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QUESTION: My urologist or at least his PA finally concluded that I have nonbacterial prostatitis  and I am still confused as to how I got it. It seemed to coincide with the last time I had sex. I was on two terms of antibiotics so bacterial has been ruled out. Could it have been diet all along? Too  much spicy or caffeine? Or is the initial cause always something else? The PA said with this  type of thing  it is often a one step forward and two step back. To me that implies it could never get better but even without meds other than hyophen occasinally I've gradually felt a little better with fewer flare ups. Also that prostatitis isn't in fact an infection but just inflamation. What does that mean? What tangible issue is there that creates the discomfort? Could the sex have somehow been the initial issue even without the presents of an STI? Now if I cut my hand when cooking and was using onions and salt it would hurt the cut but the rest of the hand feel fine. If there is no real damage to the prostate what could make it hurt? And could I never again have spicy good, caffeine, acidic foods, etc? Also I can't seem to pin point the exact foods that increase the pain. Anyway to find out scientifically?

ANSWER: James:

You are going to drive yourself crazy trying to figure out where the prostatitis came from.  And just because you were on 2 antibiotics does not necessarily mean that a bactterial source has been completely ruled out.

Prostatitis is a combination of several disorders that all involve inflammation.  Arthritis of the joints is another example of inflammation without infection.  Sexual activity is usually not considered a cause of prostatitis.

What makes the prostate hurt is the inflammation (soreness, redness and swelling) which can take place without any obvious injury.

When the prostate is acting up and sore, avoidance of caffeine, hot spices and high potassium foods is usually recommended along with taking anti-inflammatories and hot sitz baths.

The only way to find out "scientifically" which foods bother you is to avoid a particular food for 2-3 days then have a large "meal" of that food and see what happens to your prostate.  If your symptoms flare up, then you know you are probably sensitive to that particular food.

---------- FOLLOW-UP ----------

QUESTION: I am now taking a antispastic drug and avoiding spicy and caffeine. If it is nonbacterial is there a good chance I could  be cured in two months?

ANSWER: James:

There are no guarantees in prostatitis. If you respond well, symptoms could be dramatically reduced in that time.  Let's hope so.

---------- FOLLOW-UP ----------

QUESTION: You said sex is usually not the cause of prostatitis. Is it usually food alone? What is the main reason so I can make it my main focus? Masterbation a huge factor? Or should stimulating  the prostate be completely avoided? I still can't visualize what causes the inflamation and keeps it inflamed. Is it scarred and I'm  waiting for it to heal up so I can resume normal life?


The underlying cause is not well understood as some are clearly infection related and others not.  Increased sexual activity seems to be related but sex alone doesn't cause it and neither does diet.  Some scarring is likely in prolonged and severe prostatitis.  Here is a brief summary from the American Urological Association Foudnation:

Prostatitis (Prostate Infection)

What is prostatitis?

Prostatitis is a condition that involves inflammation of the prostate and sometimes the area around it.  There are several types of prostatitis, each with a range of symptoms.  Some men with the disease will experience severe pain and others will not be bothered; and the rest fall in between the two.  However, the symptoms of the disease do have a significant impact on a manís quality of life.

What are the different types of prostatitis and their causes?
Acute bacterial prostatitis is the least common type of prostatitis but the most easily recognized.  It is usually caused by a sudden bacterial infection and easy to diagnose because of the typical symptoms and signs. It is a severe urinary tract infection associated often with fevers and chills, and a visit to a doctor or hospital is required. Acute bacterial prostatitis can affect any age group. The symptoms include painful urination; inability to empty the bladder, pain in the lower back, abdomen or pelvic area; and fever and chills.
Chronic bacterial prostatitis is similar to acute bacterial prostatitis but the symptoms develop gradually and are less severe.  Characterized by recurrent urinary tract infections in men; this condition can affect any age group but is most common in young and middle-aged men.
Chronic prostatitis/chronic pelvic pain syndrome/Nonbacterial prostatitis /prostatodynia, is the most common types of prostatitis. The exact cause of this non-bacterial prostatitis condition is unknown.  However, the disease could stem from persistent infection, inflammation and/or pelvic muscle spasms. Inflammation in the prostate can also occur without symptoms. For patients experiencing symptoms they do include; pain in the genitals and pelvic area, difficulty or pain urinating, and sometimes pain during or after ejaculation.
Asymptomatic inflammatory prostatitis is prostatitis without symptoms, despite an inflammation of the prostate.  Diagnosis is made when the patient is being evaluated for symptoms unrelated to prostatitis.  In cases such as these is, evidence of inflammation is found in biopsied tissue or specimens of urine, semen or prostatic fluid.

What causes prostatitis?

The direct causes of prostatitis are not fully known by the medical community.  However, there are several accepted theories.  Some cases of prostatitis are clearly related to acute and chronic bacterial prostatitis infections.  These infections get into the prostate from the urethra by backward flow of infected urine into the prostate ducts. Bacterial prostatitis is not contagious and is not a sexually transmitted disease. A sexual partner cannot catch this infection.

Certain conditions or medical procedures increase the risk of contracting bacterial prostatitis. There is a higher risk if the man has recently had a catheter or other instrument inserted into his urethra, an abnormality of his urinary tract or a recent bladder infection.

Chronic prostatitis/chronic pelvic pain syndrome may be caused by atypical organisms such as chlamydia, mycoplasma (which may be transmitted by sexual contact) ureaplasma or may also be due to a chemical or immunologic reaction to an initial injury or previous infection. The nerves and muscles in the pelvis may cause pain in the area, either as a response to the prostate infection or inflammation or as an isolated problem itself.  


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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