Our Prostatitis Tips are very brief and cryptic. Join our prostatitis and pelvic pain forum to ask questions and get support.
The following distilled wisdom has been gleaned from the experience of the site managers, the advice of prostatitis researchers and discussion among sufferers on our CPPS/prostatitis forum. Our chronic prostatitis tips will not work for everyone, because we all have different genetic makeups, but there is a very good chance that some of these prostatitis tips could be extremely useful for you.
Things that help chronic prostatitis/CPPS
In general, to subdue symptoms you may have to change your lifestyle, diet, career, and approach to life psychologically. Maybe your genes will not comfortably allow you to be the go-getter or fire-eating Type-A personality you used to be before all this started. Maybe that high-stress power career is no good for you. At first you will mourn the loss of these things, but after a few years most men adjust and feel that the sickness has taught them valuable lessons about life, fostering a calmer, philosophical approach wherein attention is paid to relaxation, both physical and mental. Other men are able to maintain high pressure lifestyles with the addition of meditation, relaxation exercises and physical therapy.
- Release pelvic muscle spasms (read the theory behind this). Sitting tensely, unconsciously pulling the pelvic muscles upwards (check if you are doing it right now!) is probably the #1 cause of the syndrome. Consciously relax, dropping the pelvic floor whenever you can. Set a timer to remind you every 10 or 20 minutes. Seeking a physical therapist who knows about working on the pelvic floor is also highly advisable. Call around, take your time, make sure you select the right person. If you live in the US and have some funds, the Wise Anderson clinic is one of the best options.
- Avoid stress! This is one of the primary causes of the syndrome. Meditation is one of the popular and effect ways of controlling stress.
- Abdominal breathing, also known as belly breathing or diaphragmatic breathing. Diaphragmatic breathing is similar to deep sleep breathing, promoting a relaxation response that helps pelvic floor muscle relaxation via parasympathetic pathways. Abdominal breathing, especially the in-breathing, puts a gentle pressure on the pelvic floor that acts like a form of massage. So breathe deeply, using your STOMACH not chest, so that you feel your lower guts being pushed into the bottom of the pelvis. Feel the pressure right in the pelvic floor with each slow, deep breath. Do that 10 times. Then do that little exercise many times a day, whenever you remember. See how the pain subsides over a week or two.
- Stretching. Very important. Our forum describes many stretches that help to remove muscles spasms in the pelvis. There are also many available on YouTube.
- Your sympathetic nervous system is in overdrive (I'm under threat, fight or flight). This is an almost universal finding in men with UCPPS/prostatitis. You need to calm the sympathetic and boost the parasympathetic nervous system. There are many ways to do this, but breathing as above is one of the best, and see video below.
- Take Quercetin, which is a superb mast cell secretion blocker. Cycle 3 weeks on, 1 week off. It seems to work better that way. Quercetin can also be obtained in smaller quantities from natural sources, like Rooibos (Redbush) Tea, which is delicious hot or cold.
- Magnesium helps prevent muscle spasm and trigger points. Magnesium glycinate is recommended; magnesium citrate can cause diarrhea. You can also get magnesium by putting Epsom Salts in your bathwater.
- Buffered Vitamin C, up to 2g (2000mg) daily. Lowers histamine in blood by up to 38%. Protects against leaky gut. It’s a natural antihistamine (see studies 1 and 2)
- Avoid “edging” (delaying orgasm, stopping yourself from reaching orgasm right when you’re on the cusp). It is mentioned by many men as a cause or exacerbating factor in CP/CPPS.
- Consciously relax during ejaculation, which helps to avoid overstimulating the pelvic nerves and leads to far less post-orgasmic pain. Do not tense the pelvic muscles during ejaculation. Let your pelvis remain “limp”.
- Avoid fapmania (excessive masturbating). It's a known trigger for this condition. Twice a week is mentioned by many as the 'Goldilocks' frequency for ejaculation.
- Dry saunas are particularly helpful to many men because of the spasm-relaxing effect
- Avoid excessive sitting (pressure can be a mast cell trigger) and use a donut cushion if you have a sitting job. Avoid truck-driving, bicycling, computer game playing and horse riding.
- Avoid excessive exercising (a mast cell trigger) and fatigue, but do take gentle exercise, like walking.
- Climate: a hot, dry (immune-system-friendly) climate is preferable to a cold, wet one. Researchers in northern Europe report that cold weather (a mast cell trigger and muscle spasm promoter) coincides with flares.
- Elavil (amitriptyline) is a mast cell protector and muscle relaxant, and subdues nerve pain. However there are some problems.1
- Try alpha blockers (Flomax, Hytrin, Cardura etc) because they help many men. Use for at least 3 months to see full effect. Also thought to work in as yet unexplained ways (e.g. Hytrin attenuates nociception-induced substance P upregulation). There is evidence that a-blockers can lessen neurogenic inflammation.
- Antihistamine Vistaril (hydroxyzine) inhibits bladder mast cell activation by neurogenic stimuli and has anticholinergic, anxiolytic and analgesic properties. It is useful to take Flomax concurrently to stop Vistaril’s tensing (antimuscarinic) effect on bladder neck and peri-prostatic smooth muscle. Some people cannot tolerate hydroxyzine, and they may try Allegra (H1 receptor antagonist) and/or Zantac (H2 receptor antagonist). However note that only hydroxyzine is an anxiolytic and anticholinergic.
- Neurontin (an anticonvulsant) can be useful for nerve pain.
- Aloe Vera freeze dried, very useful if your main symptom is burning urethral pain. Good brands are Desert Harvest and True-Aloe.
- Botox injections (only via expert uros, currently under research) temporarily stuns nerves, allowing neural “wind up”, which causes mast cell degranulation, to subside.
- Palmitoylethanolamide (PEA), a chemical made from fat, found naturally in foods such as egg yolks and peanuts, and in the human body. It's used for pain and reduces chronic inflammation.
- Ultram (Tramadol) a synthetic analogue of codeine. Useful in breaking the pain cycle. Supposedly non-addictive, but some men have had problems. May degranulate mast cells, like other opioids (hydrocodone, Vicodin etc), so long term or frequent use not advised.
- Calcium Glycerophosphate takes acid out of food to help stop pain and urgency. Use when eating acid foods. Very useful. Cheap if you can buy the generic chemical from a lab, ridiculously expensive if you buy it as “Prelief”.
- Benzodiazepines (Valium, Klonopin, Xanax, Ativan as well as Lorazepam, Librium) for anxiety (a hallmark of CPPS patients) and to help release muscular spasm. For short term or occasional use only. Careful with addiction.
- A good nonacidic multivitamin that does not irritate the lower urinary tract. Vitamins that can burn the urothelium are Vit. C and B6 (through different mechanisms).
- Coenzyme Q10 (CoQ10): CoQ10 lessens spasm pain in CPPS patients. It is also useful for the myopathy (muscle pain) experienced by people taking statin drugs. (The effect of CoQ10 on CPPS was discovered by Mark, the webmaster of this site).
- Flower pollen extract is an anti-inflammatory, best taken in conjunction with Quercetin.
- Viagra and Cialis – also helps with sexual symptoms, if present
- Duloxetine (brand name Cymbalta) - duloxetine is a SNRI that comes with a bunch of warnings but may be worth trying if all else has failed
- Hot baths, which relax muscle tension
- Avoid foods to which you react with phlegm, stomach pain, diarrhoea, flushing, headache, rash, joint pain (allergens degranulate mast cells, releasing histamine, and this may be the cause of your condition). If you have IBS, investigate FODMAPs (google it) and consider excluding them from your diet.
- Chondroitin Sulfate also prevents mast cells from triggering pain by releasing a myriad of nasty chemicals when provoked by nerves, allergies or any of the many other things that stimulate these cells. You need to take it for a long time to get the full effect.
- Regular Ejaculation (about 2x a week) clears sequestered and irritating prostatic secretions, but avoid more than that
- Herbals / herbs : tribulus terrestris, nettle root, maca root, gotu kola and marshmallow
- Muscle relaxants like Flexeril (cyclobenzaprine) and baclofen can help some men
- CBD oil / tinctures: look for tinctures with high CBD content (>15%) and low THC content (<2%). Buy only from a dispensary or you don't know what you're buying.
- Follow the IC Diet restrictions
Stimulate the Parasympathetic Nervous System and Vagus Nerve with Belly Breathing:
Things that hurt
The traditional treatment for this malady has been (and for many urologists still is) antibiotics. We frown upon the use of antibiotics after they have failed — that’s one of the key prostatitis tips you need to remember. Avoid them. The archives are full of men reporting negative side-effects from these drugs. Most knowledgeable urologists today will discourage the use of antibiotics if they fail to cure a patient and cultures are negative. Unfortunately, many men are temporarily helped by these drugs, for complex reasons, and this convinces them that they have an infection, sending them looking for new prescriptions again and again. In extreme cases men have taken antibiotics continuously for years without any lasting benefit.
Irritants and triggers
Different people have different triggers/irritants, but here are the most common you may wish to experiment with avoiding:
- Psychological stress in mice and cats triggers their bladder mast cells. Most likely this occurs in humans and other mammals too.
- Tense sitting: computer game players ("gamers"), computer programmers, urban truck drivers, taxi drivers, all of these activities involve sitting for long periods with the pelvic muscles drawn up tight like a clenched fist. This is a one way trip to 'prostatitis'.
- Food: Excessive amounts of high sugar and acidic foods, alcohol, spices, vinegar, caffeine, coffee, chocolate, sodium benzoate (a histamine release trigger), milk products, tomatoes, cranberry drinks, Nutrasweet. Prostatitis Tip: an exclusion diet will define your unique list of food irritants and triggers.
- Wheat (and Gluten generally) can make mast cells more leaky and more prone to degranulate, and seems to be a specific trigger for many individuals, even those who test negative for celiac disease. Gluten can be a nerve poison in some individuals (search the forum for studies that prove this). The issue of diet is huge for some men, who swear that by modifying their diets they were able to calm or eliminate the pain in their groins. These men tend to be “atopic” (allergy-prone), reacting to some foods with diarrhoea, stomach pain, phlegmy or “tight” throats, headaches, rashes, excessive sweating, depression and fatigue.
- Sexual Activity: too much sex, too little sex. Avoid "edging", which gooses the pelvic nerves. Be sure to avoid “Tantric” sexual practices, which involve grasping the penis tightly to prevent ejaculation. Some men have reported that this started their problems, probably by creating pressure-induced micro-tears in the urothelium, exposing the body's immune system to spermatozoa, and causing an autoimmune reaction.
- Sitting excessively, or pressure on the perineum. Pressure may trigger mast cells. Sitting also encourages the upward-clenching of the pelvic floor.
- Marijuana is reported to be a trigger by many men (although CBD oil can be helpful, see above).
- Psychedelic mushrooms are reported as a trigger by one patient.
- Soda drinks / cooldrinks / energy drinks acidify the urine and can provoke flares.
- Anything that contains citric acid. Read ingredients!
- Exercise: strenuous exercise can provoke flares for some by triggering mast cells. Leg squats are particularly bad.
- Medications: avoid those which can cause urinary retention. Prostatitis Tip: be careful of decongestants such as Sudafed, Afrin etc. Some people report problems with SSRI antidepressants (Prozac, Zoloft, Celexa, Paxil etc). Some men say their condition was caused by thermogenics (Xenadrine, Hydroxycut). Several men have reported their condition being triggered by androstenedione (search forum), a direct hormone precursor of testosterone, which is used (abused?) to build muscles in bodybuilding. Dr Shoskes says he has seen many men report getting symptoms after taking testosterone. Some men experience bad effects from drugs like Prilosec and Aciphex (proton pump inhibitors), Lipitor (statin), Lescol (statin), and Sectral (beta blocker) to cause symptoms. Men report their prostatitis starting after using Minoxidil, others after using finasteride.
1 - Amitriptyline can have hormonal effects taken long term, and sometimes lead (in a few men) to gynecomastia (breast swelling) and impotence and/or decreased libido. It is also an anticholinergic, and taking it long-term may predispose to dementia. That said, it can be very helpful for some men. But if you start seeing libido loss, swollen breasts or erection difficulties, get off it and stay off it.