A man who goes to his doctor with prostate-related pain will probably be told that he has prostatitis and that he needs an antibiotic for the infection that is assumed to be causing his discomfort.
In most cases, that diagnosis would be wrong. He probably doesn’t have an infection, and antibiotics won’t make a bit of difference.
Only 5% to 10% of men with prostate-related symptoms have a bacterial infection. Most have what’s known as chronic nonbacterial prostatitis/chronic pelvic pain syndrome (CP/CPPS). It’s a complicated condition that typically causes pain in the perineum (the area between the testicles and the anus) and/or in the penis, testicles and pelvic area.
The pain can be so great—and/or long lasting—that it can significantly interfere with a man’s quality of life. Here’s how to ease the pain…
CP/CPPS is the third most-common urological diagnosis, after prostate cancer and lower urinary tract conditions for men 50 years and older.
CP/CPPS isn’t a single disease with one specific treatment. The discomfort has different causes and can originate in different areas, including in the prostate gland, the ejaculatory ducts, the bladder or the muscles in the pelvic floor. It can affect one or all of these areas simultaneously.
If you have pelvic pain that has lasted three months or more, you could have CP/CPPS. The pain typically gets worse after ejaculation and tends to come and go. Some men will be pain-free for weeks or months, but the discomfort invariably comes back.
A man with CP/CPPS might not get an accurate diagnosis for a year or more. Many family doctors, internists and even urologists look only for a prostate infection. They don’t realize that CP/CPPS can be caused by a constellation of different problems.
You may need to see a urologist who is affiliated with an academic medical center. He/she will be up-to-date on the latest diagnostic procedures and treatments for ongoing pelvic pain.
The UPOINT (urinary, psychosocial, organ specific, infection, neurologic/systemic and tenderness of skeletal muscles) exam categorizes the different causes of CP/CPPS and helps doctors choose the best treatments.
Your doctor will perform a physical exam and take a detailed history. He will ask where the pain is, how often you have it and how severe it is. He also will ask if you’ve had recurrent urinary tract infections, sexually transmitted diseases, persistent muscle pain, etc.
Important: Arrive for your appointment with a full bladder. You might be asked to perform a two-glass urine test. You will urinate once into a container to test for bacteria/cells in the bladder. Then you will urinate a second time (following a prostate “massage”) to test for bacteria/cells from the prostate gland.
What your doctor looks for and what he may recommend…
Infection. Even though it affects only a minority of men with pelvic pain, it’s the first thing your doctor will check. Consider yourself lucky if you have an infection: About 75% of men with bacterial prostatitis will improve when they take an antibiotic such as ciprofloxacin (Cipro).
The discomfort from an acute infection—pain, fever, chills—usually will disappear within two or three days. You will keep taking antibiotics for several weeks to ensure that all of the bacteria are gone.
In rare cases, an infection will persist and become chronic. Men who experience symptoms after the initial antibiotic therapy will need to be retested. If the infection still is there, they will be retreated with antibiotics.
Urinary symptoms. These include frequent urination, urinary urgency and residual urine that’s due to an inability to completely empty the bladder. Your doctor might prescribe an alpha-blocker medication, such as tamsulosin (Flomax), to relax muscles in the prostate and make it easier to urinate.
Also helpful: Lifestyle changes such as avoiding caffeine and limiting alcohol…not drinking anything before bedtime…and avoiding decongestants/antihistamines, which can interfere with urination.
Pelvic pain. It is the most common symptom in men with CP/CPPS. It’s usually caused by inflammation and/or tightness in the pelvic floor, a group of muscles that separates the pelvic area from the area near the anus and genitals. The pain can be limited to the pelvic area, or it can radiate to the lower back, thighs, hips, rectum or bladder.
Helpful treatments…
Mind-body approaches, including yoga and progressive relaxation exercises, can help reduce muscle spasms and pelvic pain.
Anti-inflammatory drugs, such as ibuprofen or aspirin, as directed by your doctor. If you can’t take these medications because of stomach upset or other side effects, ask your doctor about trying quercetin or bee pollen supplements. They appear to reduce inflammation in the prostate gland. Follow the dosing instructions on the label.
Sitz bath (sitting in a few inches of warm water) can relieve perianal/genital pain during flare-ups. Soak for 15 to 30 minutes.
Treatment for depression, anxiety or stress. Therapy and/or stress reduction are an important part of treatment because both approaches can reduce muscle tension. Also, patients who are emotionally healthy tend to experience less pain than those who are highly stressed.
Helpful: Cognitive behavioral therapy, which helps patients identify negative thought patterns and behaviors that increase pain.
I also strongly advise patients to get regular exercise. It’s a natural mood-booster that helps reduce stress, anxiety and pain.
