Prostatitis: Causes, Symptoms, and Treatment Options

Prostatitis

Hello Dr.
Lai,
I have been working in Japan for a long time and am concerned about urinary-related issues, which is why I am reaching out to you online.
Thank you for your guidance.

1.
In September 2009, I was hospitalized for 5 days in Japan due to acute prostatitis (the doctor performed blood tests and a digital rectal exam).
I received intravenous antibiotics (approximately 200cc each morning and evening).
After discharge, I took Cravit 500mg (one tablet each morning) for 5 days and CERNILTON for 14 days (two tablets each morning and evening).
I returned for a follow-up visit and informed the doctor that I felt fine with no abnormalities, and the doctor confirmed that I had recovered, thus ending the treatment.
2.
In February 2010, I experienced fever (axillary temperature of 36.8 to 36.9 degrees Celsius and felt very fatigued) and pain while urinating, so I visited a urologist again.
The doctor suggested a recurrence of acute prostatitis and prescribed the same medications: Cravit 500mg (one tablet each morning) and CERNILTON for 7 days (two tablets each morning and evening).
Since the pain subsided and I had no significant urinary issues, I believed I was fine.
However, I still returned for a follow-up and informed the doctor that I felt there were no problems, and the doctor agreed, thus ending the treatment.
3.
On April 25 (Sunday), I experienced painful urination and a fever of 37.5 degrees Celsius, so I went to the emergency department of a hospital in Japan.
That evening, a family medicine doctor treated me and administered the same intravenous medication as during my hospitalization in September.
The next day, April 26 (Monday), I visited the urology department.
My symptoms included painful urination, difficulty urinating, and a fever (37.2 degrees Celsius).
The doctor suggested it might be the same prostatitis and prescribed Cravit 500mg (one tablet each morning) and CERNILTON for 7 days (two tablets each morning and evening).
On April 30, I returned because although urination was less painful, I still experienced some pain and had a fever of 37.5 degrees Celsius.
The doctor performed a blood test (which seemed normal) and a digital rectal exam (which was very painful), and again prescribed Cravit 500mg (one tablet each morning) and CERNILTON for 7 days (two tablets each morning and evening).
On May 7, during my follow-up visit, I reported that urination was no longer painful, but I still felt that it was not very smooth.
I had a temperature of 37.2 degrees Celsius and felt fatigued and thirsty.
The doctor indicated that the fever might be due to unresolved prostatitis, so he prescribed the same medications: Cravit 500mg (one tablet each morning) and CERNILTON for 7 days (two tablets each morning and evening).
After taking the medication at noon, my temperature remained at 37.1 degrees Celsius in the afternoon.
By the evening, my temperature was 36.6 degrees Celsius, which seemed to be an improvement, but I will have to see if there is further improvement tomorrow.
I have the following questions:
1.
This is the first time I have experienced prostatitis in my life, back in September 2009.
Why has it occurred so frequently in the past six months? Could it be related to excessive masturbation, withholding ejaculation, or poor hygiene of the foreskin? I usually ride a bicycle for about 10 minutes each morning and evening; could that be a factor? I drink alcohol occasionally (this is the second and third time I have been ill, and I seem to have had beer a couple of days before the onset of symptoms).
If I cannot identify the root cause, I won't be able to prevent it.
2.
I have been experiencing a temperature around 37 degrees Celsius for two consecutive weeks, and I am unsure how long it will last.
This has caused significant fatigue and dry mouth, which is very distressing and concerning.
How long does prostatitis typically take to treat?
3.
The body likely has a fever due to inflammation, right? When recovering, does inflammation subside before the fever goes down, or do they resolve simultaneously?
4.
If the fever persists, would you recommend returning to Taiwan for further examination?
I apologize for the lengthy message and numerous questions.
I appreciate your advice and assistance, Dr.
Lai.
Thank you.

Yoshiki, 30~39 year old female. Ask Date: 2010/05/07

Dr. Lai Ronghao reply Urology

In the case of prostatitis accompanied by fever, antibiotic treatment should last at least two weeks.
I am not sure if you have undergone any other imaging studies, such as a CT scan or MRI? How did those examinations turn out? You experienced episodes in September 2009, February 2010, and April 2010; were you doing well during those times? If you still have concerns, I recommend that you undergo a comprehensive examination.

Reply Date: 2010/05/07

More Info

Prostatitis, particularly nonbacterial prostatitis or chronic pelvic pain syndrome (CPPS), can be a challenging condition to manage. It encompasses a range of symptoms including pelvic pain, urinary difficulties, and sexual dysfunction, which can significantly impact a person's quality of life. Understanding the causes, symptoms, and treatment options is crucial for effective management.

Causes of Prostatitis
Prostatitis can be caused by a variety of factors. In cases of acute bacterial prostatitis, bacteria infect the prostate gland, leading to inflammation. However, in nonbacterial prostatitis, the exact cause is often unclear. Some potential contributors include:
1. Pelvic Floor Dysfunction: Tension or dysfunction in the pelvic floor muscles can lead to pain and discomfort.

2. Nerve Damage: Previous infections or injuries may affect the nerves in the pelvic area, causing chronic pain.

3. Psychological Factors: Stress, anxiety, and depression can exacerbate symptoms and contribute to the perception of pain.

4. Lifestyle Factors: Activities such as prolonged sitting, cycling, or excessive sexual activity may irritate the prostate or pelvic area.

Symptoms
Symptoms of prostatitis can vary widely but often include:
- Pain in the pelvic region, lower back, or genitals
- Painful urination or difficulty urinating
- Frequent urination, especially at night
- Pain during or after ejaculation
- Flu-like symptoms in cases of acute prostatitis

Treatment Options
Managing prostatitis, particularly nonbacterial forms, often requires a multifaceted approach:
1. Medications:
- Antibiotics: While they are effective for bacterial prostatitis, they may not help in nonbacterial cases.

- Alpha-blockers: These medications can help relax the bladder neck and prostate, improving urinary symptoms.

- Pain relievers: Over-the-counter medications like ibuprofen or acetaminophen can help alleviate pain.

- Muscle relaxants: These may help if pelvic floor tension is a contributing factor.

2. Physical Therapy: Pelvic floor physical therapy can be beneficial in addressing muscle tension and improving pelvic floor function.

3. Lifestyle Modifications:
- Diet: Avoiding irritants such as caffeine, alcohol, and spicy foods can help reduce symptoms.

- Hydration: Staying well-hydrated can improve urinary function.

- Exercise: Regular, gentle exercise can help alleviate symptoms and improve overall well-being.

4. Alternative Therapies: Some patients find relief through acupuncture, biofeedback, or mindfulness techniques.

5. Surgery: In rare cases, surgical intervention may be considered if other treatments fail.

Prognosis and Follow-Up
The duration of treatment for prostatitis can vary. Acute bacterial prostatitis may resolve within a few weeks with appropriate antibiotics, while chronic prostatitis can take longer to manage effectively. It's essential to maintain regular follow-ups with a healthcare provider to monitor symptoms and adjust treatment as necessary.

When to Seek Further Help
If symptoms persist despite treatment, or if there are new concerning symptoms such as high fever, severe pain, or changes in urinary function, it is advisable to seek further medical evaluation. In some cases, additional testing may be warranted to rule out other conditions or complications.

In conclusion, while prostatitis can be a frustrating and complex condition, understanding its causes and treatment options can empower patients to take an active role in their management. Regular communication with healthcare providers and adherence to treatment plans are key to improving outcomes and quality of life.

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