Prostatitis

The prostate, part of the male reproductive system, is a walnut-sized gland that makes the seminal fluid for carrying sperm. It is located behind the base of the penis, in front of the rectum, and below the bladder. It surrounds the urethra, the tube-like channel that carries urine and semen through the penis.

Prostatitis is a condition in which the prostate and sometimes the area around it become inflamed. It affects men of all ages, but it is more common in men over the age of 50. Prostatitis can be caused by a bacterial infection (often the same bacteria that cause urinary tract infections), or it can occur in the absence of any infection.

There are several types of prostatitis:

• Acute Bacterial Prostatitis. This is a type of urinary tract infection, caused by bacteria.
• Chronic Bacterial Prostatitis. Similar to acute bacterial prostatitis, this condition develops gradually, with less severe symptoms and recurring urinary tract infections. Symptoms lasting longer than 3 months or that continue to recur are considered chronic.
• Nonbacterial Prostatitis (also called Chronic Pelvic Pain Syndrome or Prostatodynia). Causes of nonbacterial prostatitis may include stress, nerve irritation, injuries, or past urinary tract infections. This form of prostatitis has no signs of bacteria in the urine or semen.
• Asymptomatic Inflammatory Prostatitis. This condition occurs when the prostate is inflamed, with no other symptoms.

Acute Bacterial Prostatitis symptoms include:

• Chills
• Fever
• Very painful burning while passing urine
• Trouble draining the bladder
• Pain in the lower back, abdomen, or pelvic area

Symptoms can begin suddenly and be very painful. Men should get medical care right away.

Chronic Bacterial Prostatitis symptoms include:

• A burning feeling while passing urine
• The need to pass urine often (8 or more times per day)
• Pain in and around the bladder, testicles, penis, and/or anus
• Pain with ejaculation

Nonbacterial Prostatitis (Chronic Pelvic Pain Syndrome or Prostatodynia) symptoms include:

• Trouble passing urine (sometimes with pain)
• Pain in and around the bladder, testicles, penis and/or anus
• Pain with ejaculation

1. Medical History. Tell your health care provider about your symptoms, how long you’ve had them, and how they affect your everyday living. Bring a list of your over-the-counter and prescription drugs. Tell your provider about any past and current health problems and about your diet, including how much and what kinds of liquids you drink during the day and night.
2. Digital Rectal Examination (DRE). The health care provider inserts a gloved, lubricated finger into the rectum and feels the prostate.
3. Pelvic Floor and Perineum Exam. The health care provider presses on muscles and ligaments to determine the degree of pain.
4. Urine Test. A sample of your urine is taken to test for infection or blood.
5. Semen Test. A sample of your semen is taken to test for prostate infection.
6. Blood Test. A PSA test is done to check for prostate cancer.
7. Ultrasound of the prostate. This non-invasive procedure measures prostate volume.
8. Prostate Massage. This procedure draws out expressed prostatic excretion (EPS), which is analyzed with urine for signs of inflammation and infection.
9. Cystoscopy and Urodynamics. In cystoscopy, a hollow tube called a cystoscope is inserted into the urethra (the tube that carries urine out of the body) and then into the bladder. The lens in the cystoscope allows a doctor to examine the bladder lining. In urodynamics, a series of tests measures lower urinary tract function. These tests reproduce a person’s voiding patterns to help identify any underlying problems. One of the most important measurements obtained is the pressure inside the bladder and kidneys.

Prostatitis caused by bacteria is treated with antibiotics: up to 14 days for acute cases and 4 to 12 weeks for chronic ones. Treatment for other types of prostatitis includes:

• Medications to help relieve symptoms or reduce inflammation. These can include alpha blockers to help relax the prostate, helping you to urinate more freely; and NSAIDS, anti-inflammatory medications (like aspirin, ibuprofen, etc.) to help relieve discomfort.
• Prostate massages to ease pressure in the prostate. This includes draining fluid from the prostate ducts while calming nearby muscles.
• Heat therapy, such as hot baths, hot water bottles, and heating pads.
• Donut-shaped pillows or inflatable cushions for sitting.
• Pelvic muscle therapy. This can include biofeedback, in which an expert teaches you ways to relax certain muscles to lessen tension in your pelvic floor.
• Lifestyle changes, such as weight loss and diet changes, relaxation training, and exercises to ease symptoms.
• Acupuncture, in which a professional places very thin needles through your skin at different depths and points on your body to help reduce pain.
• Surgery on either the urethra or prostate. Surgery is done only in rare cases, to treat an exact problem, such as scar tissue in the urethra.