โรคต่อมลูกหมากอักเสบเรื้อรัง

อัปเดตล่าสุด: 30 สิงหาคม 2569

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When an การติดเชื้อต่อมลูกหมากเฉียบพลัน is not treated properly, around 10% of cases turn into a long-term problem — what we call ต่อมลูกหมากอักเสบเรื้อรัง. This article deals specifically with that chronic inflammation of the prostate gland. Any man who has lived with it will recognise the description immediately: it is a condition that erodes quality of life and reaches into almost every part of daily living.

Chronic prostatitis is reported in up to 9% of men, and the recurrence rate can reach 50%. It divides into two categories.

1. Chronic bacterial prostatitis — a bacterial cause is confirmed on culture.
2. Chronic pelvic pain syndrome (CPPS) — no bacterial cause is found on culture. Most patients fall into this group, and it is the reason so many men end up confused about their treatment plan: without a bacterial target, there is no single antibiotic that will fix it.

The difficulty is that both categories produce identical symptoms, so the symptoms alone cannot tell them apart.

That distinction has a practical consequence worth stating early, because it is where most of the wasted years go. If cultures are repeatedly negative, further courses of antibiotics are not the answer — not a longer course, not a stronger one, not a different one. It is the same trap that catches women with อาการปวดกระเพาะปัสสาวะ, and men with CPPS are frequently given that same treadmill for exactly the same reason. Antibiotics belong in this condition when there is something to treat.

Possible symptoms of chronic prostatitis

• Urinary — urgency and frequent urination, especially at night
• Sexual — premature ejaculation, painful ejaculation, altered sexual sensation
• ความเจ็บปวด — genital, rectal, prostatic or bladder pain
• Neurological — neuropathic pain
• Infective — pain on urination with a positive bacterial culture
• Psychosocial — depression, anxiety or stress

What has to be excluded first

Chronic prostatitis is partly a diagnosis of exclusion, and that step is not a formality. Pelvic pain and urinary symptoms in a man can also come from bladder or prostate cancer, stones, a narrowing of the urethra, a bladder condition rather than a prostate one, or from problems outside the urinary tract altogether — the hip, the lower spine, a hernia, the bowel. Which of these need looking for depends on your age, your history and what exactly you are describing, which is why the tests are chosen rather than run as a fixed panel.

Two things must not be absorbed into the diagnosis once you have it. ปัสสาวะเป็นเลือด is not a feature of chronic prostatitis and needs investigating in its own right. And a change in the character of the symptoms, as opposed to a flare of the usual ones, deserves a fresh look rather than another adjustment to the same treatment.

When to be seen the same day

Chronic prostatitis is a grinding condition rather than a dangerous one. Its acute counterpart is different, and a man with chronic symptoms can develop an acute infection on top. Go to an emergency department the same day — in Thailand you can call 1669 — for:

• Fever or shaking chills, particularly with severe pain low between the legs or in the lower abdomen, or feeling generally very unwell. An acutely infected prostate can lead to bloodstream infection quickly.
• ปัสสาวะไม่ออก, or straining with an increasingly full, uncomfortable lower abdomen — a swollen, inflamed prostate can block the outlet.
• Pain that is escalating rapidly rather than following its usual pattern.

How it is assessed and treated

After a careful history and physical examination, the investigations are tailored to the symptoms the patient actually reports rather than run as a fixed panel, and treatment then follows the evidence that emerges. The available options are:

1. Anti-inflammatory medication
2. Neuropathic pain medication
3. Prostate medication (alpha-blockers for the urinary symptoms)
4. ยารักษาโรคนกเขาไม่ขัน
5. Oral steroids
6. Herbal extracts
7. Pelvic floor physiotherapy, and other physical treatments — extracorporeal shockwave therapy, microwave thermotherapy, acupuncture
8. การบำบัดสภาพจิตใจ

That is a long list, and it is fair to ask why. The reason is that the label covers several different problems that happen to produce the same symptoms, and the treatments are aimed at different ones. This is why modern practice tries to work out which components are actually driving your case rather than starting at the top of the list and working down. The usual groupings are the urinary symptoms, the psychological burden, the prostate itself, infection where it is genuinely present, nerve-related pain, and tenderness of the pelvic floor muscles. Most men have two or three of these rather than all six, and matching the treatment to the ones you have is what makes the difference between a plan and a series of guesses.

Pelvic floor muscle tenderness deserves particular mention, because it is the component most often missed and the one where physiotherapy from a therapist trained in pelvic floor work is genuinely effective. If your pain is reproduced by pressure on those muscles, that is a finding rather than an incidental, and it points to a treatment that has nothing to do with the prostate at all.

It is also worth being straight about the evidence behind that list, since it is not uniform. The medications aimed at the urinary and pain components have the most behind them. Steroids, herbal preparations and some of the physical treatments have weaker or more mixed support, which does not mean they never help — some men respond well — but does mean they belong in a considered trial with a defined review point rather than as something to stay on indefinitely because it was started once. If you have been on something for months without being able to say whether it helped, that is worth raising.

A few practical measures are worth trying alongside whatever is prescribed, because they cost nothing: breaking up long periods of sitting, adjusting or pausing cycling if that reliably provokes symptoms, warm baths, and reducing alcohol, caffeine and spicy food if you notice they make things worse. None of these are cures. All of them are things you control, which matters in a condition where much of the frustration comes from feeling that nothing is.

Chronic prostatitis is genuinely difficult to treat, and it is rarely controlled by any single drug on its own. It takes a longer period of trial and adjustment to find the combination that works for a particular patient — which is why a steady, continuing relationship between patient and doctor matters more here than in almost any other urological condition. Progress is real, but it is measured in months rather than days.

One last thing, and I put it here rather than in a list because it gets left out of consultations. This condition affects sleep, work, mood and relationships, and men in particular tend to arrive having decided that the psychological side is not a medical matter and not worth mentioning. It is both. Low mood and anxiety are on the symptom list above for a reason, they make the pain worse through a well-recognised mechanism rather than an imagined one, and addressing them improves the pain rather than merely helping you tolerate it. Saying how much this is affecting your life is useful clinical information, not a complaint.

หากคุณกำลังประสบปัญหาอาการปวดอุ้งเชิงกรานเรื้อรัง, อาการต่อมลูกหมากอักเสบ, หรือไม่ตอบสนองต่อการรักษาด้วยยาปฏิชีวนะหลายครั้ง, พญ. โสรวีย์ วีรสพงษ์ พร้อมให้คำปรึกษาเฉพาะทางที่โรงพยาบาลกรุงเทพ สำนักงานใหญ่. นัดหมายปรึกษาแพทย์. นัดหมายที่โรงพยาบาลสมิติเวช ศรีราชา ได้โดยโทรติดต่อแผนกทางเดินปัสสาวะที่ 088-022-1445. คำถามเกี่ยวกับค่าใช้จ่ายในการปรึกษาหรือการรักษาควรสอบถามกับทางโรงพยาบาลโดยตรง สำหรับโรงพยาบาลกรุงเทพ ส่งอีเมลไปที่ bhquro@bdms.co.th.

Bangkok Hospital also runs a Telemedicine service, arranged in advance by email to the Urology department at bhquro@bdms.co.th. It suits this condition unusually well, because so much of the work is the history and reviewing what has already been tried — and men who have been through several clinics often have a great deal of that to go through. Send previous urine culture results in particular, since a run of negative cultures alongside persistent symptoms is one of the most useful things in the file. Examination and any procedures are done in person. Samitivej Sriracha is in-person only.

คำถามที่พบบ่อยเกี่ยวกับต่อมลูกหมากอักเสบเรื้อรัง

ข้อจำกัดความรับผิดชอบ This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Chronic prostatitis is diagnosed after other causes have been excluded, and new or changing symptoms should be assessed rather than attributed to it. No medical advice, diagnosis or prescription is provided through personal messaging channels or social media. Always consult a qualified healthcare professional before starting any medical treatment. In an emergency, attend the nearest emergency department — in Thailand the emergency number is 1669.