Acute and Chronic
Johns Hopkins has an excellent "white paper" on prostate disorders authored by H. Ballentine Carter, M.D. and published in 2009. Address: The Johns Hopkins White Papers, PO Box 420083 Palm Coast, FL 32142-0083. In the section on prostatitis (page 76), it states that Nearly 95% of men with prostatitis are believed to have the chronic nonbacterial form. That explains why all that Bactrim and Levaquin served only to make you feel sick and have insomnia, and didn't help your prostatitis. This paper mentions various treatments, including the fact that anti-inflammatory drugs are usually helpful. When I asked my doctor about Advil, he said it will not help. He obviously hadn't read this white paper. The paper also mentions that if ejaculation is not painful, masturbation may improve symptoms. Perhaps most importantly, the paper quotes a study which showed that acupuncture was nearly twice as effective as the sham procedure in relieving chronic prostatitis symptoms. I highly recommend this white paper.
From my experience and research, it appears to me that there is both an acute and a chronic phase to prostatitis. What works during the acute phase is different from what works during the chronic phase. Prostatitis may begin with the acute phase, and then become chronic. But in the chronic phase, triggers can make it become acute again. My experience may vary from yours, but the point is that what works for you in the acute phase may not work in the chronic phase, and vice versa.
The acute phase has a trigger. My experience and research indicated that some triggers are: 1. Drinking liquor, especially when it has more than the 3.2 % alcohol content of beer 2. Eating spicy foods, even mildly spicy 3. Vomiting, which puts pressure on the prostate 4. Anal sex, which causes direct trauma to the prostate 5. Sitting for hours at at time, such as on a long car ride or airplane flight 6. Prolonging sex by nearly reaching the point of climax, but delaying ejaculation by suddenly discontinuing penile stimumlation or by taking your mind off sex for a few minutes 7. Acupuncture when in the acute phase can make things much worse immediately. This is odd, because acupuncture helped me recover from the chronic phase.
I chose an acupuncturist with a master's degree in five-element acupuncture. I have had about 15 acupuncture treatments, and was back to "normal" until I had the stomach flu recently with extreme vomiting, which sent me back into the acute phase. I have been treated every 1-2 weeks for about six months. She has done all the acupuncture treatments in my back and feet, a few on my abdomen. No, she did not stick needles in my "privates", but she informed me that if I didn't get better, she would go between my scrotum and my anus with a needle. She puts in the needles, and I lie on my side and literally fall asleep in a very relaxing environment. She lets me lie there for 45 minutes before she removes them.
Recently, I had my first-ever acupuncture treatment while recovering from the acute phase. (All my other acupuncture treatments had been during the chronic phase.) She put the needles in my back, as usual. I had arrived at the clinic reasonably comfortable, and urinated just before the treatment. I started out quite comfortable, but within 15 minutes, the pain in my penis started, rapidly escalated, and became intolerable within 15 more minutes. I had to stop the treatment; the pain was unbearable. That, to me, proves that acupuncture in the back definitely affects the nerves in the prostate. I will wait until my acute prostatitis has completely quieted down before resuming acupuncture to relieve the chronic stage again.
In the acute phase of prostatitis, there is an intense burning of the penis and a strong sense of urgency that one needs to urinate, and therefore one goes and sits on the toilet, but doesn't truly need to urinate. The burning can be nearly disabling, making it difficult to think about anything else at the time. When severe, it can be impossible to achieve an erection no matter how erotic your experience. Also, in the acute phase it is difficult to get more than a trickle of urine to last for more than 6 seconds, and one often has to contract abdominal muscles to start the flow. The acute phase may or may not interfere with sleep. After eating mild tacos once, I was awake every hour all night to urinate. More recently, after vomiting, I experienced a recurrence of the acute phase, and it caused severe penile discomfort for over a week, especially while sitting down at my work, but I was able to sleep just fine. Penile pain in the acute phase may or may not be accompanied by lower back pain. The combination of pain after urination and lower back pain is also symptomatic of urinary tract infection, which is almost always from sexually transmitted disease. In my opinion, ejaculation may not be a good idea during the acute phase, but anti-inflammatory meds such as Advil (ibuprofen) 3200 mg per day (4 200-mg tablets every 6 hours) or Aleve (naproxen) 880 mg per day ( 2 220 mg tablets every 12 hours) helps immensely. This is twice the labeled dose, but I am a doctor, and I know this doseage is safe unless you have kidney trouble or ulcers. If in doubt, ask your doctor whether it is safe for you. The dose as labeled on the bottle has pain-killing action, but not much anti-inflammatory action. You need the high doses to suppress the inflammation of the prostate. If staying on the high dose for more than just a month or two, you should ask
your doctor if you should have periodic kidney function tests which are done by drawing blood, to be sure the pills aren't hurting your kidneys. Taking the high doses of these pills for many months or years can cause severe ulcers. If in doubt, ask your physician. Usually within just a few days or weeks you can ease off these pills. However, when you do, you may experience lower back pain and moderate recurrence of penile pain, because the analgesic effect of the pills had been masking those. If you experience stomach pain while on the pills, you should cut back or discontinue them. In the acute phase, I also take Flomax just to do everything I can to help my urination. However, I avoid ejaculation when on Flomax, because hardly any fluid comes out at the time of orgasm. The muscles of ejaculation are impaired. I suspect that prostatitis can be worsened by ejaculating when on Flomax, because of the buildup of fluid that stays in the prostate. It takes 48 hours after stopping Flomax to get a decent ejaculation, so I sometimes stop it for two days, ejaculate, then resume Flomax for a few days. It is important to lie down, or at least slouch down with your feet up whenever possible during the acute phase. Sitting is bad. So if you play X-Box or watch TV in your leisure time, do it lying or slouching, or in a recliner. It is a good idea to avoid caffeine during this phase. I find that after a morning cup of coffee, I experience increased discomfort in my groin within 20 minutes. Not severe, but definite.
In the chronic phase, I was able to get through my work week with little or no trouble. Urination was fair; I could urinate for at least 10 to 15 seconds at a time and it was easy to start the flow, but I would rarely be able to urinate for more than 15 seconds at a time. I could sleep 5 hours before waking. The problem was that I could not sit through any performances with pleasure, such as civic theatre. After an hour, the discomfort in my groin made enjoyment impossible. I would often leave the sanctuary toward the end of a church service to go urinate. Long car rides were a terror, because of the discomfort which set in about 30 minutes after starting out. Also, when I had sex, I would have moderate discomfort in my groin for perhaps 8 hours afterward, which made me want to avoid sex even though I did not have pain during ejaculation. I did not find anti-inflammatory meds such as Advil to be helpful in this phase. I also did not find Flomax to be necessary or particularly helpful. I tried ejaculating every 3-4 days despite the discomfort afterwards.
I was very frustrated because for months I was not getting better. Then I did two things. I began taking Prosta-Q (Farr labs) twice daily, and I began getting acupuncture treatments once a week. After about 8 treatments, I found that I could ejaculate with no discomfort afterwards. I stopped waking up in the night, and I would often have 20-25 seconds of flow when urinating. I could sit through entire performances with no discomfort. I had sex with my wife once a day for eight days when on vacation, with no discomfort at all, one year after the original onset of my prostatitis. I allowed myself to have a 3.2% beer occasionally. Life was good. Then I got the stomach flu. Life will be good again before too long.
In summary, for me:
Acute phase: 4 200 mg ibuprofen tablets every 6 hours. Flomax one tablet daily. Prosta-Q one tablet every 12 hours. Painkillers such as hydrocodone if needed. Avoid ejaculation while on Flomax, avoid caffeine, spicy foods, and alcohol. Lie down or recline when not at work. Avoid long car rides, avoid airplane flights, and avoid sitting through public performances.
Chronic phase: Acupuncture every week or two, Prosta-Q every 12 hours. Ejaculate every 3-4 days. No more than one cup of coffee daily. Very seldom have a beer, and drink it slowly. Avoid spicy foods at all costs.