Acute and Chronic Prostatitis (Part Two)

TREATMENT

Recent studies have noted that the use of alpha-blockers and antibiotics, as well as various combinations of these two types of medications, have yielded better results in improving clinical symptoms. Treatment with only anti-inflammatories for these pathologies has been less effective.

Alpha-blockers should be used cautiously in the treatment of prostatitis, as they can cause a significant drop in blood pressure (Hypotension).

Typically, patients undergo cycles with antibiotics and anti-inflammatories, at least for 15 days, preferring the quinolone group such as Levofloxacin and Ciprofloxacin, which can overcome the prostatic capsule and reach the prostate, followed by the group of Sulfamides and Macrolides (International Journal of Antimicrobial Agents – 2008), depending on the response of the antibiogram (when it is positive).

As sulfamide antibiotics, Bactrim (Trimethoprim) can be used for about 2 weeks.
Antibiotics should only be used in the forms of bacterial prostatitis, they are not indicated for the treatment of non-bacterial inflammatory prostatitis as well as in asymptomatic forms.

Urinary antispasmodic medications can also be used, especially in cases of urinary incontinence (involuntary urination) accompanied by prostatitis (Oxybutynin or Kentera).

The use of anti-inflammatories is controversial. Cases in favor of using Aulin are cited in the literature.

Treatment can be combined with the use of Terazosin (Prostatil), Tamsulosin (Omnic) or Silodosin (Urorec), the latter of which should not be given to patients with severe renal insufficiency.

However, the treatment should be decided by the urology specialist as well as its duration.

The patient should follow these medications, improving their lifestyle, accompanied by a healthy and balanced diet.

• Engage in regular sexual activity (protected with condoms), without long periods of abstinence.
• Limit certain food products like chocolate, eggs, dried fruits, cheeses, etc.
• Limit beverages like coffee, tea, carbonated drinks as well as alcoholic ones.
• During the day, drink fluids (mainly water) in a fractional manner, at least 2 to 3 liters, avoiding these 3 to 4 hours before going to bed to sleep.
• Take measures to avoid constipation, by using a diet rich in fibers as well as practicing regular and non-strenuous physical activity.
• Quit smoking, as nicotine is an irritant for the bladder.
• In obese individuals, weight loss often improves the clinical picture.
• It is very important that the patient listens to and respects the advice of the family doctor, or the urology specialist, who is treating this inflammatory disease.

CHRONIC BACTERIAL PROSTATITIS

Chronic bacterial prostatitis is a pathology found in many patients, who have an infection of the prostate gland and the seminal vesicles. Usually, bacteria such as Escherichia Coli (gram-negative), Enterococcus Faecalis (gram-positive), Staphylococcus Epidermidis (gram-positive) are more frequently identified.

TREATMENT

After the patient has undergone several microbiological examinations (culturing of urine or seminal fluid), to individualize the microbial agent, treatment with antibiotics should begin, at least for 30 days accompanied in this case as well by alpha-lytic products, anti-inflammatories, multivitamins, lactic ferments, etc.

If the symptoms do not improve or if there are frequent recurrences, it may proceed to a more invasive treatment, consisting of the infiltrative treatment of the prostate with cortisone substances, mixed with antibiotics, under Ultrasound.

CHRONIC NON-BACTERIAL PROSTATITIS

Chronic non-bacterial prostatitis is less commonly observed. These patients usually:

• have chronic pelvic pain and spasms of the levator ani muscles.
• have difficulty urinating and the flow of urine is weak.
• in the rectal examination, the patient experiences strong pain when touching the prostate, but only on one side. The area around the anus is also painful.

TREATMENT

The methods of treating this form are still under discussion, but these patients can be relieved by:

• A regular life and proper diet.
• From the medical side, muscle relaxants, non-hypnotic antidepressants, alpha-lytics, as well as pain medications can be used.
• Manual massage of the prostate, etc.

ADVICE FOR PATIENTS WITH ACUTE OR CHRONIC PROSTATITIS

DIET

• Consume warm foods and at regular times.
• Eliminate, during the acute period, spicy foods and pork, alcoholic beverages, grapes, tomatoes as well as other foods that may acidify the urine like chocolate, preserved foods, hot peppers, onions, cauliflower, broccoli as well as carbonated drinks.

LIFESTYLE

• Avoid sports that can potentially traumatize the prostate gland as well as cycling, motorcycling, horseback riding.
• Go for walks and engage in relaxing sports activities like swimming, light running, gymnastics for body relaxation, etc.
• Avoid sedentary activities or sitting positions like traveling by car for a long time.
• Be careful with personal and intimate hygiene, especially for those who suffer from hemorrhoids, taking medical therapy for their treatment.
• Maintain regular sexual activity (protected) without abuses, avoiding long periods of abstinence.
• Avoid wearing very tight underwear and trousers.