Background

Prostate infections in men can be acute (sudden onset and severe) and require urgent antibiotics. These infections are associated with chills, fever, pain in the lower back and genital area, urinary frequency and painful urination, body aches, and a clear infection of the urinary tract. These are relatively uncommon, and are easily diagnosed and treated by most physicians.

Much more common is low grade prostate pain, called prostadynia or Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS), or chronic nonbacterial prostatitis. These account for 90-95% of prostatitis diagnoses, and are poorly understood and treated by many physicians.

If pain is coming from up in the rectum in a male, one can use a finger to check up inside. Feel for a rounded area on the front part of the rectal wall near the end of your finger when the finger is all the way in. Normally, pushing on it will cause you to feel like you have to urinate. It should, however, not be painful. If it feels boggy when you push on it, or is painful — especially if it reproduces your pain — the prostate may be a major cause of your pelvic pain.

Treatment

Medications

Antibiotics

If chronic pelvic pain is associated with prostate tenderness, especially if you have urinary urgency with low volumes or burning when you pass water, take Cipro 500 to 750 mg twice a day or Doxycycline 100 mg twice a day (both are antibiotics) for six weeks. After six weeks stop the antibiotics. If your symptoms have improved and then recur when you stop the antibiotics, continue to take six-week courses of antibiotics until they stay gone. If they didn't improve with the first course of antibiotics, switch to the other antibiotic. This may be a very helpful treatment for you.

A few cautions: Do not use Doxycycline that is expired or out of date. This is one of the few times that an expired prescription can cause you harm or kill you. Also do not take magnesium within 4 to 6 hours of taking Cipro or it will block the absorption of the Cipro. As Cipro is more expensive (Doxycycline is cheap) it is even more important to not lose any of the absorption. Take the Cipro first thing in the morning and the last thing at night and take the magnesium in the middle of the day while you are on the Cipro.

Recommended Supplements

Antifungals

When on either of these antibiotics it is critical that you be on antifungals (like the medication Diflucan and/or an herbal antifungal mix) and a low sugar diet to prevent yeast overgrowth. Otherwise you will initially feel better and then you will get worse and worse with the antibiotics. The Diflucan dose would be 200 mg a day for 6-12 weeks and the herbal antifungal mix would be as directed each day for 2-5 months. Also note that coffee can aggravate the symptoms of prostatitis.

Other Therapies & Advice

If symptoms persist despite the antibiotics, see the sections on:

Pelvic Pain, Males

Rectal Pain

Contributor: 

Dr. Jacob Teitelbaum, MD

Jacob Teitelbaum, M.D. is a board certified internist and author of the popular free iPhone application “Cures A-Z,” which was ranked in the top 10 of all health/wellness downloads on iTunes. Dr. Teitelbaum is the author of the perennial bestseller From Fatigued to Fantastic! (Avery Penguin), which has sold over half a million copies; Pain Free 1-2-3 (McGraw-Hill); Three Steps to Happiness: Healing Through Joy (Deva Press); the Beat Sugar Addiction Now! series (Fair Winds Press);  Real Cause, Real Cure (Rodale Press); The Fatigue and Fibromyalgia Solution (Penguin/Avery); and his latest, The Complete Guide to Beating Sugar Addiction (Fair Winds Press, 2015).