Chronic Prostatitis: Symptoms, Treatments, and Management

Prostatitis

Hello Doctor, I would like to ask a few questions regarding chronic prostatitis.
I have undergone two semen cultures, which repeatedly showed gastrointestinal bacteria and Staphylococcus epidermidis.
I have also taken three courses of quinolone antibiotics (Ciprofloxacin, targeting Gram-negative bacteria) for two weeks each, along with anti-inflammatory medications like Voltaren and Celebrex.
Although my symptoms have improved each time, they have still recurred over the past year.
Currently, I am experiencing perineal discomfort, decreased libido, loss of morning erections, and lack of desire for erections.
I have stopped drinking alcohol and am close to quitting smoking.
I regularly go to the gym and try to take sitz baths and massage the perineal area, but the effects are diminishing.

1.
Could the recurrent prostatitis be due to changes in my body constitution? Since developing prostatitis, I have been feeling easily fatigued and my mood fluctuates.
2.
Is it feasible to seek Traditional Chinese Medicine to improve my constitution?
3.
Since the doctors I have seen seem to be dismissive about this condition, should I consider going to a lab for another bacterial test myself?
4.
A doctor recommended that I try extracorporeal shock wave therapy.
Since the treatment is not inexpensive, I would like to know your opinion on its effectiveness and your thoughts on this therapy.
Thank you for taking the time to respond.

Xiao Di, 20~29 year old female. Ask Date: 2023/03/04

Dr. Li Xinyi reply Urology

Enterococcus generally exhibits strong antibiotic resistance, and bacteria are difficult to eradicate within the prostate.
However, immune resistance and overall health are definitely correlated, so maintaining a positive mood, healthy diet, and regular exercise is important.
As a gentle reminder, if the infection is due to anal intercourse, remember to use condoms.
Traditional Chinese medicine may be helpful, but it should be from a certified clinic with scientifically validated herbal treatments.
It is advisable to continue monitoring your condition.
Extracorporeal shock wave therapy may be more suitable for chronic inflammation of unknown origin; however, your situation seems to indicate a confirmed infection, so it is recommended to focus on infection treatment.
This should be discussed further with your urologist.

Reply Date: 2023/03/04

More Info

Chronic prostatitis, particularly chronic pelvic pain syndrome (CPPS), can be a challenging condition to manage due to its multifaceted nature. Your experience with recurrent symptoms, including pelvic discomfort, decreased libido, and erectile dysfunction, is not uncommon among individuals suffering from this condition. Let's address your concerns systematically.

1. Understanding Recurrence and Body Changes: Chronic prostatitis can indeed be influenced by various factors, including changes in your body’s immune response, hormonal levels, and even psychological stress. The presence of gastrointestinal bacteria and Staphylococcus species in your semen cultures suggests a potential dysbiosis, which may contribute to your symptoms. It's essential to recognize that chronic prostatitis can sometimes be a manifestation of a broader systemic issue, including chronic fatigue and mood fluctuations. These symptoms may be exacerbated by the stress of dealing with a chronic condition, leading to a cycle of discomfort and emotional distress.

2. Traditional Chinese Medicine (TCM) Approach: Exploring TCM for improving your overall constitution may be a viable option. TCM often emphasizes the balance of bodily systems and may provide symptomatic relief through herbal remedies and acupuncture. Some patients report positive outcomes with TCM, particularly in managing chronic pain and enhancing overall well-being. However, it’s crucial to consult with a qualified practitioner who understands your specific condition and can tailor a treatment plan accordingly.

3. Need for Further Testing: Given your history of recurrent symptoms and the presence of specific bacteria in your cultures, it may be prudent to consider further testing. A repeat culture could help identify any persistent or new infections that may require targeted treatment. Additionally, discussing your symptoms with a urologist who specializes in chronic prostatitis may provide insights into other underlying issues that could be contributing to your condition.

4. Extracorporeal Shock Wave Therapy (ESWT): The recommendation for shock wave therapy is based on emerging evidence suggesting that it may help alleviate chronic pelvic pain by promoting healing and reducing inflammation in the prostate and surrounding tissues. While the therapy can be costly, many patients report varying degrees of success. It’s essential to weigh the potential benefits against the financial investment and consider discussing this option with your healthcare provider to determine if it aligns with your treatment goals.

In managing chronic prostatitis, a comprehensive approach is often the most effective. This includes lifestyle modifications such as regular exercise, dietary adjustments (avoiding irritants like caffeine and alcohol), and stress management techniques. Continuing your routine of warm baths and pelvic floor exercises may also provide symptomatic relief.

It's important to maintain open communication with your healthcare providers and advocate for your health. If you feel that your concerns are not being adequately addressed, seeking a second opinion or consulting a specialist in chronic pelvic pain may be beneficial. Remember, managing chronic prostatitis is often a long-term process that requires patience and persistence.

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