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Prostatitis and benign prostatic hyperplasia (BPH) are almost as common as the common cold: They affect 50 percent of men by age 50 and 80 percent of men by age 70. Still, medical experts do not completely understand the causes of these prostate problems — or how best to treat them.

Prostatitis is an inflammation of the gland; BPH is an enlargement that usually comes with aging. Both press on the urethra, making it difficult to urinate or empty the bladder, often causing frequent urination as well as pain, sexual dysfunction, and psychological distress. These prostate issues, however, are generally benign and not necessarily precursors to prostate cancer.

For BPH, Harvard Medical School experts note that “if your symptoms are mild and not particularly bothersome, your doctor will recommend a conservative approach called watchful waiting.”

Three types of drugs are available to treat BPH: 5-alpha-reductase inhibitors (5ARIs), phosphodiesterase 5 inhibitors, and alpha blockers, including the well-known Flomax. These meds can produce common side effects, including — especially in the case of 5ARIs — erectile dysfunction and lowered libido.

Prostatitis is often treated with a four- to six-week course of antibiotics, but bacteria actually cause only 5 to 10 percent of cases.

Most prostatitis incidents do not show signs of infection, according to functional-medicine practitioner Chris Kresser, MS, LAc; these cases are referred to as chronic prostatitis (CP) or chronic pelvic pain syndrome (CPPS).

“CP/CPPS is notorious for being the most difficult type of prostatitis to live with,” he writes on his blog. “Due to its complex nature, CP/CPPS is difficult to treat and often doesn’t respond to conventional medical interventions.”

“CP/CPPS is notorious for being the most difficult type of prostatitis to live with,” he writes on his blog. “Due to its complex nature, CP/CPPS is difficult to treat and often doesn’t respond to conventional medical interventions.”

New studies are revealing possible causes of CP/CPPS, Kresser reports. “Emerging research indicates that the gut microbiome and reproductive tract are closely linked in terms of health and that bacterial imbalances in the gut may increase the risk of prostatitis,” he writes.

Other causes may include disrupted urinary and seminal microbiomes; ­altered levels of adrenocortical hormones and low testosterone; inflammation and oxidative stress; exposure to environmental toxins; and autoimmunity.

With this new understanding of the root causes, practitioners are exploring new treatments. “The primary goals of the functional approach are to restore health to the gut, seminal, and urinary microbiomes, balance the HPA [hypothalamic-pituitary-adrenal] axis, reduce toxic exposures and inflammation, and decrease stress,” Kresser notes.

He also highlights the benefits of ancient natural treatments, such as phytotherapy, including saw palmetto and rye pollen extract.

Stress may play a role in prostate issues, and Kresser says mind–body therapies can also help. “Pelvic-floor biofeedback is a form of ‘muscular reeducation’ that teaches men how to relax their pelvic-floor muscles, thus helping to correct the pelvic-floor dysfunction and pelvic-pain characteristic of prostatitis.”

Trials have also found that acupuncture can reduce stress and pain, as well as ease urinary symptoms.

Michael
Michael Dregni

Michael Dregni is an Experience Life deputy editor.

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