Prostatitis is the inflammation of the prostate gland, differentiated into an acute or chronic bacterial prostatitis, a chronic nonbacterial prostatitis, and benign prostatic hypertrophy.
Bacterial Prostatitis
Acute bacterial prostatitis is an acute infection of the prostate gland, the patient presenting such symptoms as chills, fever, urinary frequency and urgency, burning upon urination, hematuria, and perineal and lumbar pain. Upon examination the prostate will feel swollen, tense, and warm to the touch, and laboratory investigation of the cultured prostatic secretions will yield a high bacterial count, most commonly enteric, gram-negative organisms.
Chronic bacterial prostatitis is similar to the former, except the symptoms are less acute and display a greater degree of variability. The symptoms are distinguished by a relapsing urinary tract infection that can range from being asymptomatic except for bacilluria, to urinary frequency and urgency, burning upon urination, hematuria, and perineal and lumbar pain. With chronic infection, the scrotal contents may become affected presenting as epididymitis and/or orchitis. Upon examination the prostate may be boggy or irregularly swollen and tense, and somewhat tender. (Berkow 1992, 1715)
The holistic treatment of bacterial prostatitis is once again similar to that mentioned in the treatment of epididymitis, with an emphasis upon urinary antiseptics, systemic antimicrobials, urinary tract demulcents, and anodynes. In chronic bacterial prostatitis dietary and lifestyle factors should be duly considered, with an emphasis upon stress reduction and management, the elimination of methylxanthine-containing beverages, and a diet refined carbohydrates which tends to increase truncal-abdominal obesity and thus promotes pelvic congestion.
Chronic nonbacterial prostatitis
Chronic nonbacterial prostatitis is more common than bacterial prostatitis but is idiopathic. The symptoms resemble those of chronic bacterial prostatitis, and although laboratory investigation may show an elevation of leukocytes in the urine, cultures of the urine and prostatic secretions fail to indicate a pathogenic organism (Berkow 1992, 1716).
The medical approach to chronic nonbacterial prostatitis is limited in scope, with a reliance upon topical measures such as sitz baths, anticholinergic drugs and prostatic massage. The holistic treatment, in contrast, views the issue somewhat differently, and takes into account several factors that are usually not addressed with a conventional approach. Chronic nonbacterial prostatitis is a congestive condition, and thus anything that promotes pelvic congestion may underlie the condition. Many men for example, spend much more time sitting than our forebears, such that it is not uncommon for men to sit for more than 8 hours a day, 5 days a week. Such inactivity, often complexed with dietary factors that inhibit liver and digestive function such as stress, a diet high in refined foods and saturated fats, as well as methylxanthine containing beverages and a high carbohydrate diet promotes pelvic congestion.
Prostatic congestion can also be a symptom of non-ejaculatory sex and extended periods of arousal, both of which enhance prostatic circulation, but inhibit elimination. Some commentators, such as James Green in his book The Male Herbal, note that men are now exposed to overt sexual stimuli in an increasing fashion, from books and magazines, to television and movies. Green suggests that such chronic stimuli congests sexual energy, promoting prostatic enlargement and inflammation (1991, 113).
There are other factors that may underlie prostatitis. Men who bicycle frequently are at an increased risk of prostatitis, and should be counseled to try many of the newly designed bicycle seats that take some of the pressure off of the perineal region. Excessive sexual activity may also irritate prostate function, as might the habitual consumption of spicy foods that are traditionally said to inhibit male sexual function. The regular excessive consumption of alcohol, and especially beer, may also tax the prostate through the distension of the urinary bladder and excessive diuresis. Another factor traditionally ascribed to prostatic inflammation is the suppression of urination. The call to eliminate should never be ignored, and many men can actually trace the cause of their prostatitis to an occasion in which the suppression of urination caused acute pain. Such an event is likely to cause permanent damage and chronic inflammation, and although the exact cause in unclear, it most likely stems from the acute distension of the urinary tract and the retrograde flow of urine.
The treatment of chronic nonbacterial prostatitis with botanicals rests upon the use of pelvic decongestants, urinary tract demulcents, anodynes, and gonadal restoratives. Additional measures include the use of botanicals that appear to have a directly decongestant activity upon the prostate such as Fireweed rood (Epilobium angustifolium), Nettle root (Urtica dioica), Saw Palmetto (Serenoa serrulata), Buchu (Barosma betulina), and Goldenrod (Solidago canadensis). Topical measures include the use of alternating hot and cold sitz baths (always ending with cold), a lotion blended with the essential oils of Lavender and Roman Chamomile (5% v/v) rubbed into the perineal area, and rectal suppositories, such as the following:
- 1 part Echinacea (Echinacea angustifolia) tincture
- 1 part Saw Palmetto (Serenoa serrulata) tincture
- 3 parts Glycero-gelatin
Prepare the glycerol-gelatin base by mixing one part glycerin, one part gelatin, and one part water in a double boiler. When constituents have dissolved add in the tinctures. Pour in suppository molds, and add about 5% essential oils of Chamomile and Lavender before suppository has cooled. Insert 1-2 suppositories before bed.
Additional measures in the treatment of nonbacterial prostatitis include stress management, Kegel exercises, Tai chi, Hatha yoga, anaerobic exercises such as leg presses and squats, and regular ejaculation. Useful supplements include zinc citrate (50 mg daily), vitamin B complex (50-100 mg daily), and EPA/DHA (1000 mg each daily). Other important dietary and lifestyle considerations include the elimination of excessive amounts of saturated fat, and the elimination of coffee, nicotine, marijuana, and alcohol. Helpful dietary measures include increasing fiber intake through the consumption of leafy green vegetables and whole grains. As previously stated, prostate problems often occur, in association with the truncal-abdominal obesity pattern, and thus measures to correct the underlying problem of insulin resistance and hyperinsulinemia are recommended.
Benign Prostatic Hypertrophy
Benign prostatic hypertrophy (BPH) refers to the adenamotous enlargement of the periurethral prostate gland, promoting obstruction of the urethra and bladder opening. It is a disease commonly seen in men over the age of 50, and although the etiology is unclear, may involve alterations in hormonal balance associated with aging. BPH is less common in the Orient and more frequent in the Western world, and within North America, has a higher frequency among blacks than whites. With aging however, the incidence of BPH increases in all populations, and by about 80 years of age, 75% of men have prostatic hypertrophy. (Berkow 1992, 1736; Rubin 2001, 501-02)
In the initial stages of the disease multiple nodules derived from epithelial, stromal and smooth muscle cells begin to occur in the periurethral region of the prostate. Five types of nodules have been found, with fibromyoadenamotous nodules being the most common. Histologically, the hyperplastic tissue is glandular, with varying amounts of stromal tissues interposed. Gradually, the progressive growth of these hyperplastic nodules begin to distort and compress the urethra, and place pressure upon the peripheral areas of the prostate. With progressive compression and urinary obstruction there is an increased risk of secondary infection, and the development of urinary calculi. The bladder becomes distended, and the retrograde flow of urine can impair renal function and promote hydronephrosis. In the latter stages the flow of urine may become completely blocked, causing acute pyelonephritis, uremia, and death. In the vast majority of cases however, BPH rarely progresses beyond being an annoying chronic condition. The symptoms of BPH are a progressive frequency and urgency, difficulty initiating urination, decreased urine flow and force, and nocturia. Upon rectal examination the prostate is enlarged and has a rubbery consistency, and an abdominal exam may reveal a distended bladder that is palpable or percussible. The congestion of the superficial veins of the prostate and the trigone muscle of the bladder can cause hematuria if the patient strains while trying to void. Burning sensations and fever indicate secondary infection. Although testosterone levels typically decline with aging, it is clear that testosterone plays a role in the pathogenesis of the hyperplasia. Specifically, it is the conversion of testosterone into 5-alpha-dihydrotestosterone by 5-alpha-reductase within the prostate that is thought to cause the hypertrophy. 5-alpha-dihydrotestosterone is about fives times more potent than testosterone and thus has a greater stimulatory effect. Additionally, with the declining levels of testosterone estrogen levels begin to increase. Some researchers have speculated that the prostate is divided into an inner and outer mass, the outer mass responsive to testosterone and the inner to estrogen. With the relative increase of estrogen with aging, complexed with the ubiquitous influence of xenoestrogens from dietary and environmental sources, causes this inner prostatic mass to enlarge. Cadmium has also been found to induce prostatic hyperplasia in animals, and has been found to be elevated in prostatic tissues in patients with BPH, proportional to the elevated levels of 5-alpha-dihydrotestosterone. (Berkow 1992, 1736-37; Rubin 2001 501-02; Green 1991, 104-05; Brys et al 1997; Hoffmann et al 1985; Habib et al 1976)
The treatment of BPH is essentially the same as it is for chronic nonbacterial prostatitis. Treatment strategies for secondary infection will resemble that of bacterial prostatitis. Saw Palmetto (Serenoa serrulata) is one botanical that has undergone extensive investigation in the treatment of BPH, and has been found to inhibit 5-?-reductase, reduce inflammation, lower androgenic activity, and prevent spasm (Newall et al 1996, 237). It is by no means the only herb for BPH and should not be relied upon exclusively. Pumpkin and squash seeds (Cucurbita spp.) have also been traditionally used in BPH, and contain curcubitacin, as well as various tocopherols and sterols, that have been shown to enhance bladder tone and promote prostatic decongestion (Weiss 1988, 254). The seeds from fresh squash and pumpkin can be soaked overnight in cool water and then blended the next day to make a soothing diuretic. Other botanicals that are of benefit in relieving prostatic congestion are Fireweed root (Epilobium angustifolium) and Nettle root (Urtica dioica). Genitourinary trophorestoratives such as Ren Shen (Panax ginseng) and Ashvagandha (Withania somnifera) have long been used by elderly men to combat the effects of aging, and may be very important adjuncts in the treatment of BPH. Useful also are botanicals typically reserved for women, such as the emmenagogue Cotton root (Gossypium herbaceum) indicated in both acute and chronic prostatitis, and the uterine tonic Dang gui (Angelica sinensis) as a gonadal restorative. Botanicals that are helpful in the elimination of urinary calculi that can accompany BPH are Gravel root (Eupatorium purpureum), Couch Grass (Agropyron repens), Hydrangea (Hydrangea arborescens), and Horsetail (Equisetum arvense). To strengthen the trigone muscle of the bladder and relieve venous stasis Michael Moore suggests that the root of Mullein (Verbascum thapsus) may be helpful (1990, 16). To relieve the pain and spasm of BPH, Kava (Piper methysticum), Black Cohosh (Cimicifuga racemosa), or Trembling Aspen bark (Populus tremuloides) are indicated. Important nutritional supplements include zinc citrate (50 mg daily) to inhibit 5-alpha-reductase activity and selenium (200 mcg daily) to counter cadmium-induced prostatic hypertrophy, as well as vitamin E (800 IU daily), vitamin B complex (100 mg daily), and EPA/DHA (1200/800 mg daily).