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- Abrasions, anal fissure, autolytic debridement, bed sore, Clostridium sp., collagen, collagen matrix, cuts, debridement, decubitus ulcer, diabetic ulcers, electrotherapy, epithelial, epithelialization phase, extravasation, gangrene, gas gangrene, human growth factors, hydrocolloid, hyperbaric oxygen, incision wounds, incontinence, infected surgical wounds, infectious arthritis, inflammatory phase, injuries, laceration, macrophages, mechanical debridement, microvascular, minor injuries, myonecrosis, necrotizing fasciitis, pressure ulcers/wound care, proliferative phase, puncture wound, remodeling phase, scrapes, scratches, sepsis, septic arthritis, skin damage caused by incontinence, skin graft healing (split thickness), skin ulcer, surgical skin flap ischemia, skin wounds, squamous, stitches, superficial, suture, vulnerary, wound care, wound healing.
- A wound is a break in the outer layer of the skin, called the epidermis. Wounds are usually caused by cuts or scrapes. Different kinds of wounds may be treated differently from one another, depending upon how they happened and how serious they are. Other wounds include puncture wounds, lacerations (cuts), pressure sores, anal fissures, extravasations (a drug accidentally going outside of a vein causing tissue damage), skin damage caused by incontinence (lack of bladder control), skin graft healing (split thickness), diabetic ulcers, and surgical skin flap ischemia (lack of blood flow to surgically attached skin).
- Healing is a response to the injury that sets into motion a sequence of events. With the exception of bone, all tissues heal with some external scarring. The object of proper care is to minimize the possibility of infection and scarring.
- There are basically four phases to the healing process: the inflammatory phase, proliferative phase, remodeling phase, and epithelialization phase.
- The inflammatory phase begins with the injury itself. In the inflammatory phase, there is bleeding, immediate narrowing of the blood vessels, clot formation, and release of various chemical substances into the wound that will begin the healing process. Specialized cells (macrophages) clear the wound of debris over the course of several days.
- Next is the proliferative phase in which a matrix or latticework of cells forms. On this matrix, new skin cells and blood vessels will form. It is the new small blood vessels (known as capillaries) that give a healing wound its pink or purple-red appearance. These new blood vessels will supply the rebuilding cells with oxygen and nutrients to sustain the growth of the new cells and support the production of proteins (primarily collagen). The collagen acts as the framework upon which the new tissues build. Collagen is the dominant substance in the final scar.
- The remodeling phase begins after 2-3 weeks. The framework (collagen) becomes more organized making the tissue stronger. The blood vessel density becomes less, and the wound begins to lose its pinkish color. Over the course of six months, the area increases in strength, eventually reaching 70% of the strength of uninjured skin.
- Epithelialization is the process of laying down new skin, or epithelial, cells. The skin forms a protective barrier between the outer environment and the body. Its primary purpose is to protect against excessive water loss and bacteria. Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean, sutured (stitched) wound. Open wounds may take 7-10 days because the inflammatory process is prolonged, which contributes to scarring. Scarring occurs when the injury extends beyond the deep layer of the skin (into the dermis, which is the second layer of skin).
- Unclear or conflicting scientific evidence:
- Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Study results of aloe on wound healing are mixed with some studies reporting positive results and others showing no benefit or potential worsening of the condition. Early studies suggest that aloe may help heal skin ulcers. High-quality studies comparing aloe alone with placebo are needed.
- Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
- Alpha-lipoic acid: Alpha-lipoic acid (ALA) may reduce tissue damage that is often caused by long-term exposure to high levels of oxygen. While early studies are promising, more research is needed to fully understand how ALA might work for wound healing in patients undergoing hyperbaric oxygen therapy.
- Avoid if allergic to alpha-lipoic acid (ALA). Use cautiously with diabetes and thyroid diseases. Avoid with thiamine deficiency or alcoholism. Avoid if pregnant or breastfeeding.
- Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required (for example, due to inborn errors of urea synthesis, protein malnutrition, excess ammonia production, excessive lysine intake, burns, infection, peritoneal dialysis, rapid growth, or sepsis). Arginine has been suggested to improve the rate of wound healing in elderly individuals. A randomized, controlled clinical trial reported improved wound healing after surgery in head and neck cancer patients, following the use of an enteral diet supplemented with arginine and fiber. Arginine has also been used topically (on the skin) to attempt to improve wound healing. Early studies suggest that arginine may also help treat chronic anal fissures. Additional studies are needed.
- Avoid if allergic to arginine, or with a history of stroke, liver, or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
- Aromatherapy: Aromatherapy is a technique in which essential oils from plants are used with the intention of preventing or treating illness, reducing stress, or enhancing well-being. Preliminary data from one small study suggests aromatherapy may contribute to reduced pain intensity during dressing changes in wound care. Data are insufficient for forming any opinion for or against this application.
- Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
- Ayurveda: There is some evidence that a traditional Ayurvedic treatment using specially prepared alkaline threads (ksharasutra or Ayurvedic setons) to achieve gradual cauterization may provide an effective alternative to surgery in patients being treated for anal fissures. Further research is needed to confirm these results.
- Ayurvedic herbs should be used cautiously. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking. Use guggul cautiously with peptic ulcer disease. User should avoid sour food, alcohol and heavy exercise. Mahayograj guggul should not be taken for long periods of time. Pippali (Piper longum) should be taken with milk and avoided with asthma. Avoid sweet flag, and avoid amlaki (Emblica officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages and medical conditions that require surgery.
- Bovine cartilage: Reduction in inflammation and edema (swelling) and enhancement of the healing of wounds were effects that appeared in the medical literature of bovine cartilage during the 1950s and 1960s. In a preliminary comparison of potential wound healing effects with a commercially available ointment of 10% powdered bovine cartilage (Catrix® 10 Ointment) or Aquaphor® original formula in post-operative facial skin care with a laser resurfacing agent, Catrix® 10 Ointment was better. However, this study was a pilot study so its results need confirmation by follow-up clinical studies that clearly have the appropriate randomization and are double-blinded, given that such were in absence in this study. Also lacking in this study was a definition of primary outcome that therapeutically differentiated Catrix® 10 Ointment.
- Avoid if allergic or hypersensitive to bovine cartilage or any of its constituents. Use cautiously with cancer, renal (kidney) failure, or hepatic (liver) failure. Avoid if pregnant or breastfeeding.
- Calendula: Calendula (Calendula officinalis), also known as pot marigold, has been widely used on the skin to treat minor wounds, skin infections, burns, bee stings, sunburn, warts, and cancer. Calendula is commonly used topically (on the skin) to treat minor skin wounds. Reliable human research is necessary before a firm conclusion can be drawn regarding the use of calendula for wound healing.
- Avoid if allergic to plants in the Aster/Compositae family, such as ragweed, chrysanthemums, marigolds, and daisies. Use cautiously in patients taking sedatives, blood pressure medications, cholesterol medications, blood sugar-altering agents, and immunomodulators. Use cautiously with diabetes and in children. Avoid if pregnant or breastfeeding.
- Chamomile: Chamomile (Matricaria recutita, Chamaemelum nobile) has been used medicinally for thousands of years, and is widely used in Europe. There is promising preliminary evidence supporting the topical use of chamomile for wound healing. However, the available literature is not adequate to support the use of chamomile for this indication.
- Avoid if allergic to chamomile. Anaphylaxis, throat swelling, skin allergic reactions and shortness of breath have been reported. Chamomile eyewash can cause allergic conjunctivitis (pinkeye). Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
- Chitosan: There is limited evidence on the effects of chitosan in wound healing. Better studies are needed.
- Avoid if allergic or sensitive to chitosan or shellfish. Use cautiously with diabetes or bleeding disorders. Use cautiously if taking drugs, herbs, or supplements that lower blood sugar or increase the risk of bleeding. Chitosan may decrease absorption of fat and fat-soluble vitamins from foods. Chitosan is not recommended during pregnancy or breastfeeding.
- Dimethylsulfoxide (DMSO): Dimethylsulfoxide (DMSO) is a sulfur-containing organic compound. DMSO occurs naturally in vegetables, fruits, grains, and animal products. DMSO applied to the skin may prevent tissue death after extravasation of anticancer agents. It can be applied alone or with steroids. Limited available study also suggests that DSMO improves lack of blood flow in surgical skin flap ischemia. Currently, there is not enough scientific evidence available for the use of topical DMSO for diabetic ulcers.
- Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.
- Eucalyptus oil: Eucalyptus (Eucalyptus globulus) oil contains 70-85% 1,8-cineole (eucalyptol), which is also present in other plant oils. Limited evidence suggests that eucalyptus essential oil may be beneficial for patients with skin ulcers when combined with antibiotics. More studies are needed to confirm these early findings.
- Case reports describe allergic rash after exposure to eucalyptus oil, either alone or as an ingredient in creams. Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use caution if driving or operating machinery. Avoid with a history of acute intermittent porphyria. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
- Gotu kola: Gotu kola, Centella asiatica (formerly known as Hydrocotyle asiatica), has a long history of use, dating back to ancient Chinese and Ayurvedic medicine. Preliminary study has demonstrated the ability of Centella asiatica extracts to promote wound healing, possibly through the stimulation of collagen synthesis. However, additional human study is needed in this area.
- Avoid if allergic to gotu kola, asiaticoside, asiatic acid, or madecassic acid. Avoid with a history of high cholesterol, cancer, or diabetes. Avoid if pregnant or breastfeeding.
- Honey: Honey is a sweet, viscid fluid produced by honeybees (Apis melliflera) from the nectar of flowers. The primary studied use of honey is for wound management, particularly in promoting rapid wound healing, deodorizing, and debriding necrotic tissue. The types of wounds studied are varied; most are non-healing wounds such as chronic ulcers, postoperative wounds, and burns. Currently, there is insufficient human evidence to support the use of honey for skin graft healing. Although honey has apparent antibacterial effects, more human study is needed in this area.
- Avoid if allergic or hypersensitive to honey, pollen, celery, or bees. Honey is generally considered safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
- Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. These approaches have been used for the relief of various diseases and injuries, or for general well being. Hydrotherapy has been used in patients with pressure ulcers, and preliminary research suggests that daily whirlpool baths may reduce the time for wound healing. Better research is necessary in this area before a firm conclusion can be drawn.
- There is a risk of infection from contaminated water if sanitary conditions are not maintained. Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.
- Iodine: It is not clear if healing of wounds or skin ulcers is improved with the application of topical iodine solutions. Iodine solutions may assist with sterilization as a part of a larger approach to the wound healing process.
- Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
- Magnet therapy: The use of magnets to treat illness has been described historically in many civilizations. In modern times, magnetic fields play an important role in Western medicine, including use for magnetic resonance imaging (MRI), pulsed electromagnetic fields, and experimental magnetic stimulatory techniques. Early scientific evidence suggests that the time to heal wounds, including ulcers, may decrease with the use of static magnets. Better quality studies are needed before a firm recommendation can be made for wound healing.
- Avoid with implantable medical devices, such as heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment.
- Pantothenic acid (vitamin B5): Pantothenic acid (vitamin B5) is essential to all life and is a component of Coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol. In animal research, oral and topical pantothenic acid has been associated with accelerated skin wound healing. However early human study results conflict. Additional evidence is necessary before a clear conclusion can be reached regarding this use of pantothenic acid or dexpanthenol.
- Avoid if allergic or hypersensitive to pantothenic acid or dexpanthenol. Avoid with gastrointestinal blockage. Pantothenic acid is generally considered safe in pregnant and breastfeeding women when taken at recommended doses.
- Papain: Papain is an enzyme that breaks protein bonds and has been used in Africa for treating burns. In standard western medical care, papain-containing debridement agents are commonly used to remove necrotic tissue and slough in burns, postoperative wounds, pilonidal cyst wounds, carbuncles, trauma wounds, infected wounds, and chronic lesions, such as pressure ulcers, and varicose and diabetic ulcers. According to reviews and clinical trials, papain may be very useful for wound debridement and for stimulating wound healing. More high-quality research is needed in this area.
- Use cautiously in patients sensitive to papain. Use cautiously in patients being treated for prostatitis. Use Wobenzym®, which contains papain, cautiously, especially in those with bleeding disorders or taking anticoagulants or antiplatelets. Use cautiously as an adjuvant to radiation therapy. Avoid in patients with gastroesophageal reflux disease. Avoid in patients using immunosuppressive therapy.
- Physical therapy: Physical therapy techniques, such as laser treatment, have been used to clean and heal wounds. Early evidence also suggests that high voltage stimulation or pulsed electrical stimulation may speed the healing of some types of skin ulcers. More research with similar outcome measures is needed to better understand the role of physical therapy for wound care.
- Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
- Psyllium: Psyllium, also referred to as ispaghula, is derived from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber, and is the chief ingredient in many commonly used bulk laxatives. Results from human study suggest that psyllium may reduce the number of surgeries necessary to heal anal fissures. Further evidence is necessary.
- Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantains (Plantago lanceolata). Avoid in patients with esophageal disorders, gastrointestinal atony, fecal impaction, gastrointestinal tract narrowing, swallowing difficulties, and previous bowel surgery. Avoid ingestion of psyllium-containing products in individuals with repeated or prolonged psyllium exposure who have not manifested allergic or hypersensitive symptoms. Prescription drugs should be taken one hour before or two hours after psyllium. Adequate fluid intake is required when taking psyllium-containing products. Use cautiously with blood thinners, antidiabetic agents, carbamazepine, lithium, potassium-sparing diuretics, salicylates, tetracyclines, nitrofurantoin, calcium, iron, vitamin B12, other laxatives, tricyclic antidepressants (amitriptyline, doxepin, and imipramine), antigout agents, anti-inflammatory agents, hydrophilic agents, and chitosan. Use cautiously with diabetes and kidney dysfunction. Use cautiously if pregnant or breastfeeding.
- Rose hip: Rose hips are the fruits that develop from the blossoms of the wild rose (Rosa spp.). They are typically orange to red in color, but some species may be purple or black. When applied topically, the volatile oils of aromatic plants may have physiological effects that will facilitate wound healing. Rose hips contain several vitamins and minerals, including vitamin C, vitamin B1, vitamin E, calcium, zinc, and carotenoids, which could potentially promote wound healing when applied to the skin. Much larger and high quality clinical trials are needed to establish the therapeutic efficacy of rose hip and rose oil preparations in the topical treatment of surgical wounds and ulcers.
- Use cautiously in patients who are avoiding immune system stimulants. Use cautiously in patients who are taking anticoagulant or anti-platelet aggregating agents, antibiotics, antineoplastics, antiretrovirals, anti-inflammatory agents, "Long-Life CiLi", antilipemics, aluminum-containing antacids, salicylates, or laxatives. Avoid in patients who are allergic to rose hips, rose pollen, its constituents, or members of the Rosaceae family.
- TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. TENS is often used to treat pain, as an alternative or addition to pain medications. Therapy sessions may last from minutes to hours. TENS is often used in conjunction with acupuncture therapy. TENS has been tested for its effects on blood flow to skin flaps used in plastic surgery procedures such as breast reconstruction. TENS has also been evaluated in patients with skin ulcers, diabetic foot ulcers, and chronic ulcers of various causes. More research is needed in this area.
- Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
- Therapeutic touch: Although some studies report an improvement in wound healing with therapeutic touch, others show no benefits.
- Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation, and on body areas with cancer.
- Vitamin A: In preliminary study, retinol palmitate significantly reduced rectal symptoms of radiation proctopathy, perhaps because of wound healing effects. Further research is needed to confirm these results.
- Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears to be safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Excessive doses of vitamin A have been associated with central nervous system malformations. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
- Zinc: Although zinc is frequently cited as having beneficial effects on healing of incision wounds, few studies have investigated this use. Further research is needed. There are conflicting findings regarding the potential benefit of zinc for healing leg ulcers. Available studies reported no or few adverse effects.
- Preliminary evidence suggests that topical zinc oxide oil may help manage perianal and buttock skin damage in incontinent patients. Further research is needed to better understand the role of zinc for treatment of skin damage caused by incontinence.
- Zinc is generally considered to be safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
- Fair negative scientific evidence:
- Aloe: A well-designed human trial found no benefit of topical acemannan hydrogel (a component of aloe gel) in the treatment of pressure ulcers.
- Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
- This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
- American Academy of Family Physicians. .
- American Academy of Pediatrics. .
- Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg. 2006;117(7 Suppl):42S-58S.
- Centers for Disease Control and Prevention. .
- Dini V, Bertone M, Romanelli M. Prevention and management of pressure ulcers. Dermatol Ther. 2006;19(6):356-64.
- Langemo D, Anderson J, Hanson D, et al. Nutritional considerations in wound care. Adv Skin Wound Care. 2006;19(6):297-8, 300, 303.
- de Laat EH, Schoonhoven L, Pickkers P, et al. Epidemiology, risk and prevention of pressure ulcers in critically ill patients: a literature review. J Wound Care. 2006;15(6):269-75.
- Natural Standard: The Authority on Integrative Medicine. .
- National Institute of Allergy and Infectious Diseases. .
- Pieper B, Sieggreen M, Nordstrom CK, et al. Discharge knowledge and concerns of patients going home with a wound. J Wound Ostomy Continence Nurs. 2007;34(3):245-53; quiz 254-5.
- Wu SC, Driver VR, Wrobel JS, et al. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag. 2007;3(1):65-76.
- Overview: As males age, they tend to experience a decrease in their sex hormone, which is called testosterone. This process is called andropause or sometimes male menopause. Most males go through andropause when they are between the ages of 40 and 55 years old.
- Causes: Andropause is caused by decreased levels of the hormone testosterone and is considered a natural part of aging in males.
- Symptoms: Common symptoms of andropause include fatigue, depression, hot flashes, night sweats, infertility, decreased sex drive, and erectile dysfunction. Erectile dysfunction (ED), also called impotence, occurs when a male is unable to achieve or maintain an erection. Men also have an increased risk of developing osteoporosis, or weak, brittle bones, after andropause.
- Diagnosis: If it is suspected that a male patient is going through andropause, a blood sample may be taken to measure the amount of testosterone in the blood. Males who have undergone andropause may have low levels of testosterone in their blood. Patients may also have increased levels of globulin. This hormone binds to testosterone, resulting in lower levels of testosterone in the tissues.
- Treatment: Although hormone replacement therapy has been used to treat andropause, there is little research on its safety or effectiveness.
- Males who experience ED as a complication of andropause may receive treatment. Several drugs, including sildenafil (Viagra®), tadalafil (Cialis®), and vardenafil (Levitra®), have been used treat males who experience ED as a result of aging. These drugs are taken by mouth a few hours before sexual activity. These drugs should not be taken more than once every 24 hours. In general, side effects may include headache, upset stomach, diarrhea, dizziness, flushing, or stuffy nose. Serious side effects may include sudden severe loss of vision, blurred vision, changes in color vision, painful erection, priaprism (a prolonged erection lasting longer than four hours), fainting, chest pain, difficulty breathing, hoarseness, itching or burning during urination, and rash. Patients should seek immediate medical treatment if any of these serious side effects develop.
- Prevention: Andropause is a normal part of aging. Strength training may be beneficial because the body produces testosterone when a person builds or maintains muscle mass.
Benign prostatic hyperplasia (bph)
- Overview: Benign prostatic hyperplasia (BPH) is a normal, gradual enlargement of the prostate gland, which is located in front of the rectum and under the bladder. BPH usually beings during middle age. Hormonal changes in the prostate tissue are linked to BPH. For instance, decreases in testosterone and increases in dihydrotestosterone (DHT) and estrogen have been shown to cause BPH.
- This condition is called "benign" because it does not lead to cancer. BPH does not generally cause pain, but discomfort (a feeling of pressure) in the groin area is generally found. An enlarged prostate may push against the urethra and interfere with urination. The bladder wall also thickens and becomes irritated. The bladder starts to contract even when it contains small amounts of urine, which results in frequent urination.
- Causes: BPH affects about half of men who are 60 or older and 80 percent of men who are 80 or older. It is considered by clinicians to be related to aging because most men older than 45 have some prostate enlargement. However, symptoms are rarely felt before the age of 60.
- Symptoms: Common symptoms of BPH include difficulty urinating, altered urinary flow (including variable flow rate), frequent urination, urinary urgency, dribbling of urine at the end of urination, and frequent urination at night (called nocturia). As the bladder weakens, it may not empty completely after urination. When the prostate blocks or narrows the urethra, it may lead to several problems, such as urinary tract infections (UTIs), bladder stones, or kidney or bladder damage.
- Diagnosis: A digital rectal exam (DRE) is commonly performed during routine physical examinations. During a DRE, a doctor feels the prostategland by passing a gloved finger into the individual's rectum. If hard or lumpy areas of the gland are detected, it may indicate anabnormality. If the doctor suspects an abnormal prostate, a sample of urine and prostate fluid may be analyzed.
- The doctor may also assess the degree of pain or discomfort the person feels when the muscles and ligaments of the pelvic floor and perineum are pressed. Patients with BPH generally do not feel pain.
- A doctor may also take a sample of blood to analyze the patient's prostate-specific antigen (PSA) levels. PSA is an enzyme normally made by cells in the prostate gland that helps break down proteins in seminal fluid to aid with fertility. It is normal for the bloodstream to contain some PSA (about 4.0 nanograms per milliliter (ng/ml)). However, if the PSA level is elevated, it may indicate prostate infection, inflammation, enlargement (BPH), or cancer. If the PSA level is above 4.0, further tests, such as an ultrasound or prostate biopsy, are usually recommended. Even if the PSA is less than 4.0, further tests may be recommended if the PSA has risen a significant amount since a prior measurement. PSA values tend to be lower in younger men, and it has been suggested that the PSA level at which to consider a biopsy should be lower for younger men than for older men.Even if the PSA is elevated, it does not necessarily mean that cancer is present, since there are other causes of PSA elevation. This is why further evaluation with a biopsy is often recommended.
- Treatment: The U.S. Food and Drug Administration (FDA) has approved several drugs for the treatment of BPH symptoms, although drug therapy is not effective in all patients. 5-alpha reductase inhibitors, including finasteride (Proscar®) and dutasteride (Avodart®), may help prevent the progression of prostate enlargement or help shrink the prostate gland. Other drugs, called alpha blockers, may also help reduce bladder obstruction. FDA-approved drugs include terazosin (Hytrin®), doxazosin (Cardura®), tamsulosin (Flomax®), and alfuzosin (Uroxatral®). Terazosin and doxazosin were first developed to treat high blood pressure. Tamsulosin and alfuzosin were developed specifically to treat BPH.
- Some patients may require surgery. Transurethral resection of the prostate (TURP) is a surgical procedure that involves removing tissue from the prostate that may be blocking urine flow. This surgery is sometimes performed to relieve symptoms caused by benign (noncancerous) tumors. Transurethral resection of the prostate may also be done in men who cannot have a radical prostatectomy because of their age or overall health.
- Several laser procedures are also available. They are performed to remove obstructing prostate tissue. Laser procedures generally require less anesthesia and are associated with a lower risk of bleeding and a quicker recovery time than TURP. However, laser procedures may not be as effective in the long term as TURP.
- Microwave therapy may also be performed. During this procedure, microwave energy is delivered to the prostate in order to kill some of the cells and shrink the prostate. Although microwave therapy is not a cure, it may help reduce urinary frequency, urgency, and straining, as well as intermittent urine flow. It has not been shown to improve symptoms of incomplete bladder emptying.
- The FDA has also approved the Transurethral Needle Ablation (TUNA) System for the treatment of BPH. The TUNA System is a minimally invasive procedure that involves placing interstitial radiofrequency (RF) needles through the urethra and into the prostate. The low-level radiofrequency energy burns away part of the prostate. The TUNA System has been shown to improve urine flow and relieve symptoms with fewer side effects than TURP. Neither incontinence nor impotence has been observed.
- Prevention: It has been suggested that ejaculating on a regular basis may help prevent BPH. However, this has not been scientifically proven. Drinking eight glasses of water per day may help prevent UTIs in men with BPH. However, if the patient is experiencing increased urinary frequency as a symptom of BPH, drinking more water may worsen the symptom.
- Overview: Erectile dysfunction (ED), sometimes called impotence, occurs when a man is unable to achieve or maintain an erection that is firm enough for sexual intercourse. The term impotence may also refer to other problems that interfere with sexual intercourse, such as decreased sexual desire or difficulty with ejaculation.
- Although ED is more common in men older than 65, it can occur at any age. Occasional ED is considered normal and happens to most men. As men age, it is also normal to experience changes in erectile function. For instance, it may take longer to achieve erections or they may be less rigid. Some men may have less intense orgasms or produce less ejaculate. The recovery time between erections may also increase with age.
- Causes: There are many causes of erectile dysfunction. In some instances, ED may be one of the first signs of an underlying medical problem. Physical diseases account for about 70 percent of ED cases. For instance, long-term diseases that affect the lungs, liver, kidneys, heart, nerves, arteries, or veins are risk factors for ED. The most common causes of ED include heart disease, high blood pressure, clogged arteries (called atherosclerosis), diabetes, obesity, and metabolic syndrome. This is because an erection is dependent on proper blood flow in the penis.
- If the veins and muscles in the penis cannot prevent blood from leaving the penis during sexual arousal, an erection cannot be maintained. Venous leakage can be the result of injury, disease, or damage to the veins in the penis.
- Prostate gland enlargement, such as with benign prostatic hyperplasia (BPH), can also cause symptoms of ED by placing pressure on the blood vessels that fill the penis to cause an erection.
- Damage to the nerves that control erections can cause erectile dysfunction. It may result from an injury to the pelvic area or spinal cord. Surgery to treat bladder, rectal, or prostate cancer may also damage sensitive nerves and blood vessels and may cause ED.
- Spinal cord and brain injuries can cause impotence if they interfere with nerve impulses transferred from the brain to the penis. Other nerve disorders, such as multiple sclerosis (MS), Parkinson's disease, and Alzheimer's disease, may also result in ED.
- Hormonal disorders cause less than five percent of ED cases. Testosterone deficiency, although uncommon, may result in a decreased sex drive and ED. An excess of the hormone prolactin, caused by a pituitary gland tumor, can reduce levels of testosterone and cause ED. Hormone imbalances can also result from kidney or liver disease, causing ED.
- Peyronie's disease is a rare inflammatory condition that causes scarring of erectile tissue. The normal skin cells are replaced by scar tissue. Scarring causes the penis to curve and may interfere with sexual function, cause painful erections, and even block some of the blood flow.
- Psychological conditions, such as performance anxiety, stress, guilt, or depression, may also contribute to loss of sexual drive and may result in ED. If an individual experiences loss of erection during sexual intercourse, he may worry that it will happen again. This can produce anxiety associated with performance and may lead to ED during sex.
- ED is also a common side effect of many medications. In fact, medications may cause as much as 25 percent of all ED cases. Several types of drugs can cause ED by interfering with nerve impulses or blood flow to the penis. Examples include antidepressants (e.g., Elavil®, Prozac®, Paxil®, or Zoloft®), stimulants (e.g., Adderall®), antihistamines (e.g., Benadryl® or Allegra®), medications to treat high blood pressure (e.g., Inderal® or Catapres®), heart medications (e.g., Lanoxin®), antiulcer drugs (e.g., Tagamet®), pain relievers (e.g., methadone, codeine, morphine, or oxycodone), prostate cancer drugs (e.g., Proscar®), tranquilizers (e.g., Valium® or Xanax®), and sleeping aids (e.g., Restoril® or Ambien®). Excessive or long-term use of alcohol, marijuana, heroin, cocaine, methamphetamine, or other drugs often cause ED and decreased sexual drive.
- Low levels of iron may also lead to ED.
- Symptoms: Symptoms associated with ED include the occasional inability to obtain a full erection, inability to maintain an erection throughout sexual activities, and complete inability to achieve an erection. Lack of morning erections is also seen along with a decrease in sex drive (libido).
- Diagnosis: After a physical examination, several tests are available to determine the cause of erectile dysfunction.
- A complete blood count may be taken to determine if the patient has low levels of iron in the blood. Low levels of iron may lead to erectile dysfunction.
- A blood test may be performed to determine whether or not high levels of fat in the blood are causing the condition.
- Low levels of sex hormones, including testosterone, may indicate erectile dysfunction.
- A duplex ultrasound, which takes pictures of the penis, may also be performed. An ultrasound helps the healthcare provider evaluate blood flow to the penis. It can detect leaking arteries, hardened or blocked arties, or tissue scarring, which may be causing erectile dysfunction.
- Treatment: Several drugs, including sildenafil (Viagra®), tadalafil (Cialis®) and vardenafil (Levitra®), have been used to treat males who experience ED as a result of aging. These drugs are taken by mouth a few hours before sexual activity. These drugs should not be taken more than once every 24 hours.
- In general, side effects may include headache, upset stomach, diarrhea, dizziness, flushing, or stuffy nose. Serious side effects may include sudden severe loss of vision, blurred vision, changes in color vision, painful erection, prolonged erection lasting longer than four hours (called priaprism), fainting, chest pain, difficulty breathing, hoarseness, itching or burning during urination, and rash. Individuals should seek immediate medical treatment if any of these serious side effects develop.
- Prevention: A simple way to help prevent ED is to introduce lifestyle changes. For some men, adopting a healthier lifestyle by quitting smoking, exercising regularly (at least 30 minutes daily), or reducing stress may be all that is needed to find relief. For others, adopting these lifestyle changes in addition to other treatments, such as medicines or surgery, can further help.
- Some additional methods that may help prevent symptoms of ED include limiting or avoiding the use of alcohol and other recreational drugs (marijuana, cocaine), getting enough sleep (eight hours a night), dealing with anxiety or depression (through counseling and medication), and seeing a doctor for regular checkups and medical screening tests.
- Overview: Male hypogonadism is a hormonal disorder that occurs when the male gonads (testes) are underactive. The testes secrete testosterone, which is a hormone that is essential for reproductive function, development of secondary sexual characteristics, body composition, and mood.
Some males may be born with hypogonadism, while others develop it later in life.
- Causes: Primary hypogonadism occurs when the gonads are directly affected. Common causes of primary hypogonadism in males include a genetic disorder called Klinefelter's syndrome, undescended testicles, mumps orchitis, testicle injury, cancer treatment, or an inherited disorder called hemochromatosis, which causes the body to absorb too much iron.
- Secondary hypogonadism occurs when other parts of the body, such as the hypothalamus or pituitary gland (both located in the brain), cause the gonads to be underactive. Common causes of secondary hypogonadism include Kallman syndrome, opiate medications, inflammatory diseases (such as sarcoidosis), and obesity.
- Symptoms: If the body does not produce enough testosterone during fetal development, the growth of sex organs may be impaired. Male children born with hypogonadism may have female genitals, ambiguous genitals that are neither male nor female, or underdeveloped male genitals. If hypogonadism occurs during puberty, the male may experience decreased development of muscle mass, impaired growth of body hair, impaired growth of genitals, excessive growth of the arms and legs in proportion to the trunk of the body, development of breast tissue, and a lack of deepening of the voice. Males who develop hypogonadism during adulthood may experience erectile dysfunction, infertility, decreased body hair growth, increased body fat, decreased testicle size, decreased muscle mass, development of breast tissue, and osteoporosis (hollow, brittle bones).
- Diagnosis: Hypogonadism is diagnosed when a patient experiences symptoms that are characteristic of the disorder and has low levels of sex hormones in the blood. Males will have low levels of testosterone. Additional tests may be performed to determine the underlying cause.
- Treatment: Patients with hypogonadism typically receive hormone replacement therapy (HRT) with testosterone injections. This treatment has been shown to stimulate puberty and restore fertility in patients.
- Prevention: Because obesity may lead to secondary hypogonadism, patients who maintain a normal body weight can reduce their risk of developing the condition. Reducing the risk of head trauma may also reduce the risk of hypogonadism. This is because some cases occur as a result of injury to parts of the brain, such as the hypothalamus.
- Overview: Prostate cancer is the uncontrollable growth of cells in the prostate gland. After skin cancer, prostate cancer is the most common form of cancer in America, affecting about one in six men.
- The prostate gland, which is located in front of the rectum and under the bladder, is part of a man's reproductive system. It surrounds the urethra, the tube that carries urine. A healthy prostate is about the size of a walnut.
- Prostate tumors are masses of prostate cells. Prostate tumors can be noncancerous (benign) or cancerous (malignant). Benign tumors in the prostate are rarely life-threatening. Benign prostatic hyperplasia (BPH) is the abnormal growth of noncancerous prostate cells. The prostate grows larger and squeezes the urethra, preventing the normal flow of urine. BPH is common, affecting about 30 million men worldwide.
- Malignant prostate tumors are generally more serious than benign tumors. In some cases, malignant prostate tumors may be life-threatening, especially if they spread to other areas of the body, such as the lymph nodes, liver, bones, colon, and other organs.
- When diagnosed and treated early, prostate cancer can be successfully cured more than 90 percent of the time. It is important to be diagnosed early, which is why the American Cancer Society recommends that healthcare professionals offer screening tests annually, beginning at age 50. Men at high risk may be encouraged to undergo screening earlier.
- Causes: As men get older (particularly after age 50), their risk of prostate cancer increases.
- The incidence of prostate cancer varies among populations worldwide. Asian men typically have a very low incidence of prostate cancer, with age-adjusted incidence rates ranging from 2-10 per 100,000 men. Higher incidence rates are generally observed in northern European countries. African-American men, however, have the highest incidence of prostate cancer in the world. In the United States, African-American men have a 60 percent higher incidence rate compared with Caucasian men.
If an immediate family member has prostate cancer, the risk of developing the disease is greater than that of the average American man.
- A high-fat diet and obesity may increase the risk of prostate cancer. Researchers theorize that fat increases production of the hormone testosterone, which may promote the development of prostate cancer cells. Obese men who are diagnosed with prostate cancer are two-and-a-half times more likely to die from the disease than men of normal weight at the time of diagnosis. Scientists believe that obesity increases the risk of prostate cancer by increasing inflammation and steroid hormones, such as testosterone.
- Because testosterone naturally stimulates the growth of the prostate gland, men who have high levels of testosterone are more likely to develop prostate cancer than men who have lower levels of testosterone. It has also been suggested that testosterone therapy might increase or speed up the growth of prostate cancer that is already present.
- Symptoms: If the cancer is identified at its earliest stages, most men will not experience any symptoms. Some men, however, experience symptoms, such as a need to urinate frequently (especially at night); difficulty starting or stopping urination; weak or interrupted flow of urine; a painful or burning sensation during urination; difficulty having an erection; painful ejaculation; blood in urine or semen; or frequent pain or stiffness in the lower back, hips, or upper thighs. Because these symptoms can also indicate the presence of other conditions, such as urinary tract infections or bladder problems, men who experience any of these symptoms will undergo a thorough work-up to determine the underlying cause of the symptoms.
- Diagnosis: Men with risk factors for developing prostate cancer, such as men older than 50 years of age, should undergo routine prostate cancer screenings.
- The digital rectal exam (DRE) is commonly performed during routine physical examinations. During a DRE, a doctor feels the prostategland by passing a gloved finger into the patient's rectum. A hard or lumpy area may indicate anabnormality.
- A doctor may also take a sample of blood to analyze the patient's prostate-specific antigen (PSA) levels. PSA is an enzyme normally made by cells in the prostate gland that helps break down proteins in seminal fluid to aid with fertility. It is normal for the bloodstream to contain some PSA. In the United States, a generally accepted standard PSA level is 4.0 nanograms per milliliter (ng/ml). However, if the PSA level is elevated, it may be an indication of prostate infection, inflammation, enlargement (BPH), or cancer. Using the PSA test to screen men for prostate cancer is controversial because it is not yet known if this test actually saves lives. It is also unclear if the benefits of PSA screening outweigh the risks of follow-up diagnostic tests and cancer treatments. For instance, the PSA test may detect small tumors that would never become life-threatening.
- If the PSA level is elevated, or if the person has an abnormal digital rectal exam, a doctor may recommend a prostate biopsy. The patient will be prescribed antibiotics, usually a three-day course, before the surgery. Most individuals receive local anesthesia, such as lidocaine (Xylocaine®). To do a biopsy, a doctor inserts a small, lubricated probe (called a transrectal ultrasound) into the rectum. The probe uses sound waves, which are then converted to visual data in order to see a picture of the prostate gland, which is then analyzed for changes. If an abnormal area is seen on the transrectal ultrasound, the doctor will likely biopsy that area. During a biopsy, a fine, hollow needle is aimed at the abnormal area(s) of the prostate, and a small section of tissue is removed. Biopsies generally take about 15-45 minutes to complete, depending on the procedure. The procedure used to diagnose prostate cancer (prostate biopsy) may cause side effects, such as bleeding and infection. Fifty-five percent of men report discomfort during the biopsy. The same procedure can be performed through the perineum area (between the anus and the scrotum) and is called a transperineal biopsy, or through the urethra (the canal that the urine travels through for elimination), and is called a transurethral biopsy.
- If a doctor thinks the cancer may have spread to other parts of the body, other tests may be used. These include procedures such as a bone scan, ultrasound, a computerized tomography (CT) scan, magnetic resonance imaging (MRI), and lymph node biopsies.
- Treatment: When prostate cancer has not spread beyond the prostate, most practitioners will discuss options with patients that include the surgical removal of the prostate (called a prostatectomy), radiation treatment, or active surveillance (also called watchful waiting or observation). The goal of a prostatectomy and radiation treatment is to cure the patient by eradicating the cancer. There are other, less well-established approaches, including cryotherapy and high-intensity focused ultrasound (HIFU), for which there is less scientific evidence available compared to prostatectomy or radiation therapy.
- When prostate cancer has spread beyond the prostate, it is said to be ''metastatic'' or to have metastasized. The most common areas of metastasis are the bones (especially the ribs, spine, skull, and pelvis) and lymph nodes, and less commonly the lungs and liver. Once the cancer spreads to the bones, liver, or lungs, it is not generally curable, and treatments are aimed at controlling the growth of the cancer for as long as possible. The standard initial treatment for metastatic prostate cancer is hormonal therapy. Chemotherapy is generally not given unless the cancer becomes resistant to the effects of hormonal therapy. Generally, the prostate area itself is not treated if the cancer has spread, although in some cases if there is a lot of cancer in the prostate area, radiation may be given for ''local control'' to avoid complications from the cancer growing too large in the pelvis area.
- Prevention: A new vaccine, although not FDA-approved, has been developed to help extend survival for patients with deadly metastatic prostate cancer. The FDA has requested additional clinical data before the vaccine, called Provenge®, can be approved. The vaccine is targeted at individuals with prostate cancer who have ceased responding to hormone therapy and have cancer that has spread to other organs and tissues. Reported side effects include fever, chills, and fatigue (tiredness).
- Because high-fat dairy products and the calcium contained in dairy may increase the risk of developing prostate cancer, these foods should be limited. Examples of high-fat dairy foods include cheese, sour cream, and ice cream.
- Cruciferous vegetables (such as broccoli, cabbage, and cauliflower) have been reported to contain cancer-fighting phytochemicals that may decrease the chance of developing prostate cancer. Antioxidant-containing foods, including fruits (such as berries, grapes, and tomatoes) and vegetables (such as peppers and carrots) may help prevent the development of prostate cancer.
- Eating large amounts of red meat or processed meats has been shown to increase the risk of colon cancer. It has also been suggested to increase the risk of developing prostate cancer, although this is an area of ongoing research.
- Exercise (at least 30 minutes daily for five days a week), smoking cessation, and relaxation all may contribute to decreasing the risk of developing prostate cancer.
- Overview: Prostatitis is inflammation of the prostate gland. It often affects younger men. With treatment, prostatitis generally goes away within several days to two weeks. Treatment of chronic (long-term) bacterial prostatitis usually involves antibiotics for 4-12 weeks. This type of prostatitis is difficult to treat and recurrence is possible.
- Causes: Prostatitis usually results from the blockage or irritation of some of the ducts within the prostate gland, and the cause may be mechanical (such as a narrowing of the urethra) or infectious. Infectious causes may be viral or bacterial, including E. coli or sexually transmitted infections such as chlamydia.
- There are four types of prostatitis. Chronic nonbacterial prostatitis is the most common type. Prostadynia, also known as chronic pelvic pain syndrome, is a condition associated with similar symptoms as chronic nonbacterial prostatitis, but which has no evidence of prostate inflammation. Chronic bacterial prostatitis is not very common. It typically affects men who are 40-70 years old. Asymptomatic inflammatory prostatitis does not cause symptoms and generally occurs in men who are 60 years of age or older. Acute bacterial prostatitis is the least common form. It usually occurs in men who are younger than 35.
- Symptoms: Symptoms of prostatitis may include painful, burning, or frequent urination; weak urine flow or incomplete emptying; fever and chills; lower abdominal pain or pressure; painful ejaculation; impotence; and low back pain.
- Chronic prostatitis and chronic pelvic pain syndrome are the most common types of prostatitis, but are probably the most poorly understood. Symptoms may go away and then reappear without warning. The infection may be considered inflammatory. This occurs when the infecting organism is not present in the urine, semen, or other secretions but infection-fighting cells are present. In other cases, the infection may be considered noninflammatory, in which inflammation and infection-fighting cells are both absent.
- Chronic bacterial prostatitis is a frequent infection of the prostate gland that is difficult to treat. Symptoms are often similar to acute bacterial prostatitis, but they are often less severe. Symptoms of chronic bacterial prostatitis generally last longer and do not cause a fever.
- Asymptomatic inflammatory prostatitis may be diagnosed when infection-fighting cells are present, but common symptoms of prostatitis are not. A diagnosis is usually made incidentally during an examination for other conditions, such as infertility or prostate cancer.
- Acute bacterial prostatitis can occur at any age. Symptoms are usually sudden and severe. Symptoms may include painful and/or difficult urination, fever, chills, lower back pain, pain in the genital area, frequent urination, burning during urination, urinary urgency at night, and aches and pains throughout the body.
- Treatment: Acute bacterial prostatitis (infectious prostatitis) is usually treated with oral antibiotics for one to two weeks. The commonly used antibiotics include quinolones, such as norfloxacin (Noroxin®), ciprofloxacin (Cipro®), or levofloxacin (Levaquin®). In severe cases, treatment with intravenous (IV) antibiotics may be necessary. Chronic bacterial prostatitis is also treated with oral antibiotics for 4-12 weeks. Other medications used to treat infectious prostatitis include: stool softeners, such as docusate sodium (Colace®); anti-inflammatory medications, such as ibuprofen (Motrin®); analgesics or pain medications, such as hydrocodone (Vicodin®, Lortab®); alpha blockers such as tamsulosin (Flomax®); and 5-alpha reductase inhibitors, such as finasteride (Proscar®) or dutasteride (Avodart®).
- If the individual has nonbacterial prostatitis, antimicrobial medication is not needed. Treatment depends on the symptoms. If the condition responds to muscle relaxation, the individual may be given an alpha blocker, a drug that can relax the muscle tissue in the prostate and reduce the difficulty in urination. Pain meditations, anti-inflammatories, and warm sitz baths may also be helpful.
- Chronic prostatitis may respond to multidisciplinary approaches incorporating exercise, progressive relaxation, and counseling. Asymptomatic inflammatory prostatitis may respond to the same treatment measures, but this condition generally does not require treatment.
- Prevention: Men are encouraged to practice good hygiene. Keeping the penis clean can help prevent some types of infections that can lead to prostatitis. Patients are encouraged to drink plenty of fluids, especially water, to cause regular urination.
Copyright © 2011 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.