Prostatitis

Overview

By Sarah Maurer

Prostatitis is an infection or inflammation of the prostate gland, a walnut-sized gland located just under the bladder in men. Its job is to produce prostatic fluid, which, as a major component of semen, serves to nourish and transport sperm. When the prostate is swollen or enlarged, its lobes can compress the urethra, causing problems with urination and sexual function.

Prostatitis is quite common, affecting five to nine percent of men in their lifetimes. It occurs in men of all ages, but is most common in young and middle-aged men.

Prostatitis occurs in four types:

  • Acute bacterial prostatitis, caused by an infection, is least common but easiest to diagnose and treat. Symptoms come on strong and suddenly. This type of prostatitis can be quite serious if the infection spreads to the blood or other parts of the body.
  • Chronic bacterial prostatitis develops more gradually, and symptoms are usually less severe than in the acute form. The condition may be long-lasting or may recur after treatment.
  • Chronic abacterial prostatitis, or chronic pelvic pain syndrome, is prostatitis without a clear cause and, actually, the most common type. Symptoms may be constant or occur as occasional flare-ups. Sometimes tests will detect infection-fighting cells in the urine or semen, but no bacteria can be found.
  • Asymptomatic inflammatory prostatitis is diagnosed when infection-fighting cells are present in prostate tissue, urine or semen but no symptoms are present. This type is sometimes discovered by accident when patients are treated for another problem.

Causes and Risk Factors

Lateral view of prostateBacterial prostatitis usually occurs when urine infected with bacteria flows backward through the ducts connecting the urethra and prostate gland. This is most common during or just after a urinary tract infection. Trauma to the pelvic area due to medical procedures or activities like cycling can increase the risk of bacterial infection.

Bacterial prostatitis can become chronic if antibiotics fail to kill all the bacteria in the prostate. Sometimes medicines can't penetrate deeply enough into the prostate tissue to reach all the bacteria. Some types of bacteria are also more resistant to antibiotics than others.

The medical community is not sure exactly what causes abacterial prostatitis. In many cases, it seems to be due to an infection that tests can't detect. Other possible causes include pelvic muscle spasms due to a nervous system disorder or persistent immune reaction to an injury or previous infection.

Symptoms

Symptoms of prostatitis are nonspecific, meaning they're shared by many other diseases, including serious ones like prostate cancer. For this reason, it is important to seek medical help promptly.

Common symptoms include:

  • Pain or burning during urination
  • Difficult urinating (a dribbling or hesitant urine stream, or inability to empty the bladder)
  • Frequent urination, especially at night
  • Urgency (the need to urinate quickly)
  • Pain in the abdomen, pelvic area, low back or perineum (between the scrotum and the rectum)
  • Pain or unusual sensations in the penis and testicles
  • Painful orgasm and ejaculation
  • Impotence or decreased libido

In addition, bacterial prostatitis may cause flu-like symptoms, including fever, chills and muscle aches.

Diagnosis and Treatment

Cross-section of prostate and male urinary anatomySome types of prostatitis are difficult to diagnose. For this reason, men may benefit from consulting a urologist, a doctor who specializes in urinary and male reproductive health.

Common diagnostics include:

  • Digital rectal exam. The physician inserts a gloved, lubricated finger into the rectum to feel the prostate for swelling, tenderness or lumps. The physician may also probe pelvic muscles and ligaments for pain and discomfort.
  • Urinalysis, which detects bacteria, white blood cells and other signs of infection in the urine. In some cases, the physician massages the prostate gland with a finger (as in the digital rectal exam) to stimulate the release of prostate fluid before the urine sample is collected.
  • Urine culture. Urine is placed in a medium that encourages bacterial growth.
  • Blood culture, used to see whether bacterial prostatitis has spread to the blood.
  • Urodynamic tests, which provide a clearer picture of bladder functioning and mechanics.
  • Prostate-specific antigen (PSA) test, a blood test that measures levels of a certain protein released by the prostate. This test is usually performed when the man is also at risk for prostate cancer.

Abacterial prostatitis is a diagnosis of exclusion, meaning other causes must be ruled out. To do so, the doctor may order additional tests such as MRI, cystoscopy, ultrasound and biopsy.

Acute bacterial prostatitis can be effectively treated with antibiotics. Usually oral antibiotics suffice, but intravenous antibiotics may be necessary in severe cases. Therapy lasts two to four weeks.

Chronic bacterial prostatitis is treated with a longer course of antibiotics, typically eight to 12 weeks. For men with recurring infections, the doctor may prescribe low-dose antibiotic therapy for up to six months.

Antibiotics are sometimes effective even when tests show no signs of bacteria. For this reason, they are also often prescribed as the first line of treatment for chronic abacterial prostatitis.

Urinary symptoms can be relieved by a class of medications called alpha blockers that help to relax the muscles around the bladder and prostate.

Nonsteroidal anti-inflammatory drugs such as ibuprofen help to relieve pain and fever associated with prostatitis. They may be purchased over the counter or prescribed by a physician depending on the strength needed.

Regular prostate massage performed by a physician may help drain prostate fluid from the inflamed ducts and relieve pressure.

At home, patients can try soaking in a warm sitz bath to relieve symptoms. Some men find it more comfortable to sit on a pillow or inflatable cushion. Avoid alcohol, caffeine and acidic and spicy substances that tend to irritate the bladder.

Most acute bacterial prostatitis cases and about 75 percent of chronic bacterial prostatitis cases clear up completely with antibiotic therapy. When prostatitis can't be cured with antibiotics, the goal of treatment shifts to symptom management. Most men continue their normal activities with treatment and a few accommodations.

Prevention

It is unknown whether prostatitis can be prevented, but the following tips may help to reduce your risk:

  • Seek medical attention promptly if you have symptoms or prostatitis or a urinary tract infection.
  • Wear appropriate protective gear when playing sports to prevent trauma to the pelvic area.
  • For cyclists, invest in a well-engineered seat that minimizes pressure on the prostate.
  • Drink plenty of water and stay hydrated. Limit your intake of caffeine and alcohol and spicy or acidic substances that can irritate the bladder.
  • If your doctor prescribes antibiotics for prostatitis, take them as directed. Avoid skipping doses or stopping early, even if you feel better.

Sources

  • "Diseases and Conditions: Prostatitis." Mayo Foundation for Medical Education and Research, 2014. http://www.mayoclinic.org/diseases-conditions/prostatitis/basics/definition/con-20020916. Accessed April 11, 2014.
  • "Prostatitis: Disorders of the Prostate." National Institute of Diabetes and Digestive and Kidney Diseases, 2012. http://kidney.niddk.nih.gov/kudiseases/pubs/prostatitis/. Accessed April 12, 2014.
  • "Prostatitis (Prostate Infection)." Urology Care Foundation, 2013. http://www.urologyhealth.org/urology/index.cfm. Accessed April 12, 2014.
  • "Treatment of Prostatitis." James J. Stervermer and Susan Easley. American Family Physician, May 15 2000, vol. 61, no. 10, pp. 3015-22.
  • "What Are The Treatment Options for Recurrent Prostate Infection?" Erik Castle, Mayo Foundation for Medical Education and Research, 2011. http://www.mayoclinic.org/diseases-conditions/prostatitis/expert-answers/prostate-infection/faq-20058501. Accessed April 12, 2014.