Prostatitis

Non-pharmacological conservative measures

• Physiotherapy. A physiotherapist can help treat trigger points, defined as musculoskeletal areas where pressure or movement triggers pain. Treatment primarily involves massage, stretching, trigger point release through acupressure, myofascial release techniques, and addressing diaphragmatic and abdominal muscle hypertonia. Time is a crucial factor, as releasing these muscle fibers is a slow process.
• Electromagnetic therapy and microwave thermotherapy. Some studies with a small number of patients have demonstrated its usefulness in improving symptoms.
• Acupuncture. It involves inserting very fine needles into the skin at strategic points to stimulate nerves, muscles, and connective tissues, and to activate blood flow. A recent meta-analysis of 471 patients showed that acupuncture improved symptoms, suggesting it should be considered an effective and safe therapeutic alternative.
• Tibial nerve stimulation. These types of techniques, although promising, are reserved for very specific cases.
• Shock waves. In recent years, several studies have confirmed that therapy with shock waves It can improve the symptoms of chronic pelvic pain, while also improving quality of life and bladder emptying capacity, without showing significant adverse effects. Most studies are conducted with weekly treatment for 4 weeks, and it can be administered entirely on an outpatient basis and without anesthesia. This treatment helps regenerate blood vessels in the perineal muscles, reducing prostate inflammation, decreasing muscle contractures, and increasing blood flow to the prostate.

Pharmacotherapy

•  Anti-inflammatories. Nonsteroidal anti-inflammatory drugs (NSAIDs) improve symptoms related to chronic pelvic pain. However, this improvement is limited to the duration of treatment.
•  Alpha-blockers. Several studies have examined the effect of these drugs in treating this condition, with conflicting results. They likely have a beneficial effect, although this will be more pronounced in patients who also have urinary problems.
• Antibiotic therapy. This has long been the cornerstone of treatment, based on the clinical improvement patients experience while taking it. However, it remains unclear whether the long-term response rate is good. If administered, it should always be taken in long courses, for 6 weeks.
• 5-alpha-reductase inhibitors. Based on the available evidence, the use of this type of drug cannot be recommended in the treatment of chronic pelvic pain, at least not in general.
• Phytotherapy. Various extracts have shown benefits in improving symptoms compared to placebo, although the wide variety of available compounds does not allow for generalized conclusions to be drawn.
• Botulinum toxin. A recent study has demonstrated the possible effectiveness of Botox® injections in the pelvic muscles, although further studies are needed to support its usefulness.

Psychological therapy

In many cases, chronic pelvic pain has significant psychological consequences for the patient. These can range from general mood changes to difficulties with sexual performance. In these cases, a psychological/sexological evaluation can help improve the situation.