Prostatitis
Treatment
in Seomyeon, Busan

What Is Prostatitis?

Normal prostate (left) vs inflamed prostate (right) — inflammation narrows the urethral passage and causes pelvic pain.

Prostatitis (전립선염) is inflammation of the prostate gland — a common urological condition affecting men of all ages, unlike BPH which is primarily age-related. Unlike BPH which produces obstructive urinary symptoms without pain, prostatitis characteristically causes pelvic, genital, perineal, or lower back pain, combined with urinary and sometimes sexual symptoms. Approximately 10-15% of men will experience prostatitis symptoms at some point in their lives, making it one of the most common reasons for urology consultation in men under 50.

Prostatitis is not a single disease but a group of conditions with distinct causes, symptoms, and treatments. The National Institutes of Health (NIH) classification defines four categories based on the underlying pathology. Accurate categorisation is essential because treatment differs fundamentally — bacterial prostatitis requires targeted antibiotics, while the most common form (CPPS / chronic pelvic pain syndrome) is primarily non-infectious and responds to a very different treatment approach. Misdiagnosis leads to ineffective repeated antibiotic courses and prolonged patient suffering — a common pattern we see in revision cases.

Common Prostatitis Symptoms

NIH Classification — 4 Types of Prostatitis

Accurate categorisation determines treatment. At consultation, the urologist uses history, symptoms, and diagnostic testing to identify your specific category.

3 Treatment Modalities

Once the prostatitis category is identified, treatment combines one or more of three main modalities. Acute bacterial prostatitis is primarily treated with antibiotics. Chronic bacterial prostatitis requires prolonged targeted antibiotics plus supportive care. CPPS (the most common form) responds best to a multimodal approach combining all three modalities simultaneously.

Modality 01

Physical Therapy

— 물리치료 (Thermal & Pelvic Floor)

Thermal therapy using the Beluga device delivers controlled heat to the prostate, improving blood flow, reducing inflammation, and relaxing pelvic floor muscle tension. Combined with pelvic floor physiotherapy and biofeedback for comprehensive non-medication treatment — especially effective for CPPS.

• Beluga thermal prostate therapy device
• Pelvic floor relaxation and biofeedback
• Sessions: 2–3 per week for 4–8 weeks
• Ideal for: CPPS, chronic pelvic pain
• Drug-free treatment modality

Modality 02

Targeted Medication

— 약물치료 (Drug Therapy)

Culture-guided antibiotics for bacterial types (fluoroquinolones, Bactrim — prostate-penetrating drugs), alpha-blockers for urinary symptoms, NSAIDs or anti-inflammatories for pain and inflammation, muscle relaxants for pelvic tension, and neuromodulators (amitriptyline, pregabalin) for neuropathic pelvic pain in selected CPPS cases.

• Antibiotics: culture-guided, 4–12 weeks
• Alpha-blockers: tamsulosin, silodosin
• Anti-inflammatories: NSAIDs, COX-2
• Neuromodulators: for chronic CPPS pain
• Individualised per NIH category

Modality 03

Symptomatic Care

— 대증요법 (Supportive Therapy)

Warm sitz baths (15-20 minutes, 2-3 times daily) provide immediate symptomatic relief by relaxing pelvic muscles. Lifestyle modification includes hydration, avoiding prolonged sitting, dietary adjustments (limiting spicy foods, caffeine, alcohol), stress management, and regular gentle exercise. Often combined with the other modalities.

• Warm sitz baths 15-20 min, 2-3x daily
• Hydration 2-3L water daily
• Diet: avoid spicy, caffeine, alcohol triggers
• Activity: avoid prolonged sitting, cycling
• Stress management and sleep hygiene

Treatment Matching by NIH Category

• Category I (Acute Bacterial): immediate broad-spectrum IV/oral antibiotics, then culture-guided 4-6 week course. Supportive care for symptoms.
• Category II (Chronic Bacterial): 6-12 weeks of culture-guided prostate-penetrating antibiotics (fluoroquinolones, Bactrim). Alpha-blocker for urinary symptoms.
• Category III (CPPS): multimodal approach combining all three modalities — physical therapy + tailored medication + symptomatic care. 3-12 months expected treatment duration.
• Category IV (Asymptomatic): usually no treatment needed; observation and counselling. Treatment only if PSA concerns or infertility.