Chronic Prostatitis Treatment Protocols
Please note that much of this information is now superseded by data discussed at our prostatitis and pelvic pain forum. Please join the forum for the latest information.
The cause of chronic prostatitis/chronic pelvic pain syndrome is unknown and treatments are empiric. Hence, the principal purpose in evaluation of the patient is to exclude a treatable cause of symptoms. (Alexander & Pontari, AUA Meeting 2001)
The following distilled wisdom has been gleaned from the experience of the site managers, the advice of prostatitis researchers and discussion among sufferers on the CPPS / prostatitis forum. It has made many sufferers feel close to normal again. (Caveat: Information on the forum —which has a joining fee— will be more up-to-date and you are urged to join the forum rather then following the advice on this page). Do not take any of the prescription medications mentioned herein without discussing it first with your doctor!
The traditional treatment for this malady has been (and for many urologists still is) antibiotics. We frown upon the use of antibiotics after they have failed. The archives are full of men reporting negative side-effects from these drugs. Most knowledgeable urologists today will discourage the use of antibiotics if they fail to cure a patient and cultures are negative. Unfortunately, many men are temporarily helped by these drugs, for complex reasons, and this convinces them that they have an infection, sending them looking for new prescriptions again and again. In extreme cases men have taken antibiotics continuously for years without any lasting benefit.
In order to subdue symptoms you may have to change your lifestyle, diet, career, approach to life psychologically. Maybe your genes will not comfortably allow you to be the go-getter or fire-eating Type-A personality you used to be before all this started. Maybe that high-stress power career is no good for you. At first you will mourn the loss of these things, but after a few years most men adjust and feel that the sickness has taught them valuable lessons about life, fostering a calmer, philosophical approach wherein attention is paid to relaxation, both physical and mental. Other men are able to maintain high pressure lifestyles with the addition of meditation, relaxation exercises and physical therapy (as outlined in the Wise-Anderson Protocol).
With care, it is indeed possible for many sufferers to have long periods of feeling extremely well with symptoms so subdued that they are hardly noticeable.
The future looks very promising for this disease/syndrome. New treatments (releasing pelvic muscle spasms, neural stimulation, tinkering with genes, drugs which target tiny subsections of the immune system etc.) offering even more efficacious symptom control and perhaps even a total cure are looming on the horizon.
is a superb mast cell secretion blocker. This site has a page on quercetin. Take ~2g (2000mg) quercetin daily. Cycle 3 weeks on, 1 week off. It seems to
work better that way. Only buy the most reliable brands of quercetin
like Prosta-Q* or Q-Urol* (new!). Read a study of quercetin and CP/CPPS. Quercetin can also be obtained in smaller quantities from natural sources,
like broccoli and Rooibos (Redbush) Tea, which is delicious hot
In addition to quercetin, it is advisable and useful to take some key supplements to bolster your immune system and subdue inflammation.
- Chondroitin Sulfate - This substance prevents mast cells from triggering pain by releasing a myriad of nasty chemicals when provoked by nerves, allergies or any of the many other things that stimulate these cells. The longer you take it the better it works.
- Calcium with Vit D - Adequate calcium is vital for the proper functioning of the immune system. To protect the prostate from cancer, always take Vit D3 when taking Calcium supplements. Studies have shown that calcium alone may promote prostate cancer.
- Magnesium Citrate - Helps prevent muscle spasm and trigger points; counterbalances Calcium.
- Ester C - Take 2g daily. Lowers histamine in blood by up to 38%. Protects against leaky gut. Natural antihistamine (1, 2)
- Selenium - Take only once a week. Immune system support.
- Zinc Cellmins - 30mg daily. Cycle 4 weeks on, 4 weeks off. Vital for prostate health.
- Enteric Coated Fish Oil Softgels - Contains anti-inflammatory oils (EPA).
- Evening Primrose Oil Softgels - Contains anti-inflammatory oils (GLA).
- Flax Seed Oil -
Contains anti-inflammatory oils (ALA). 1 tablespoon daily if possible. Drizzle on salad.
Avoid stress. Avoid excessive sitting (pressure can be a mast cell trigger) and use a donut cushion (see page on sitting) if you have a sitting job. Avoid truck-driving, bicycling and horse riding. Avoid excessive exercising (a mast cell trigger) and fatigue, but do take gentle exercise, like walking. Avoid foods to which you react with phlegm, stomach pain, diarrhoea, flushing, headache, rash, joint pain (allergens degranulate mast cells, releasing histamine, and this may be the cause of your condition). Eat blue/red onions (full of natural quercetin) as is broccoli. Climate: a hot, dry (immune-system-friendly) climate is preferable to a cold, wet one. Researchers in northern Europe report that cold weather (a mast cell trigger and muscle spasm promoter) co-incides with flares.
The following agents help some but not all sufferers. You may wish to experiment, especially if our protocol as outlined above does not do the trick for you (listed in no particular order):
- Condoms for intercourse and consciously relaxing during masturbatory ejaculation help many men avoid overstimulating the pelvic nerves and lead to far less post-orgasmic pain. Do not tense the pelvic muscles during ejaculation. Let your pelvis remain "limp".
- Alpha blockers (Flomax, Hytrin, Cardura) relax smooth muscles in area. Also thought to work in as yet unexplained ways (e.g. Hytrin attenuates nociception-induced substance P upregulation).
- Antihistamines like Vistaril (hydroxyzine) antihistamine, inhibits bladder mast cell activation by neurogenic stimuli, and has anticholinergic, anxiolytic and analgesic properties. It is useful to take Flomax concurrently to stop Vistaril's tensing (antimuscarinic) effect on bladder neck and peri-prostatic smooth muscle. Some people cannot tolerate hydroxyzine, and they may try Allegra (H1 receptor antagonist) and/or Zantac (H2 receptor antagonist).
- Neurontin (anticonvulsant) useful for nerve pain.
- Elavil a mast cell protector, muscle relaxant, subdues nerve pain.
- Botox injections (only via expert uros, currently under research) temporarily stuns nerves, allowing neural "wind up", which causes mast cell degranulation, to subside.
- Ultram (Tramadol) a synthetic analogue of codeine. Useful in breaking the pain cycle. Supposedly non-addictive, but some men have had problems. May degranulate mast cells, like other opioids (hydrocodone, Vicodin etc), so long term or frequent use not advised.
- Calcium Glycerophosphate takes acid out of food to help stop pain and urgency. Use a tiny pinch in water when eating acid foods that irritate the inflamed bladder and/or prostate. Very useful. The cheapest way to get this food-grade chemical is here (no affiliation or relationship to our website).
- Benzodiazepines (Valium, Klonopin, Xanax, Ativan as well as Lorazepam, Librium) for anxiety and to help release muscular spasm. Careful with addiction.
More details of medications, including side effects, can be viewed on our medications page.
Other items rumored to help:
- Indomethacin a NSAID, preferably as suppository
- Arthrotec the arthritis drug (anti-inflammatory)
- Melatonin (anti-inflammatory)
- Saw Palmetto a traditional remedy.
- Celebrex as needed (anti-inflammatory)
- Cernilton (Cernitin) pollen extract, anti-inflammatory
- L-carnitine decreases reactive oxygen species
- Grape Seed Extract
- Viagra - also helps with sexual symptoms, if present.
- Ketoconazole or Proscar (anti-androgens)
- Gentle prostate massage for boggy glands. Some men report flare-ups from this, probably because the most common muscle trigger points in the pelvis are located behind the prostate gland in the insertions of the levator ani muscles.
- Hot shallow baths (sitz baths) - not too long, or it's enervating.
- Regular Ejaculation
- Walnuts (rich in anti-inflammatory omega-3 fatty acids; keep refrigerated).
- Herbals / herbs : tribulus terrestris, nettle root, maca root, gotu kola and marshmallow
IRRITANTS AND TRIGGERS
Different people have different triggers/irritants, but here are the most common you may wish to experiment with avoiding:
- Psychological: Stress in mice and cats triggers their bladder mast cells. Most likely this occurs in humans and other mammals too.
- Food: Excessive amounts of high sugar foods, alcohol, spices, vinegar, caffeine, coffee, chocolate, sodium benzoate (a histamine release trigger), milk products, very acid foods (e.g. tomatoes, cranberry drinks), Nutrasweet. An exclusion diet will define your unique list of food irritants and triggers. Wheat (a lectin that can make mast cells more leaky and more prone to degranulate) seems to be a specific trigger for many individuals, even those who test negative for celiac disease (sprue). Their stories are available on the prostatitis newsgroup archives. Gluten can be a nerve poison in some individuals (see prostatitis forum). The issue of diet is a huge one for some men, who swear that by modifying their diets they were able to calm or eliminate the pain in their groins. These men tend to be "atopic", reacting to some foods with diarrhoea, stomach pain, phlegmy or "tight" throats, headaches, rashes, excessive sweating, depression and fatigue. If that sounds familiar, read this excellent book: Food Allergies and Food Intolerance : The Complete Guide to Their Identification and Treatment Jonathan Brostoff MD, Linda Gamlin
- Sexual Activity: too much sex, too little sex. Find the right frequency for you. Be sure to avoid "Tantric" sexual practices, which involve grasping the penis tighly to prevent ejaculation. Some men have reported that this started their problems.
- Sitting or pressure on the perineum. Pressure may trigger mast cells.
- Exercise: strenuous exercise can provoke flares for some by triggering mast cells.
- Medications: avoid those which can cause urinary retention. Be careful of decongestants and antihistamines such as Sudafed, Tavist-D, Contact, Afrin etc. Some people report problems with SSRI antidepressants (Prozac, Zoloft, Celexa, Paxil etc). Some men say their condition was caused by thermogenics (Xenadrine, Hydroxycut). Several men have reported their condition being triggered by androstenedione (see prostatitis forum), a direct hormone precursor of testosterone, which is used (abused?) to build muscles in bodybuilding. Dr Shoskes says he has seen many men report getting symptoms after taking testosterone. Some men experience bad effects from drugs like Prilosec, Lipitor, Lescol, and Aciphex. One man reported Sectral to cause symptoms.
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