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General Medical Questions
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Question : I commonly have discomfort when I urinate and aching in my pelvic area. My doctor thinks I have chronic prostatitis. I have taken two different antibiotics without relief. Are there other treatments?
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The Trusted Source
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Howard LeWine, M.D.

Howard LeWine, M.D., is chief editor of Internet Publishing, Harvard Health Publications. He is a clinical instructor of medicine at Harvard Medical School and Brigham and Women's Hospital. Dr. LeWine has been a primary care internist and teacher of internal medicine since 1978.

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August 17, 2012
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A:

Your symptoms do suggest chronic prostatitis. This is a persistent inflammation of the prostate gland. It can be caused by an infection. But doctors often find no specific reason for the inflammation.

Like you, most men are initially treated with antibiotics. Often for several weeks at a time. This is likely to help men with bacteria and white blood cells in their urine. It may also help those who have normal urine but a swollen, tender prostate gland. Most experts think that antibiotics are unlikely to help men with a normal prostate exam and no evidence of infection in their urine.

If a long course (or several courses) of antibiotics fail, there are a wide variety of other drugs and treatments available:

  • Alpha-blockers such as tamsulosin or terazosin. These drugs are commonly recommended. They’re especially useful in men whose major symptoms are hesitancy or weakness of the urinary stream.
  • Anti-inflammatory drugs (such as ibuprofen) or muscle relaxants (such as diazepam or baclofen). These may reduce pelvic pain or discomfort during urination.
  • Anticholinergics (such as tolterodine). These drugs may help men with urgency or bladder spasms. But there is a risk of it making symptoms worse.
  • Cutting caffeine and alcohol out of the diet. Both substances may irritate the bladder and prostate.
  • Some doctors advise men to reduce the “congestion” in the prostate with frequent ejaculation or massaging the gland with their finger. But it’s not clear if these remedies are effective.
  • There are also many supportive treatments available. These include biofeedback, relaxation exercises, massage and acupuncture.

As you can see from this long list of possible treatments, many men experience symptoms that are not relieved by antibiotics, and persistent discomfort.

Chronic prostatitis is never life threatening. But it can be a very frustrating condition. It often requires several trials of different treatments to find one that helps. If you have symptoms of chronic prostatitis — and have not sought medical advice – speak with your doctor about other options.

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