Treatment

Prostatitis

Conservative non-pharmacological measures

• Physiotherapy. The intervention of a physiotherapist can help to treat trigger points, defined as osteo-muscular areas, whose pressure or mobilization triggers pain. It is based, above all, on massage, stretching, release of trigger points by acupressure, myofascial induction techniques and treatment of diaphragmatic hypertonia and abdominal musculature. Time is a key factor, as the release of fibers is a slow process.
• Electromagnetic therapy and microwave thermotherapy. Some studies with few patients have demonstrated their usefulness in the improvement of symptoms.
• Acupuncture. It consists of inserting very fine needles into the skin at strategic points in order to stimulate nerves, muscles and connective tissues and activate blood flow. In a recent meta-analysis of the experience of 471 patients, it was observed that acupuncture improved symptoms, so it should be considered as an effective and safe therapeutic alternative.
• Tibial nerve stimulation. These types of techniques, although promising, are reserved for very specific cases.
• Shockwave. In recent years, several studies have confirmed that shock wave therapy can improve the symptoms of chronic pelvic pain, while improving the quality of life and the ability to empty the bladder, without showing significant adverse effects. Most of the studies are conducted with a weekly treatment for 4 weeks, being possible to administer it on a completely ambulatory basis and without anesthesia. This treatment contributes to regenerate the blood vessels at the level of the perineal muscles allowing to diminish the inflammation of the prostate, to diminish the muscular contractures and to increase the blood flow in the prostate.

Pharmacological treatment

• Anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs (NSAIDs) improve symptoms related to chronic pelvic pain. However, this improvement is limited to the time of treatment with them.
• Alpha-blockers. Several studies have observed the effect of these drugs in the treatment of this pathology with discordant results. They probably have a beneficial effect, although this will be more pronounced in patients who also present voiding problems.
• Antibiotic therapy. This has been the mainstay of treatment for a long time, based on the clinical improvement patients show while taking it. However, it is not clear that the long-term response rate is good. If given, 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 drugs in the treatment of chronic pelvic pain cannot be recommended, at least in general.
• Phytotherapy. Several extracts have shown benefits in symptom improvement with respect to placebo, although the wide variety of available compounds does not allow drawing generalized conclusions.
• Botulinum toxin. In a recent study, the possible efficacy of Botox® injections in the pelvic musculature has been demonstrated, although more studies are needed to support its usefulness.

Psychological therapy

In many cases, chronic pelvic pain has important psychological consequences for the patient. These can range from general mood alterations to difficulties in sexual performance. In this case, a psychological/sexological evaluation may help to improve the condition.