As men age, many begin to suffer problems with the prostate gland. Prostate enlargement is the condition that is most widely recognized, but there can be another culprit.

Often-overlooked condition: At some point in their lives, about one in 10 men will be diagnosed with chronic prostatitis, pain and swelling of the prostate due to inflammation that results from unknown causes or an infection.

Like an enlarged prostate, chronic prostatitis causes urinary difficulties, such as urinary frequency (urinating more than once every two hours)...urinary urgency (urination is hard to delay once the urge occurs). and reduced stream (slow urinary flow).

Chronic prostatitis also can lead to symptoms that do not typically occur with an enlarged prostate-for example, pain in the perineum (the area between the anus and the scrotum)... the tip of the penis...the testicles...the bladder area and the rectum. Men with prostatitis may even suffer pain during urination or orgasm.

Symptoms, which last for three months or more, are intermittent or constant. In severe, untreated cases, the condition may interfere with a man's sleep, desire for sex and overall enjoyment of life—indefinitely.

Lessons Learned

When chronic prostatitis is diagnosed, more than 70% of primary care physicians prescribe an antibiotic such as ciprofloxacin (Cipro), according to a recent survey. About half of the surveyed doctors prescribe an alpha-blocker drug. such as alfuzosin (Uroxatral) or tamsulosin (Flomax), which is typically used for prostate enlargement (benign prostatic hyperplasia).

Antibiotics are prescribed because many doctors believe that chronic prostatitis is an infectious disease-but, in fact, bacteria are present in only about 5% of cases. Alpha-blockers are used in the hope they might relax the prostate and the perineum. But recent studies show that these approaches don't work.

New thinking: Because the symptoms are real, but no biochemical or mechanical cause has yet been found, nonbacterial chronic prostatitis is now considered to be a pain "syndrome," called chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Diagnosing The Problem

If you think you have CP/CPPS, see a urologist for a standard urological evaluation. Urinary and prostate fluid cultures should be ordered to look for infection. Urodynamic testing to measure the functioning of the bladder and prostate) and cystoscopy (an examination of the urethra and bladder) also may be performed. These and other tests will help rule out other diseases, such as prostate cancer or bladder cancer.

Treatments Worth Trying

If you are suffering from CP/CPPS, there are several effective therapies to consider…

  • Quercetin. This antioxidant/anti-inflammatory is found in red wine, onions and green tea. By reducing inflammation, it may help curb the pain and urinary difficulties of CP/CPPS.

Scientific evidence: When researchers at the Harbor-UCLA Medical Center in Los Angeles asked 28 men with CP/CPPS to take either a quercetin supplement or a placebo twice daily for one month, those taking quercetin had a 35% decrease in pain, while the placebo group experienced only a 7.2% reduction

Resource: Most reputable brands of quercetin should have this effect. In one part of the study described above, men took the quercetin containing product Prosta-Q, available from the manufacturer, Farr Laboratories (877-284-3976,

Caution: Don't take any quercetin product along with a quinolone antibiotic-such as ciprofloxacin...levofloxacin (Levaquin)...norfloxacin (Noroxin)...or ofloxacin (Floxin). The supplement can interfere with the antibiotic's action.

  • Relaxation and trigger point therapy. Some scientists theorize that CP/CPPS is caused by chronic tension in the pelvis. This, in turn, creates knots (trigger points) in the muscles, reduces blood flow and irritates pelvic nerves. If you consciously learn to relax those muscles, even when you're in pain..and a physical therapist locates and releases the trigger points with pressure and stretching-symptoms can be reduced.

Scientific evidence: When 138 men whose CP/CPPS symptoms did not respond to any treatment underwent a relaxation and trigger point therapy called the Stanford Protocol, 72% said their symptoms were moderately or markedly improved in one month.

Resource: The Stanford Protocol is offered in a six-day program in northern California. To learn more, call 707-874-2225 or consult

  • Acupuncture. Researchers believe that pain occurs in CP/CPPS patients when stimulation, such as that caused by sitting or sexual activity, travels up the spinal cord and becomes magnified in the brain. Introducing a different stimulus, such as acupuncture, in the area where the pain originates can interrupt the cycle.

Scientific evidence: When 10 men whose CP/CPPS symptoms did not respond to at least one conventional medical treatment received acupuncture twice a week, their pain and urinary symptom scores dropped by more than 70%.

Resource: To find an acupuncturist near you, consult the National Certification Commission for Acupuncture and Oriental Medicine (904598-1005,

  • Biofeedback. A biofeedback machine monitors a specific bodily function that we typically are not conscious of, such as muscular tension. When the function is abnormal, the machine gives feedback, such as a beep or flashing light.

Scientific evidence: When 31 men with CP/ CPPS underwent a "pelvic floor biofeedback reeducation program—a series of biofeedback treatments that showed them when pelvic muscles were tense and how to relax them—the men had a 52% decrease, on average, in pain and urinary symptom scores

Resource: To find a biofeedback practitioner near you, consult the Association for Applied Psychophysiology and Biofeedback, 800-477-8892,

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