Chronic Prostatitis and Cystitis: Symptoms, Causes, and Treatment Options

Q: Chronic Prostatitis and Cystitis: Symptoms, Causes, and Treatment Options

Caution： The prostate, also known as the prostate gland, is an organ that only males possess; females do not have it. <br>Chronic prostatitis and chronic cystitis refer to inflammation that lasts for more than six months. <br>Generally, chronic conditions are more difficult to tr

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Hello Dr.
Hsu: I have had a habit of holding in my urine since my student days, and I often experience frequent urination and a feeling of incomplete emptying.
Six months ago, I sought medical attention, and the doctor said I had no issues.
Recently, I have been feeling a lot of soreness in my lower back, so I went for another check-up.
After a urinalysis, the doctor only mentioned a bacterial infection and advised me to drink more water, without giving me a chance to ask questions.
However, I noticed on the prescription label that it mentioned chronic prostatitis and chronic cystitis.
I would like to ask Dr.
Hsu: <1> What are chronic prostatitis and chronic cystitis? Are they also caused by bacteria? Can lower back soreness be attributed to these two conditions? <2> Many people tell me not to hold in my urine, but I often feel the urge to urinate.
I have also heard that frequent urination can cause the bladder to lose elasticity, similar to overusing a rubber band.
Is this true? <3> What are the treatment options? What should I pay attention to? Should I undergo any other tests? Thank you for your response, Dr.
Hsu.

Xiao Xin, 20~29 year old female. Ask Date: 2004/12/17

Dr. Xu Weikai reply Urology

Caution: The prostate, also known as the prostate gland, is an organ that only males possess; females do not have it.
Chronic prostatitis and chronic cystitis refer to inflammation that lasts for more than six months.
Generally, chronic conditions are more difficult to treat.
In simpler terms, "chronic" indicates that due to incomplete treatment of the acute phase or ongoing damage, fibrotic changes and other chronic conditions develop, and in most cases, there are no bacteria present.
Sometimes, it may start with a bacterial infection that damages the tissue, and if the tissue does not have enough time to heal, it can become reinfected or re-injured (such as from holding urine), preventing the tissue from fully returning to normal.
This phenomenon is referred to as chronic.
In your case, there may have been an early infection combined with prolonged urine retention, which has prevented the bladder and prostate from fully healing, leading to fibrotic changes.

Symptoms may include urinary issues and lower back pain due to the presence of scar tissue (fibrosis), causing significant distress for the patient.
Generally, chronic prostatitis or cystitis requires a great deal of patience, with treatment often exceeding six months, and sometimes it may not be completely curable.

Many people think that simply wanting to urinate without doing so is considered holding urine.
However, this notion is not entirely accurate; it should be understood in the context of normal physical and mental health.
Why? In your case, you might feel the urge to urinate 2 to 3 times an hour, or even more, but each time you only pass a small amount (this is due to the bladder's sensation being affected by inflammation, leading to impaired judgment).
Over time, this prevents the bladder from resting, causing further confusion about whether it is truly full.

What is the correct understanding? Proper urination should involve passing approximately 150 cc or more, but not exceeding 400 cc at a time, which is considered normal.
If you exceed 400 cc, it is termed holding urine.
If most urinations are less than 100 cc, we refer to this as problematic frequency.
If you are urinating 4 to 5 times an hour due to increased fluid intake or diuretics, with each volume exceeding 200 cc, this is considered normal frequency (as the bladder has a limited capacity), resulting from the production of urine being too high too quickly, indicating that the bladder itself is not the issue.
Now, regarding how to improve your situation, here are my suggestions:
1.
Develop a habit of drinking water at regular intervals and in appropriate amounts: For example, drink 50-150 cc of water every hour during the day (or 200 cc every two hours, which can be paired with breaks).
Next, establish fixed times to use the restroom, such as every two hours; however, if the urine volume is too low, extend the time; if the volume is large, shorten the interval.
This can help train your injured bladder, similar to how one would train a baby.
2.
If there is a long-term bacterial infection, consider adding cranberry juice: During acute episodes (when discomfort is higher), drink 500 cc daily, and for maintenance, 300 cc is advisable.
If acidity is a concern, you can add ice, honey, or sugar; if weight gain is a concern, opt for low-sugar products.
Relevant information can be found online.
3.
In addition to the aforementioned maintenance, if necessary, seek medical attention promptly; this is essential.
Taiwan's Ministry of Health and Welfare Taitung Hospital
Urology Department
Director Xu Wei-Kai

Reply Date: 2004/12/17

More Info

Chronic prostatitis and chronic cystitis are conditions that can significantly impact a person's quality of life. Understanding their symptoms, causes, and treatment options is crucial for effective management.

1. Understanding Chronic Prostatitis and Chronic Cystitis
Chronic Prostatitis is a condition characterized by inflammation of the prostate gland that lasts longer than three months. It can be classified into several categories, with the most common being Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS), which is not primarily caused by bacterial infection. Symptoms may include pelvic pain, painful urination, difficulty urinating, and sexual dysfunction. In some cases, chronic prostatitis can be associated with bacterial infections, but this is less common.

Chronic Cystitis, on the other hand, refers to inflammation of the bladder that persists over time. It can be caused by recurrent urinary tract infections (UTIs), irritants (like certain foods or medications), or autoimmune conditions. Symptoms typically include frequent urination, urgency to urinate, and pelvic discomfort. While bacterial infection is a common cause of acute cystitis, chronic cystitis may not always be due to an infection.

Connection to Symptoms: The lower back pain you are experiencing could indeed be related to either chronic prostatitis or chronic cystitis. Inflammation in the pelvic region can lead to referred pain in the lower back. Additionally, chronic pelvic pain syndromes often have overlapping symptoms, making it challenging to pinpoint the exact cause without thorough evaluation.

2. The Impact of Urinary Habits
The advice against holding in urine is well-founded. Regularly delaying urination can lead to bladder dysfunction over time. The bladder is a muscular organ that can become overstretched if frequently filled beyond its capacity. This overstretching can lead to decreased bladder elasticity, resulting in a condition known as bladder overactivity or urgency. Over time, this can contribute to chronic urinary symptoms, including frequency and urgency.

3. Treatment Options and Considerations
Treatment for Chronic Prostatitis and Cystitis:
- Medications: Depending on the underlying cause, treatment may include antibiotics (if a bacterial infection is suspected), anti-inflammatory medications, or medications specifically targeting bladder pain and urgency. Alpha-blockers may also be prescribed to help relax the muscles around the bladder and prostate.

- Lifestyle Modifications: Staying well-hydrated is essential, but it’s also important to avoid irritants such as caffeine, alcohol, and spicy foods, which can exacerbate symptoms. Regular pelvic floor exercises may help strengthen the muscles and improve bladder control.

- Physical Therapy: Pelvic floor physical therapy can be beneficial for individuals with chronic pelvic pain, as it addresses muscle tension and dysfunction in the pelvic area.

- Further Evaluation: If symptoms persist despite treatment, further evaluation may be warranted. This could include imaging studies (like ultrasound or MRI) to assess the bladder and prostate, as well as urodynamic studies to evaluate bladder function.

Conclusion
Chronic prostatitis and chronic cystitis are complex conditions that require a comprehensive approach to diagnosis and management. If you are experiencing persistent symptoms, it is essential to communicate openly with your healthcare provider about your concerns and the impact on your daily life. A tailored treatment plan that includes lifestyle modifications, appropriate medications, and possibly physical therapy can significantly improve your quality of life. Always remember that early intervention and proactive management are key to preventing complications and enhancing your overall well-being.

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