<unk><unk> <unk><unk>  is difficult to treat. Initial recommendations include education regarding the condition, stress management, and behavioral changes. Non-drug treatments Current guidelines by the European Association of Urology include: *<unk>  education: conversation with the patient about<unk> , its causes and impact. * Physical therapy: some protocols focus on stretches to release overtensed muscles in the<unk>  or anal area (commonly referred to as trigger points) including intrarectal digital massage of the<unk>  floor, physical therapy to the<unk>  area, and progressive relaxation therapy to reduce causative stress. A device, that is typically placed in the rectum, has also been created for use together with relaxation. This process has been called the Stanford protocol or the Wise-Anderson protocol. The American Urological Association in 2014 listed manual physical therapy as a second line treatment. Kegel exercises are not recommended. Treatment may also include a program of "paradoxical relaxation" to prevent<unk>  tensing of the<unk>  musculature. * Psychological therapy: as most<unk> <unk>  conditions, psychotherapy might be helpful in its management regardless its direct impact on<unk> . Other non-drug treatments that have been evaluated for this condition include acupuncture, extracorporeal shockwave therapy, programs for physical activity, transrectal thermotherapy and a different set of recommendations regarding lifestyle changes. Acupuncture probably leads to a decrease in prostatitis symptoms when compared with standard medical therapy but may not reduce sexual problems. When compared with a simulated procedure, extracorporeal shockwave therapy also appears to be helpful in decreasing prostate symptoms without the impact of negative side effects but the decrease may only last while treatment is continued. As of 2018 use of extracorporeal shockwave therapy had been studied as a potential treatment for this condition in three small studies; there were short term improvements in symptoms and few adverse effects, but the medium terms results are unknown, and the results are difficult to generalize due to low quality of the studies. Physical activity may slightly reduce physical symptoms of<unk>  prostatitis but may not reduce anxiety or depression. Transrectal thermotherapy, where heat is applied to the prostate and<unk>  muscle area, on its own or combined with medical therapy may cause symptoms to decrease slightly when compared with medical therapy alone. However, this method may lead to transient side effects. Alternative therapies like prostate massage or lifestyle modifications may or may not reduce symptoms of prostatitis. Transurethral needle ablation of the prostate has been shown to be ineffective in trials. Neuromodulation has been explored as a potential treatment option for some time. Traditional spinal cord stimulation, also known as dorsal column stimulation has been inconsistent in treating<unk> <unk> : there is a high failure rate with these traditional systems due to the inability to affect all of the<unk> ful areas and there remains to be consensus on where the optimal location of the spinal cord this treatment should be aimed. As the innervation of the<unk>  region is from the sacral nerve roots, previous treatments have been aimed at this region; however<unk>  pathways seem to elude treatment solely directed at the level of the spinal cord (perhaps via the sympathetic nervous system) leading to failures. Spinal cord stimulation aimed at the mid- to high-thoracic region of the spinal cord have produced some positive results. A newer form of spinal cord stimulation called dorsal root ganglion stimulation (DRG) has shown a great deal of promise for treating<unk> <unk>  due to its ability to affect multiple parts of the nervous system simultaneously - it is particularly effective in patients with "known cause" (i.e. post surgical<unk> , endometriosis, pudendal neuralgia, etc). Medications A number of medications can be used which need to be tailored to each person's needs and types of symptoms (according to UPOINTS). * Treatment with antibiotics is controversial. A review from 2019 indicated that antibiotics may reduce symptoms. Some have found benefits in symptoms, but others have questioned the utility of a trial of antibiotics. Antibiotics are known to have anti-inflammatory properties and this has been suggested as an explanation for their partial efficacy in treating CPPS. Antibiotics such as fluoroquinolones, tetracyclines and macrolides have direct anti-inflammatory properties in the absence of infection, blocking inflammatory chemical signals (cytokines) such as interleukin-1 (IL-1), interleukin-8 and tumor necrosis factor (TNF), which coincidentally are the same cytokines found to be elevated in the semen and EPS of men with<unk>  prostatitis. The UPOINT diagnostic approach suggests that antibiotics are not recommended unless there is clear evidence of infection. * The effectiveness of alpha blockers (tamsulosin, alfuzosin) is questionable in men with CPPS and may increase side effects like dizziness and low blood pressure. A 2006 meta-analysis found that they are moderately beneficial when the duration of therapy was at least 3 months. * An estrogen reabsorption inhibitor such as mepartricin improves voiding, reduces urological<unk>  and improves quality of life in patients with<unk>  non-bacterial prostatitis. * Phytotherapeutics such as quercetin and flower pollen extract have been studied in small clinical trials. A 2019 review found that this type of therapy may reduce symptoms of CPPS without side effects, but may not improve sexual problems. * 5-alpha reductase inhibitors probably help to reduce prostatitis symptoms in men with CPSS and don't appear to cause more side effects than when a placebo is taken. * Anti-inflammatory drugs may reduce symptoms and may not lead to associated side effects. * When injected into the prostate, Botulinum toxin A (BTA) may cause a large decrease in prostatitis symptoms. If BTA is applied to the muscles of the<unk> , it may not lead to the reduction of symptoms. For both of these procedures, there may be no associated side effects. * For men with CPPS, taking allopurinol may give little or no difference in symptoms but also may not cause side effects. * Traditional Chinese Medicine may not lead to side effects and may reduce symptoms for men with CPPS. However, these medicines probably don't improve sexual problems or symptoms of anxiety and depression. * Therapies that have not been properly evaluated in clinical trials although there is supportive anecdotal evidence include gabapentin, benzodiazepines and amitriptyline. * Diazepam suppositories are a controversial treatment for CPPS - proponents believe that by delivering the medication in a closer proximity to the area of<unk>  that better relief can be achieved. This has never been substantiated in any research and this hypothesis is invalid due to the fact that benzodiazepines act on the GABA receptor which is present in the central nervous sytem. This means that regardless of the route of administration (oral versus rectal/intra-vaginal), the drug will still need to travel to the central nervous system to work and is no more or less effective when given in this capacity. Research shows this method of delivery takes longer to achieve peak effect, lower bioavailability and lower peak serum plasma concentration. Emerging research In a preliminary 2005 open label study of 16 treatment-recalcitrant CPPS patients, controversial entities known as nanobacteria were proposed as a cause of prostatic calcifications found in some CPPS patients. Patients were given EDTA (to dissolve the calcifications) and 3 months of tetracycline (a calcium-leaching antibiotic with anti-inflammatory effects, used here to kill the "pathogens"), and half had significant improvement in symptoms. Scientists have expressed strong doubts about whether nanobacteria are living organisms, and research in 2008 showed that "nanobacteria" are merely tiny lumps of abiotic limestone. The evidence supporting a viral cause of prostatitis and<unk><unk> <unk><unk>  is weak. Single case reports have implicated herpes simplex virus (HSV) and cytomegalovirus (CMV), but a study using PCR failed to demonstrate the presence of viral DNA in patients with<unk><unk> <unk><unk>  undergoing radical prostatectomy for localized prostate cancer. The reports implicating CMV must be interpreted with caution, because in all cases the patients were immunocompromised. For HSV, the evidence is weaker still, and there is only one reported case, and the causative role of the virus was not proven, and there are no reports of successful treatments using antiviral drugs such as aciclovir. Due to the concomitant presence of bladder disorders, gastrointestinal disorders and mood disorders, research has been conducted to understand whether<unk>  might be caused by problems with the hypothetical bladder-gut-brain axis. Research has been conducted to understand how<unk>  bladder<unk>  affects the brain, using techniques like MRI and functional MRI; as of 2016, it appeared that males with<unk>  have increased grey matter in the primary somatosensory cortex, the insular cortex and the anterior cingulate cortex and in the central nucleus of the amygdala; studies in rodents have shown that blocking the metabotropic glutamate receptor 5, which is expressed in the central nucleus of the amygdala, can block bladder<unk> .
Chronic prostatitis/chronic pelvic pain syndrome
Benign prostatic hyperplasia
symptom of Benign prostatic hyperplasia
Cancer
symptom of Urethral cancer
Prostatitis
symptoms of Bladder cancer
Overactive bladder