Complaints & connections · borters.ch
Nine out of ten cases are not bacterial — so another antibiotic is not what helps there, but the pelvic floor.
Also known as: prostatitis · chronic pelvic pain syndrome (CPPS)
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Prostatitis gathers four rather different conditions under one word, and telling them apart is the heart of the matter. The acute bacterial form is rare but unmistakable: high fever, chills, a strong sense of illness, pain on passing water. It needs antibiotics quickly and is not waited out. The chronic bacterial form is rarer still. By far the commonest — about nine in ten cases — is the third, chronic pelvic pain syndrome, and in it no bacteria are involved at all. It shows itself as pressure or burning between scrotum and anus, often spreading into testicles, penis, groin or lower back, worsened by long sitting, and frequently with urinary and sexual complaints alongside. The misunderstanding that costs many years lies in the name: because the ending -itis means inflammation, one antibiotic follows another although there is nothing to fight. In truth the origin often sits in a tense pelvic floor, with nerve sensitivity and tension added. Accordingly what helps aims at muscles and nervous system: pelvic floor physiotherapy, warmth, relief when sitting, and patience.
An inflammation lifts the PSA markedly and lets it fall again only after weeks. Measuring too early leads into a workup that was never needed — four to six weeks in between saves a great deal.
In non-bacterial pelvic pain syndrome this is the measure with the best record. What is meant is releasing and relaxing, not strengthening — ordinary pelvic floor exercises can even do harm here.
A cushion with a cut-out, standing up often, no narrow bicycle saddle during a flare. That often takes more off the picture than any medicine.
Warm sitz baths or a cherry-stone cushion loosen the muscles and are well tolerated. They work briefly and can be repeated as often as wanted.
Without an organism identified, another course is a trial on suspicion. The identification decides whether there is anything to treat — and if so, for how long.
Inflammation lifts the value strongly. Measuring during a flare brings a fright and a chain of further tests that would not have been needed.
Lasting pain in the pelvis and tension reinforce each other. Relaxation methods, sleep and, where needed, psychological support are part of the treatment here and not an addition.
The world’s most common curable sexually transmitted infection — and in men usually without complaints. With lasting pelvic complaints and no bacterial finding it belongs in the work-up.
In the bacterial form the antibiotic needs four to six weeks, because it penetrates the tissue poorly. In the far more common non-bacterial form no organism is found and antibiotics change nothing — there, pelvic floor relaxation, warmth and alpha blockers work. That distinction decides months.
The bacterial form makes up less than a tenth of cases; more than ninety in a hundred are chronic pelvic pain syndrome with no organism found. In the bacterial form, treatment lasts four to six weeks, because the antibiotic penetrates the tissue poorly. In pelvic pain syndrome no antibiotic works; there pelvic floor physiotherapy and alpha blockers show an effect over eight to twelve weeks. About one in ten men experiences it once in life.
Driving, an office chair, a bicycle saddle. If standing and walking bring relief, that speaks for the pelvic floor and against an infection.
The typical place, often described as pressure or as sitting on a ball. From there it spreads into testicles, tip of the penis, groin or lower back.
After two unsuccessful courses with no bacteria found, a third is not a good plan. That piece of information shifts the direction clearly.
That is the other story: the acute bacterial form. It belongs treated quickly, and massaging the prostate is expressly to be avoided.
Weeks of trouble alternate with quiet spells, often linked to tension and stress. This course is characteristic of pelvic pain syndrome.
Plus a dull pressure in the perineum or lower abdomen and a weak stream. Trouble that comes and goes speaks for the chronic form.
The test that separates the bacterial from the non-bacterial form. Without it every course of antibiotics stays a trial.
Clearly raised in the acute bacterial form, normal in chronic pelvic pain syndrome. A simple difference, quickly available.
Rises markedly during inflammation and then misleads. Not measured during a flare but four to six weeks later.
An unrecognised diabetes favours recurring infections in the urinary tract. With repeated bacterial episodes it belongs checked once.
A sufficient amount of urine across the day dilutes what would otherwise crystallise or irritate. Spread evenly it works better than in two large portions.
With reduced kidney function it rises and becomes dangerous for the heart rhythm; under water tablets it falls. In both directions it belongs measured and not guessed.
Cutting out calcium is the wrong route with stones: it binds oxalate already in the bowel. Calcium with the meal instead of between meals is the lever, not avoidance.
Much salt drives calcium into the urine and so raises stone formation; it also lifts the blood pressure that strains the kidneys. Most of it sits in bread, cheese and ready meals.
The prostate grows and works under DHT. In the chronic form with no detectable bacteria, medicines that lower this hormone work for some men — the effect needs 6 months.
The chronic form often goes with tension in the pelvic floor, and stress amplifies both. That is why relaxing the pelvic floor here often does more than the next antibiotic.
In chronic pelvic pain many report worsening from these three. Controlled studies are lacking; two weeks without and then testing one at a time shows whether it applies.
Warm sitz baths release the pelvic floor tension that is often central in the chronic form.
Small-flowered willowherb is central Europe’s best-known prostate herb — a cup a day over months. Barely studied; the experience is widespread, the evidence thin.
The root, not the leaf — that is the difference that counts here. With a benignly enlarged prostate it is among the better-studied plant remedies, with small effects over 6 to 12 months.
In a sitz bath blend, warm. In the chronic form without bacteria, relaxing the pelvic floor often does more than the next antibiotic — the bath works in the same direction.
Traditionally used for congestion and swelling, here in a small amount in the sitz bath.
Where three meridians meet, above the inner ankle — the point for the whole lower belly. In pregnancy it is traditionally avoided.
The functional circle TCM assigns reproduction, bladder and prostate to. In the chronic form without bacteria both systems work on the same place — the tense pelvic floor.