Definition of Prostatitis
Prostatitis is an inflammation of the prostate gland. The prostate is a reproductive gland located just below the bladder and in front of the rectum, in men. It wraps around the urethra, a tube that carries urine from the bladder. The prostate gland produces fluid (semen) that nourishes and transports sperm. Prostatitis often causes pain and swelling.
Prostatitis can be caused by a number of different things. When prostatitis is caused by an infection with bacteria, it is called bacterial prostatitis.
Depending on the cause, prostatitis may come on gradually or suddenly. It may get better quickly, either on its own or with treatment. Chronic bacterial prostatitis is an infection that lasts for 3 months or more.
Cause of Prostatitis
Acute bacterial prostatitis is often caused by common strains of bacteria that cause bladder infections. These include E. coli, Klebsiella, and Proteus.
Small amounts of bacteria that aren’t eliminated with antibiotics may cause chronic bacterial prostatitis. Some men with chronic prostatitis have pain but no evidence of an inflamed prostate.
The causes of chronic prostatitis without infection and asymptomatic inflammatory prostatitis is not clearly understood.
In most cases of prostatitis, the cause is never identified. Causes other than bacterial infection can include:
- An immune system disorder
- Bladder outlet obstruction
- A nervous system disorder
- Injury to the prostate or prostate area
- Urinary catheter, cystoscopy, or prostate biopsy (removing a piece of tissue to look for cancer)
Signs and Symptoms of Prostatitis
Based on your symptoms and laboratory tests, your doctor may conclude that you have one of the following types of prostatitis:
Symptoms of acute bacterial prostatitis:
- Flushing of the skin
Chronic bacterial prostatitis. This is bacterial prostatitis that lasts for at least three months due to recurring or difficult-to-treat infections. Urinary tract infections are common with this type of prostatitis. Urinary symptoms:
- Blood in the urine
- Difficulty starting to urinate or emptying the bladder
- Foul-smelling urine
- Burning or pain with urination (dysuria)
- Weak urine stream
Chronic prostatitis not caused by bacteria. This condition is often referred to as chronic abacterial prostatitis or chronic pelvic pain syndrome. There is recurrent pelvic, testicle, or rectal pain without evidence of bladder infection. There may be difficulties with painful urination or ejaculation, and erectile dysfunction. It lasts for at least three months.
Prostatitis that doesn’t cause symptoms. This type of prostatitis is called asymptomatic inflammatory prostatitis, and it doesn’t cause any symptoms as its name describes.
Risk Factors for Prostatitis
Risk factors for prostatitis include:
- Being a young or middle-aged man
- Having many sexual partners
- Having a past episode of prostatitis
- Having an infection in the bladder or the tube that transports semen and urine to the penis (urethra)
- Having a pelvic trauma, such as injury from bicycling or horseback riding
- Not drinking enough fluids (dehydration)
- Using a urinary catheter, a tube inserted into the urethra to drain the bladder
- Certain sexual practices, such as having anal sex without wearing a condom
- Having HIV/AIDS
- Being under psychological stress
- Having certain inherited traits
Diagnosis of Prostatitis
Diagnosing prostatitis involves ruling out other conditions that may be causing your symptoms and determining what kind of prostatitis you have. Diagnosis may include the following:
- Physical examination and digital rectal exam. Your doctor will examine your abdomen and genitals and will likely preform a digital rectal examination (DRE). During a digital rectal exam, your doctor will gently insert a lubricated, gloved finger into your rectum. Your doctor will be able to feel the surface of the prostate and judge whether it is large and soft (with a chronic prostate infection), or warm, soft, swollen, or tender (with an acute prostate infection).
- Prostate-specific antigen (PSA). Prostatitis may affect the results of the prostate-specific antigen (PSA), a blood test used to screen for prosate cancer.
- Urine and semen test. Urine samples may be collected for urinalysis and urine culture.
- Examination with a viewing scope (cystoscopy). A cystoscope is a small tube with a light and magnifying lens or camera that’s inserted through the urethra and into the bladder. An instrument called a cystoscope may be used to examine the urethra and bladder.
- Bladder tests (urodynamic tests). These tests are used to check how well you can empty your bladder.
Prevention of Prostatitis
Not all types of prostatitis are preventable.
- Practice good hygiene, and keep your penis clean.
- Limit or avoid alcohol, caffeine, and spicy or acidic foods.
- Drink enough fluids to cause regular urination.
- Avoid bicycling, or wear padded shorts and adjust your bicycle to relieve pressure on your prostate.
- Seek early treatment of a possible urinary tract infection.
- Practice safe sex behaviours to prevent infections caused by STDs.
Treatment of Prostatitis
Prostatitis treatments vary depending on the underlying cause. They can include:
- Antibiotics: The most commonly prescribed treatment for prostatitis is antibiotics. The choice of medication is bades on the type of bacteria that may be causing your infection. If you have severe symptoms, you may need intravenous (IV) antibiotics. You’ll likely need to take oral antibiotics for four to six weeks, but may need longer treatment for chronic or recurring prostatitis. Often, the infection will not go away, even if you’ve been taking antibiotics for a long time. After you stop taking antibiotics, your symptoms may return.
- Prostate massage: This is done by your physician using a lubricated, gloved finger — a procedure similar to a digital rectal exam. It may provide some symptom relief, but doctors disagree about how effective it is.
- Other treatments: Alpha-adrenergic blockers are other medication possibilities. Tamsulosin (Flomax) and terazosin (Hytrin) are drugs that block the non-heart adrenaline receptors and are used in treating BPH and bladder outlet obstruction.