammation.31 However, there is no scientific research evaluating the effects of saw palmetto in men with prostatitis.
In a small preliminary trial, men with chronic prostatitis or BPH were given 200 mg per day of pygeum extract for 60 days, resulting in some improvement of symptoms and laboratory evaluation of the prostate and urinary tract.32 The extract used in this study was standardized to contain 14% beta-sitosterol and 0.5% n-docosanol. Other preliminary trials have also reported improvement of prostatitis symptoms with pygeum.33
Pau d’arco extract has been used traditionally for prostatitis.34 According to test tube studies, pau d’arco exerts antibacterial activity against E.coli,35 which suggests a possible mechanism for this claim. However, no scientific studies of the effectiveness of pau d’arco for preventing or treating prostatitis have been done.
Are there any side effects or interactions with prostatitis?
Refer to the individual herb for information about any side effects or interactions.
Holistic approaches that may be helpful for prostatitis
Acupuncture may be helpful for chronic prostatitis according to one small, uncontrolled study.36 Seventeen patients with chronic prostatitis that was unresponsive to conventional therapy were treated with electroacupuncture (acupuncture with electrical stimulation). The effectiveness of electroacupuncture therapy was reported to be moderate in 70% and excellent in 30% of the patients treated.
Prostatic massage through the rectum was once a common treatment for CBP and NBP, and is still prescribed by some practitioners. Prostatic massage is thought to promote circulation and drainage of infected areas.37 While little scientific research has been done to evaluate the effectiveness of this treatment, some physicians and their patients have reported symptomatic improvement.38 Prostatic massage should be conducted only by a trained specialist. Prostatic massage should be avoided in ABP because it is painful and could spread the infection.39 Also avoid this therapy in the presence of prostatic calculi (stones), a condition common in elderly men in which small calcifications develop in the prostate.
Controlled studies indicate psychological factors, such as anxiety and depression, occur more frequently in men with NBP and PD.40 41 42 This may be because psychological factors contribute to the development of NBP and PD, or perhaps they occur as a result of prostatitis. Nonetheless, some practitioners believe psychotherapy may help reduce symptoms in these cases.43
Some researchers have reported that certain cases of chronic prostatitis are helped by biofeedback (using simple electronic devices to measure and report information about a person’s biological system) and other treatments aimed at reducing chronic pain.44 This suggests that some of the causes of PD, and possibly NBP, may be neuromuscular. In support of this idea, smooth muscle relaxing medications are reported to reduce symptoms in men with CBP, NBP, and PD, and to reduce the recurrence rate of CBP.45 However, no controlled research has explored the effectiveness of biofeedback or alternative neuromuscular therapies for prostatitis.
A sitz bath is the immersion of the pelvic region (up to the navel) in water. Sitz baths are reported to provide temporary relief of symptoms in men with chronic prostatitis, although no controlled research has evaluated these claims.46 47 This therapy is not recommended in ABP, as it may worsen the infection.48 In chronic prostatitis, doctors of natural medicine recommend “contrast sitz baths,” a series of alternating hot and cold baths, requiring two tubs (or a bathtub and adequately sized basin), one for each temperature. The hot sitz bath is taken first with the water at a temperature of 105–115ºF for 3 minutes. This is immediately followed by the cold sitz bath at 55–85º F for 30 seconds. This process is repeated two more times, for a total of six baths (three hot and three cold) per treatment.49