Get Help With Prostatitis From Baptist Health
Prostatitis isnt cancer, but our cancer care experts at Baptist Health can diagnose it and prescribe treatment. If its determined that you need an anti-inflammatory for prostatitis, they can recommend an OTC NSAID or prescribe one.
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Next Steps and Useful Resources
Data Sources And Retrieval Strategy
This research retrieves literature by employing the following databases from inception to November 2020: PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, and Wanfang database. The free text words and medical subject headings were adopted. The restriction of language includes English and Chinese. Besides, we manually retrieved the reference of involved researches.
After overlaps were removed by EndNote X9, two researchers browsed the titles and abstracts of involved researches respectively. Besides, we also confirmed the potential articles. Any divergence could be solved through discussions or negotiations with a superior researcher.
Physiotherapy And Pelvic Floor Muscle Relaxation
Prostatic massage, perineal or pelvic floor massage, and myofascial trigger-point release have been proposed as a beneficial treatment modality for patients who complain of perineal soreness and difficulty in bladder/rectal evacuation. Muscle tenderness is clearly an important cause of chronic pain and the derived increase in intrapelvic pressure can also lead to worsening of bladder/prostatic symptoms in addition to possible effects in developing chronic orchialgia or low back pain.56,57
Anderson et al, in a series of 74 patients, demonstrated the relationship between specific areas of pelvic pain and specific myofascial trigger points, showing a clear relationship of visceral pain to particular muscular areas.58 Many studies have reported pain relief after muscular massage or physical therapy. One of the most relevant is a study by Fitzgerald et al,59 which demonstrated better symptom relief for CPPS patients undergoing specific myofascial therapy over global massage, with global response assessment response rates of 57% vs 21% . It is thus important to refer patients to highly specialized physiotherapy centers.60
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Study Characteristics Of The Involved Researches
FIGURE 2. PRISMA flow diagram for eligible RCTs.
Thirty studies with 2,996 patients involving 11 oral Chinese patent medicine and 11 interventions with CP/CPPS with SD were included in this NMA. The age range of the participants was approximately 15 to 66, and the young and middle-aged crowd made up the majority. Ten comparisons were appraised: Compound Xuanju Capsules+WM vs. WM , Congrong Yishen Granules+WM vs. WM , Liuwei Dihuang Pills/Yougui capsules+WM vs. WM , Longqing Tablets+WM vs. WM , Ningmitai Capsules+WM vs. WM , Qianlie Beixi Capsules+WM vs. WM , Qianlie Shutong Capsules+WM vs. WM , Relinqing Granules+WM vs. WM , Shugan Jieyu Capsules+WM vs. WM and Shugan Yiyang Capsules+WM vs. WM . Western medicine regimen contained antibiotics, -blockers, phosphodiesterase type-5 inhibitor , an anti-inflammatory drug, pollen extract, etc. All the eligible Chinese patent medicine were taken orally, and the course of treatment ranged from 3 to 12 weeks, and most of the studies were 8 weeks. The detailed characteristics of included researches are demonstrated in Table 1, the patented formulations of involved literature are listed in Supplementary Table S1 and the network plots about diverse results could be found in Figure 3.
TABLE 1. Characteristics of included studies.
FIGURE 3. Network graphs for various outcomes NIH-CPSI IIEF-5 the clinical effective rate of CP/CPPS the clinical effective rate of SD.
The Clinical Effective Rate Of Cp/cpps
All 24 pieces of research including nine OCPM and nine interventions recorded the clinical effective rate of CP/CPPS. It was considered to the main outcomes, was displayed in the right upper quarter of Table 4 and Figure 5C, CRYSG+WM, CXJC+WM, LWDHP/YGC+WM, NMTC+WM, QLBXC+WM, and SGYYC+WM were better than the WM regimen alone according to the clinical effective rate of CP/CPPS. These results were statistically significant, ORs and 95% CIs were 0.21 , 0.31 , 0.12 , 0.20 , 0.13 , and 0.22 , respectively. Nevertheless, other interventions had no statistical difference. On the basis of the ranking probabilities of Figure 6C and Table 3, LWDHP/YGC+WM was the optimum combination in improving the clinical effective rate of CP/CPPS, QLBXC+WM was number two, and NMTC+WM was the third.
TABLE 4. Odds ratios of the clinical effective rate of CP/CPPS and SD .
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When To Seek Medical Care For Prostate Infections
Contact a doctor for any of the following symptoms. These symptoms are even more significant if accompanied with high fever and chills:
- Urinary burning or pain
- Difficulty or pain when starting urination
- Pain in the genital area
Doctors usually diagnose and treat prostate infections on an outpatient basis. If a person develops high fever with chills or a new onset of difficulty in urinating, seek medical care immediately or go to a hospitals emergency department because the infection may be spreading to other areas of the body.
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Treating Bacterial Prostatitis By Type
Bacterial infection can cause two types of prostatitisacute and chronic .
Acute Bacterial Prostatitis
The main treatment for acute bacterial prostatitis is the use of antibiotics to kill the bacteria. Depending on the antibiotic and the type of bacteria, this treatment can last anywhere from several weeks to a few months. Escherichia coli infections are one of the most common causes, with this species of bacteria found in 65 to 80 percent of cases.
Severe infections may require hospitalization for monitoring and additional antibiotics. In addition, the infection can cause the prostate to grow bigger and block the urethra, the tube that removes urine from the body. Such blockages are especially important to treat so as to prevent urine from backing up in the urinary tract and damaging the kidneys.
Chronic Bacterial Prostatitis
With chronic bacterial prostatitis, bacteria can linger in the prostate even after treatment about 5 percent of men with acute bacterial prostatitis end up with the chronic type. E. coli has been implicated in chronic prostatitis, too, as has a species of Corynebacterium. When these bacteria hang around, they can also cause occasional urinary tract infections.
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What Are The Complications Of Prostatitis
Men with acute bacterial prostatitis may develop . This widespread inflammation can be life-threatening. It requires immediate medical treatment.
Antibiotics can cause an upset stomach. Men with chronic bacterial prostatitis may need lots of antibiotics to treat recurring infections. Some people develop antibiotic resistance, making treatment ineffective.
Asymptomatic inflammatory prostatitis can lower sperm count, affecting fertility.
Neuromuscular And Chronic Pain Therapy
Patients with CP/CPPS will often complain of pain and spasm of the pelvic floor muscles. Therapies aimed at relaxation of these muscle groups and proper use of pelvic floor muscle may therefore be expected to be beneficial. Unfortunately, not very many large clinical trials have been published, data is available from small trials. For instance, biofeedback physical therapy and pelvic floor re-education lead to a significant improvement of the NIH-CPSI score in men with CP/CPPS . In another study, myofascial trigger point release and pelvic floor re-education also lead to a significant improvement in NIH-CPSI score and also improved sexual function in men with CP/CPPS . Also, a sham-controlled study of men with CP/CPPS found that electromagnetic therapy could significantly improve the NIH-CPSI score of the patients, with the greatest improvement in the pain related symptoms . Amytriptyline and gabapentin can both be useful for the management of chronic pain and chronic muscle pain conditions and we have used them with some success in the management of patients with CP/CPPS.
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The Upoint Clinical Phenotyping System For Cpps
The most widely adopted questionnaire for clinical evaluation of CPPS is the National Institutes of Health Chronic Prostatitis Symptom Index .16 This tool, validated in 1999, is composed of nine different questions investigating pain, urinary symptoms, and QoL related to CPPS. In 2009, Shoskes et al17 proposed a dedicated clinical classification of CPPS, to separately identify the different possible reported symptoms. It considers: Urinary symptoms Psychosocial dysfunction Organ-specific findings Infection Neurological/systemic and Tenderness of muscles .
The understanding of this clinical phenotyping system for CP/CPPS can explain why this disease has a wide multifactorial genesis, potentially different in each patient, therefore generating an individual multifaceted complex of symptoms for every patient diagnosed with CP/CPPS. A review by Magistro et al23 analyzed 28 randomized controlled trials evaluating various treatments for CP/CPPS, and underlined that monotherapy is never enough to achieve symptom relief and that the therapeutic approach should focus on the different symptomatic pattern presented by the patient in a multimodal setting.
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Clinical Presentation And Diagnostic Evaluation
ABP typically presents abruptly with voiding symptoms and distressing but poorly localized pain and is often associated with systemic findings . Clinicians should enquire about urogenital disorders, recent genitourinary instrumentation, and new sexual contacts. Only 5% of men with ABP develop CBP, and 2% develop a prostatic abscess. CBP usually presents with more-prolonged urogenital symptoms. The hallmark is relapsing UTI , but < 50% of patients with CBP have this history . Between symptomatic UTIs, patients may be asymptomatic, despite ongoing prostatic infection.
Physical examination should include obtaining vital signs and examining the lower abdomen , back , genitalia, and rectum. Digital prostate palpation in ABP can cause discomfort and can potentially induce bacteremia but is safe if done gently. In ABP, the gland is typically tender, swollen, and warm, whereas in CBP, there may be some tenderness, softening , firm induration, or nodularity.
Best Medicine For Prostatitis
Prostatitis is a common genitourinary condition found in men. It accounts for more than 1.5 million visits to the doctorâs office in the United States each year. Oftentimes, patients visit numerous clinics both public and private in search of a remedy desperately, but all they ever have usually is disappointment. Unlike similar prostate conditions, little research has been conducted on prostatitis. But some are already on the way. The term prostatitis, which translates to inflammation of the prostate, refers to a loose assemblage of syndromes reflected by urinary problems.
It has also been found that beginning a daily regimen of vitamin and mineral supplements would come as an efficient medicine in curing prostatitis. Fruit beverages like cranberry juice have properties that wash away dislodging bacteria. Another natural medicine would be garlic, which contains antibiotic and anti-inflammatory properties that are able to reduce inflammation and terminate the infection.
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How Are Bacterial Forms Of Prostatitis Managed Or Treated
Antibiotics can kill bacteria that cause bacterial types of prostatitis. Men with acute bacterial prostatitis may need 14 to 30 days of antibiotics, starting with IV antibiotics in the hospital. Rarely, men need surgery to drain an abscess on the prostate.
Treating chronic bacterial prostatitis is challenging. You may need up to three months of antibiotics to sterilize the prostate. If the prostate cant be sterilized, low-dose antibiotics can be used long term to prevent recurrences. Some men need surgery to remove prostate stones or scar tissue in the urethra. Rarely, surgeons remove part or all of the prostate gland .
What If My Prostatitis Is Not Caused By Infection
Because we do not understand what causes prostatitis without infection, it can be hard to treat. Your doctor might try an antibiotic to treat a hidden infection. Other treatments are aimed at making you feel better. Nonsteroidal anti-inflammatory medicines, such as ibuprofen or naproxen, and hot soaking baths may help you feel better. Some men get better by taking medicines that help the way the bladder or prostate gland work. These medicines include oxybutynin, doxazosin, prazosin, tamsulosin and terazosin.
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Recommendations For A General Approach
Although evidence to support them is scarce, the following recommendations are offered. If the history and physical examination suggest prostatitis, physicians may consider a diagnostic test, such as the four-glass test or the PPMT. In most cases, empiric antibiotic therapy is reasonable whether or not the diagnostic test proves a bacterial cause. Common choices include TMP-SMX, doxycycline or one of the fluoroquinolones. Treatment is often recommended for four weeks, although some clinicians use shorter courses. Physicians should encourage hydration, treat pain appropriately and consider the use of NSAIDs, an alpha-blocking agent, or both. If symptoms persist, a more thorough evaluation for CNP/CPPS should be pursued. Some patients may need several trials of different therapies to find one that alleviates their symptoms.
The term prostatitis describes a wide spectrum of conditions with variable etiologies, prognoses and treatments. Unfortunately, these conditions have not been well studied, and most recommendations for treatment, including those given here, are based primarily on case series and anecdotal experience. For these reasons, many men and their physicians find prostatitis to be a challenging condition to treat.
What Questions Should I Ask My Doctor
You may want to ask your healthcare provider:
- What type of prostatitis do I have?
- What is the best treatment for this type of prostatitis?
- What are the treatment risks and side effects?
- How can I avoid getting prostatitis again?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Prostatitis is a common problem that affects many men. Unfortunately, theres a lot of confusion about the disease. People use the word prostatitis to describe four different conditions. There isnt a one-size-fits-all treatment for prostatitis, which is why an accurate diagnosis is so important.
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Can Prostatitis Come Back
Men who have had prostatitis once are more likely to get it again. Antibiotics may not get into the prostate gland well. Small amounts of bacteria might hide in the prostate and not be killed by the antibiotic. Once you stop taking the antibiotic, the infection can get bad again. If this happens, you might have to take antibiotics for a long time to prevent another infection. Prostatitis that is not caused by infection is often chronic. If you have this kind of prostatitis, you might have to take medicine for a long time.
Treating Prostatitis Effectively: A Challenge For Clinicians
Nhuan Nguyen, PharmD, MBA, CHEClinical PharmacistGR Health, Georgia Regents Medical CenterAugusta, GeorgiaCharlie Norwood VA Medical CenterAugusta, GeorgiaUniversity of Georgia College of PharmacyAthens, Georgia
US Pharm. 2014 39:35-40.
ABSTRACT: Prostatitis, which affects 5% to 9% of males and occurs mostly in middle age, is classified based on signs and symptoms, with urinary urgency, frequency, and pain typical in nearly all categories. Most physicians are not familiar with prostatitis, particularly chronic prostatitis associated with chronic pelvic pain syndrome . Accordingly, patients are often misdiagnosed and receive ineffective treatment, resulting in poor quality of life. CP/CPPS is challenging to treat, as its causes are not clearly defined and the antibiotics used for therapy have low effective rates. Clinical pharmacists can contribute significantly to patient care by advising physicians and other medical professionals regarding drug efficacy, adverse drug reactions, and drug interactions, and by assisting in the selection of optimal antibiotics and/or treatment regimens for prostatitis.
Prostatitis , which occurs in 5% to 9% of males aged 18 years and older, most often develops in middle age.1 In the early 1990s, prostatitis accounted for about 1% and 8% of office visits to family practitioners and urologists, respectively.1
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Make Some Lifestyle Changes
There are a number of things you can try that other men have found helpful. You might want to plan your day more, to allow for things like toilet trips. Trying different things can help you feel more in control, and that you are actively doing something to improve your health. If one thing doesnt work, try something else. Here are some suggestions.
- Watch what you drink. Drink plenty of fluids about six to eight glasses of water a day. And cut down on fizzy drinks, artificial sweeteners, alcohol and drinks that contain caffeine as these can irritate the bladder and make some urinary problems worse.
- Watch what you eat. Some foods may make your symptoms worse. Try to work out what these are so you can avoid them. Theres some evidence that spicy foods can make the symptoms of CPPS worse.
- Avoid cycling. Its a good idea to avoid activities that put pressure on the area between your back passage and testicles , such as cycling. They can make symptoms worse. If you want to keep cycling, you could try using a different saddle, such as one made from gel.
- Keep a diary. This can help you spot things that make your symptoms worse, and can be a useful way of showing your doctor what youre experiencing. Record things like food, drink, exercise, how stressed you feel and your symptoms.