Chronic Prostatitis: Seeking Effective Treatment and Accurate Diagnosis

I have been worried and troubled for over two years, gradually losing weight?

Chronic prostatitis can be challenging to treat.
The accuracy of diagnostic tests can vary, and if calcification is present, it may complicate the situation.
Unfortunately, some physicians may indicate that there are no effective medications available for this condition.
If you are experiencing symptoms such as burning pain at the urethral opening, it is important to seek further evaluation and possibly consider a second opinion from another urologist.
Managing chronic prostatitis often involves a combination of lifestyle changes, physical therapy, and sometimes medications for symptom relief.
Please consult a healthcare professional who specializes in this area for personalized advice and treatment options.

Jiu wo, 30~39 year old female. Ask Date: 2005/10/18

Dr. Lin Hexing reply Urology

Chronic prostatitis is indeed a condition that is difficult to diagnose and treat.
For a definitive diagnosis, it is best to perform urine culture before and after prostate massage.
If the bacterial count in the post-massage urine culture increases by tenfold compared to the pre-massage sample, it can confirm the diagnosis.
Generally, imaging studies, including transrectal ultrasound, CT scans, or MRIs, are not very helpful in this context.
Prostate calcification is a common change that does not typically cause severe symptoms and cannot be eliminated with standard medications.
The only way to remove calcification is through surgical resection of the prostate, but one should not become overly anxious about the presence of calcification.
In terms of treatment, it is important to maintain a positive outlook, as this can enhance the likelihood of effectiveness.
If the post-massage urine culture is positive, treatment tends to be more effective.
However, if clinical symptoms strongly align with chronic prostatitis, antibiotic treatment can still be appropriate.
Typically, Bactrim is prescribed at two tablets twice daily for at least 4-6 weeks, with some recommending a duration of 12 weeks.
If the urine culture identifies specific bacteria, using the most effective antibiotic based on sensitivity testing is advisable.
For those considering out-of-pocket expenses for broader-spectrum antibiotics, Bauidal 400 mg taken twice daily for at least four weeks may be an option.
Other medications that may help alleviate symptoms include non-steroidal anti-inflammatory drugs (NSAIDs) and alpha-blockers.
Stool softeners can also reduce symptoms caused by pressure on the prostate from bowel movements.
There are reports suggesting that allopurinol, a medication used to lower uric acid levels, may also have a beneficial effect.
Taking warm baths for 20 minutes can also help improve symptoms.
If all the aforementioned methods have been tried without any improvement, the final option may be to consider transurethral resection of the prostate to remove the source of inflammation and calcification, although one must consider the potential impact on future fertility.

Reply Date: 2005/10/18

More Info

Chronic prostatitis is a complex condition that can significantly impact a patient's quality of life. It is characterized by pelvic pain and urinary symptoms that can persist for months or even years. The diagnosis and treatment of chronic prostatitis can be challenging, as the underlying causes are often multifactorial and not always clearly identifiable.

Diagnosis of Chronic Prostatitis
The diagnosis of chronic prostatitis typically involves a thorough medical history, physical examination, and various diagnostic tests. A healthcare provider may perform a digital rectal exam (DRE) to assess the prostate's size and tenderness. Urinalysis and urine cultures are commonly conducted to rule out urinary tract infections (UTIs) or other bacterial infections. In some cases, prostate secretions may be analyzed for the presence of white blood cells or bacteria, although this is not always necessary.

In your case, it seems that multiple tests have been performed, including urine tests and imaging studies, which have not indicated any significant abnormalities. This can be frustrating, especially when symptoms persist. It is important to note that chronic prostatitis can occur without clear evidence of infection, often referred to as chronic pelvic pain syndrome (CPPS). This condition can be classified into different categories, including inflammatory and non-inflammatory types.

Treatment Options
Treatment for chronic prostatitis can vary widely depending on the specific symptoms and underlying causes. Here are some common approaches:
1. Antibiotics: While antibiotics are often the first line of treatment for bacterial prostatitis, they may not be effective for chronic prostatitis without a clear bacterial cause. If you have been on multiple courses of antibiotics without improvement, it may be worth discussing with your doctor whether further antibiotic therapy is warranted.

2. Pain Management: Pain relief is a crucial aspect of managing chronic prostatitis. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and inflammation. In some cases, medications such as alpha-blockers may be prescribed to relax the bladder neck and improve urinary symptoms.

3. Physical Therapy: Pelvic floor physical therapy can be beneficial for patients with chronic pelvic pain. This therapy focuses on relieving muscle tension and improving pelvic floor function.

4. Lifestyle Modifications: Dietary changes, such as avoiding caffeine, alcohol, and spicy foods, can help reduce symptoms. Regular exercise and stress management techniques, such as yoga or meditation, may also provide relief.

5. Alternative Therapies: Some patients find relief through alternative treatments, such as acupuncture or biofeedback. These therapies can help manage pain and improve overall well-being.

6. Surgical Options: In rare cases, surgical intervention may be considered, especially if there are anatomical issues contributing to the symptoms.

Addressing Your Concerns
Regarding your specific concerns about the accuracy of tests and the statement from the physician that there is "no cure," it is essential to understand that chronic prostatitis can be a long-term condition that may require ongoing management rather than a definitive cure. The goal of treatment is often to reduce symptoms and improve quality of life.

If you feel that your current treatment plan is not effective, it may be beneficial to seek a second opinion from another urologist or a specialist in chronic pelvic pain. They may offer new insights or alternative treatment options that have not yet been explored.

In summary, chronic prostatitis is a challenging condition that requires a multifaceted approach to diagnosis and treatment. While it may not always be possible to achieve complete resolution of symptoms, many patients find effective strategies to manage their condition and improve their quality of life. Open communication with your healthcare provider is crucial in navigating this complex issue.

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