Men’s Health - Prostatitis

Here at Box Acupuncture, Dr. Aaron Lee, is Certified in administering Pelvic Floor Acupuncture and Dry Needling Therapy. He is well versed and experienced in needling muscles of the pelvic floor which is relatively painless but effective.

If you’re considering treatment for prostatitis, please reach out to the clinic to schedule an evaluation where we can discuss your current health concerns and to go over a comprehensive and individually tailored treatment plan.


Muscles Involved in Prostatitis

While prostatitis primarily affects the prostate gland, several pelvic and surrounding muscles can become involved due to pain, inflammation, or compensatory tension. These include:

  1. Pelvic Floor Muscles:

    • Levator ani group (pubococcygeus, puborectalis, iliococcygeus) – Supports the pelvic organs and can spasm due to chronic prostatitis.

    • Coccygeus – Involved in pelvic floor tension.

    • Obturator internus – Can refer pain to the perineum.

    • Piriformis – May contribute to referred pain in the pelvic and gluteal region.

  2. Lower Abdominal Muscles:

    • Rectus abdominis – Can become tight due to chronic pelvic pain.

    • Transversus abdominis – Engages in core stability, possibly affected by pelvic tension.

  3. Hip and Adductor Muscles:

    • Adductor longus & brevis – Tightness can contribute to pelvic pain.

    • Iliopsoas – May become hypertonic, worsening pelvic discomfort.

  4. Perineal and Urogenital Muscles:

    • Bulbospongiosus and Ischiocavernosus – May be tender due to persistent inflammation and pain.

    • External urethral sphincter – Can be affected by inflammation, causing urinary dysfunction.

Symptoms of Prostatitis

Symptoms vary based on the type of prostatitis (acute, chronic bacterial, chronic pelvic pain syndrome, or asymptomatic), but common signs include:

  1. Urinary Symptoms:

    • Frequent urination (polyuria)

    • Painful urination (dysuria)

    • Weak urine stream or difficulty urinating

    • Urgency and hesitancy

    • Nocturia (frequent nighttime urination)

  2. Pelvic and Perineal Pain:

    • Pain in the lower abdomen, perineum, scrotum, or lower back

    • Testicular pain or discomfort

    • Pain during or after ejaculation

  3. Sexual Dysfunction:

    • Erectile dysfunction

    • Painful ejaculation

    • Reduced libido

  4. Systemic Symptoms (More Common in Acute Bacterial Prostatitis):

    • Fever and chills

    • Fatigue

    • Flu-like symptoms

Diagnosis of Prostatitis

Diagnosis includes:

  1. Medical History & Physical Exam

    • Digital rectal exam (DRE) – The prostate may feel tender, swollen, or boggy.

    • Pelvic floor assessment (for chronic cases)

  2. Laboratory Tests:

    • Urinalysis & Urine Culture – Checks for bacterial infection.

    • Prostate-Specific Antigen (PSA) – Elevated in inflammation but not a diagnostic marker.

    • Semen Analysis – Can show white blood cells or bacteria.

  3. Imaging Studies (If Needed):

    • Transrectal ultrasound (TRUS) – To evaluate prostate structure.

    • MRI or CT scan – If complications like abscess formation are suspected.

  4. Urodynamic Testing:

    • May be done to assess bladder function in chronic cases.

Conventional Treatment of Prostatitis

1. Acute Bacterial Prostatitis:

  • Antibiotics (Fluoroquinolones or Trimethoprim-Sulfamethoxazole for 4-6 weeks)

  • Pain Relievers (NSAIDs like ibuprofen)

  • Alpha-Blockers (e.g., Tamsulosin) to improve urine flow

  • Hospitalization in severe cases with intravenous antibiotics

2. Chronic Bacterial Prostatitis:

  • Longer antibiotic course (6–12 weeks)

  • Alpha-blockers to relieve urinary symptoms

  • Anti-inflammatory medications

3. Chronic Pelvic Pain Syndrome (CPPS)/Non-Bacterial Prostatitis:

  • Pelvic floor physical therapy (to relieve muscle tension)

  • Alpha-blockers (to reduce urinary symptoms)

  • NSAIDs or other pain relievers

  • Biofeedback therapy (for pelvic muscle dysfunction)

  • Stress management (as stress may exacerbate symptoms)

  • Lifestyle changes (dietary modifications, hydration, avoiding caffeine and alcohol)

4. Asymptomatic Prostatitis:

  • Usually does not require treatment unless found in conjunction with infertility or elevated PSA levels.

Prognosis of Prostatitis

  • Acute Bacterial Prostatitis: Generally has a good prognosis with timely antibiotic treatment, but delays can lead to complications like prostate abscesses.

  • Chronic Bacterial Prostatitis: May require extended treatment; recurrence is common.

  • Chronic Pelvic Pain Syndrome (CPPS): Long-term management is needed; symptoms may fluctuate over time.

  • Asymptomatic Prostatitis: Typically does not cause issues unless linked to fertility concerns.

Aaron Lee