Conditions and Treatments

Prostatitis

WHAT IS THE PROSTATITIS?

Prostatitis is an infection or inflammation of the prostate gland which can cause the prostate to become irritated or swell. The swelling of the prostate squeezes the urethra and blocks the neck of the bladder resulting in urinary symptoms. It is a common disease that sometimes has no symptoms or can be very painful. Studies suggest prostatitis affects over 10% of all men especially those over the age of 50.

WHAT ARE THE DIFFERENT TYPES OF PROSTATITIS AND THEIR CAUSES?

The four types of are:

  1. Nonbacterial prostatitis is an inflamed or swollen prostate without bacterial infection.
  2. Chronic nonbacterial prostatitis or chronic pelvic pain syndrome (CPPS)  

Nonbacterial prostatitis and chronic pelvic pain syndrome are the most common types of prostatitis. The exact cause of these non-bacterial prostatitis conditions is not known, but may be due to persistent infection, inflammation and/or pelvic muscle spasm. Inflammation in the prostate can also occur without symptoms.

  1. Acute bacterial prostatitis is the least common type of prostatitis and is caused by bacterial infection. It is usually easy to diagnose because of the typical symptoms and signs. It is a severe urinary tract infection associated often with fevers and chills. Acute bacterial prostatitis requires immediate medical attention because severe complications may develop if not treated promptly. Acute bacterial prostatitis can affect any age group but commonly occurs in older and middle-aged men.
  2. Chronic bacterial prostatitis is also caused by bacterial infection and is characterized by recurrent urinary tract infections in men. When symptoms do appear, they are generally less severe than acute bacterial prostatitis and rarely have fever, but often recur. This condition can also affect any age group but is most common in young and middle-aged men.

WHAT CAUSES PROSTATITIS?

The bacteria that cause acute and chronic bacterial prostatitis 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 considered to be 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 you have recently had a catheter or other instrument inserted into your urethra, an abnormality of your urinary tract or a recent bladder infection.

Chronic nonbacterial prostatitis and chronic pelvic pain syndrome while the most common form is the least understood form.  Contributing factors may include

  1. Atypical organisms which may be transmitted through sexual contact
  2. Chemical or immunologic reaction to an injury
  3. Pelvic muscle spasm
  4. Persistent  bladder infection
  5. Stress
  6. Dietary bladder or prostate irritants

 

WHAT ARE THE SYMPTOMS OF PROSTATITIS?

The symptoms of prostatitis depend upon the type.

In acute bacterial prostatitis, the symptoms are severe and sudden and require immediate medical care. Chills, fever, severe burning during urination and the inability to completely empty the bladder are common.

In chronic bacterial prostatitis, the symptoms are similar but and do not produce fever. Symptoms may come and go. They include: burning during urination; urinary frequency, especially at night; perineal, testicular, bladder and low back pain; and painful ejaculation.

The symptoms of chronic prostatitis/chronic pelvic pain syndrome include difficult and sometimes painful urination, discomfort or pain in the perineum, bladder, testicles and penis as well as difficult and painful ejaculation. In some cases, these symptoms can be indistinguishable from those described above for chronic bacterial prostatitis.

HOW IS PROSTATITIS DIAGNOSED?

The correct diagnosis is very important because the treatment is different for the different types of prostatitis syndromes. In addition, it is extremely important to make sure that the symptoms are not caused by other conditions such as an enlarged prostate or cancer

To examine the prostate gland, the urologist will perform a digital rectal examination (DRE), a simple examination in which the urologist will pass a lubricated, gloved finger into the rectum. The urologist will be able to determine whether the prostate is enlarged or tender. Lumps or firm areas can suggest the presence of prostate cancer. The urologist will also assess the degree of pain or discomfort you experience as he presses the muscles and ligaments of the pelvic floor and perineum. If you have prostatitis, this examination may produce momentary pain or discomfort but it causes neither damage nor significant prolonged pain.

If our urologists requires a closer look at the prostate gland or decides that a biopsy is necessary, he may order a transrectal ultrasound, which allows him to see the prostate gland. If you are at risk for cancer, your urologist will consider ordering a PSA test. During a prostate infection however, the PSA can be falsely elevated.

Various urine specimens and prostatic fluid samples will be analyzed for signs of inflammation and infection. These samples may help the urologist determine whether your problem is inflammation or infection and whether the problem is in the urethra, bladder or prostate.

Other tests the urologist may consider employing include

  1. Cystoscopy in which a small telescope is passed through the urethra into the bladder permitting examination of the urethra, prostate and bladder. The urologist may also order
  2. Urine flow studies, which help measure the strength of your urine flow and any obstruction caused by the prostate, urethra or pelvic muscles.

HOW IS PROSTATITIS TREATED?

If acute bacterial prostatitis is diagnosed, you will need to take antibiotics for a minimum of 14 to 21 days. Sometimes, this means being admitted to the hospital and being given intravenous antibiotics at the start. A catheter is sometimes required if the you have difficulty urinating. Almost all acute infections can be cured with this treatment. Frequently, the antibiotics will be continued for as long as four weeks.

If chronic bacterial prostatitis is diagnosed, antibiotics will be required for a longer period of time, usually four to 12 weeks. About 75 percent of all cases of chronic bacterial prostatitis clear up with this treatment. Sometimes the symptoms recur and antibiotic therapy is again required. For cases that do not respond to this treatment, long-term, low dose suppressive antibiotic therapy may be recommended to relieve the symptoms.

You may not need antibiotics if you are diagnosed with chronic pelvic pain syndrome. Frequently, physicians have difficulty trying to decide whether a patient has bacterial or nonbacterial prostatitis. This is because of the difficulties in obtaining a specimen and the fact that previous antibiotic therapy obscures the diagnosis. An organism that responds to antibiotics, but is difficult to diagnose may also cause chronic pelvic pain syndrome. For these reasons, antibiotics may be prescribed, at least initially, even when a definitive diagnosis of bacterial prostatitis has not been ascertained. Your response to the antibiotic therapy will decide whether or not it should be continued. Many men without a true infection may feel better during antibiotic therapy because many antibiotics have direct anti-inflammatory effects. Depending on your symptoms you may receive one of a variety of other treatments including alpha-blockers, anti-inflammatory drugs, muscle relaxants, plant extracts (quercetin and/or bee pollen) and repetitive prostatic massage (to drain the prostate ducts).

Various heat therapies, biofeedback and relaxation exercises may alleviate some of the symptoms. You may be advised to discontinue some foods (e.g. spicy) and drinks (e.g. caffeinated, acidic) and avoid circumstances (e.g. bicycle riding) that exacerbate the problem. Once a correct diagnosis has been made, one of the best therapies may be that of reassurance that the patient does not have a life threatening condition.

Treatment for asymptomatic prostatitic inflammation is usually not required.