Prostatitis

Prostatitis is often described as an infection of the prostate. It can also be an inflammation with no sign of infection. Just 5% to 10% of cases are caused by bacterial infection. It does not raise the risk of getting prostate cancer.

Prostatitis can affect men of all ages. According to the National Institutes of Health, prostatitis may account for up to 25% of all office visits for complaints involving the genital and urinary systems from young and middle-aged men. In fact, chronic prostatitis (which means it doesn't go away) is the number-one reason men under age 50 visit a urologist. In some cases, chronic prostatitis follows an attack of acute prostatitis. Chronic prostatitis may also be related to other urinary tract infections.

The primary symptom of chronic infectious prostatitis is usually repeated bladder infections. Prostatitis is considered chronic if it lasts more than three months.

Types of prostatitis include:

  • Acute bacterial prostatitis. A sudden bacterial infection marked by inflammation of the prostate. This is the least common form of prostatitis, but the symptoms are usually severe. Patients with this condition have an acute urinary tract infection with increased urinary frequency and urgency, a need to urinate a lot at night, and have pain in the pelvis and genital area. They often have fever, chills, nausea, vomiting, and burning when urinating. Acute bacterial prostatitis requires prompt treatment, as the condition can lead to bladder infections, abscesses in the prostate or, in extreme cases, completely blocked urine flow. Left untreated, the condition can cause confusion and low blood pressure, and may be fatal. The condition is usually treated in the hospital with intravenous antibiotics, pain relievers, and fluids.
  • Chronic bacterial prostatitis. This condition is the result of recurrent urinary tract infections that have entered the prostate gland. It is thought to exist for several years in some men before producing symptoms. The symptoms are similar to acute bacterial prostatitis, but are less severe and can fluctuate in intensity. The diagnosis of this condition is often challenging. It's often difficult to find the bacteria in the urine. Treatment includes antibiotics for four to 12 weeks and other treatment for pain. Sometimes men are given suppressive low-dose, long-duration antibiotic therapy.
  • Chronic nonbacterial prostatitis/chronic pelvic pain syndrome. This is the most common form of the disease, accounting for 90% of the cases. The condition is marked by urinary and genital pain for at least three of the past six months. Patients have no bacteria in their urine, but may have other signs of inflammation. The condition can be confused with interstitial cystitis (a chronic inflammation of the bladder).

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What Causes Prostatitis?

prostatitis

How the prostate becomes infected is not clear. The bacteria that cause prostatitis may get into the prostate from the urethra by backward flow of infected urine or stool from the rectum.

At one time, prostatitis was believed to be a sexually transmitted disease, but more recent research suggests that only a small number of cases are passed on through sex.

Certain conditions and medical procedures increase the risk of developing prostatitis. You are at higher risk for getting prostatitis if you:

  • Recently have had a medical instrument, such as a urinary catheter (a soft, lubricated tube used to drain urine from the bladder) inserted during a medical procedure
  • Engage in rectal intercourse
  • Have an abnormal urinary tract
  • Have had a recent bladder infection
  • Have an enlarged prostate

Other causes may include autoimmune disease (an abnormal reaction of the body to the prostate tissue).

What Are the Symptoms of Prostatitis?

You may have no symptoms of prostatitis or symptoms so sudden and severe that you seek emergency medical care.

When present, symptoms include:

  • Frequent urge to urinate
  • Difficulty urinating
  • Pain or burning during urination
  • Chills and fever

Other symptoms may include pain that comes and goes low in the abdomen, around the anus, in the groin, or in the back. In some cases, bacteria can get into the vas deferens (the tube that carries sperm from the testicles to the urethra), causing groin pain or an infection of the epididymis (area near the testicles where sperm mature and are stored).

The prostate may swell, causing a less forceful urine stream. Sometimes blood in the urine and painful ejaculation are other symptoms of prostatitis.

Men may also complain of pelvic pain, pain during ejaculation, and pain with sexual intercourse.

How Is Prostatitis Diagnosed?

If your doctor suspects that you have prostatitis or another prostate problem, he or she may refer you to a urologist (a doctor who specializes in diseases of the urinary tract and the male reproductive system) to confirm the diagnosis.

Patients typically undergo a comprehensive exam, including a digital rectal exam. The doctor will be able to evaluate whether the prostate gland is enlarged or tender. Then, if the doctor is still not sure what you have, more tests may be done, such as a prostate fluid analysis for signs of infection, transrectal ultrasound, biopsy, or voiding studies. Voiding studies involve the collection and analysis of urine to determine which part of the urinary system is infected.

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What Is the Treatment for Prostatitis?

Treatments vary among urologists and are tailored to the type of prostatitis you have. Correct diagnosis is crucial and treatments vary. It's important to make sure your symptoms are not caused by urethritis (inflammation of the urethra) or some other condition that may lead to permanent bladder or kidney damage.

Treatments for prostatitis can include:

  • Anti-inflammatory drugs along with warm sitz baths (sitting in two to three inches of warm water); this is the most conservative treatment for chronic prostatitis.
  • Antibiotics for infectious prostatitis; these drugs are not effective treatments for noninfectious prostatitis. For acute infectious prostatitis, patients usually need to take antibiotics for 14-21 days. Almost all acute infections can be cured with this treatment.
  • For chronic infectious prostatitis, antibiotics are taken for a longer period of time, usually four to 12 weeks. About 75% of all cases of chronic infectious prostatitis clear up with this treatment. For cases that don't, taking antibiotics at a low dose for a long time may be recommended to relieve the symptoms.
  • Pain medications
  • Muscle relaxants
  • Surgical removal of the infected portions of the prostate; a doctor may advise this treatment for severe cases of chronic prostatitis or for men whose swollen prostate is blocking the flow of urine.
  • Supportive therapies for chronic prostatitis, including stool softeners and prostate massage

Other treatments for chronic noninfectious prostatitis include the use of the alpha blocker drugs such as Hytrin, Cardura, Tamsulosin (Flomax), Rapiflo, or Uroxatral. These drugs relax the muscles of the prostate and bladder to improve urine flow and decrease symptoms. Other drugs that lower hormone levels, such as Proscar, may help to shrink the prostate gland in some men.

Some people may benefit from avoiding spicy foods and caffeinated or acidic drinks. Activities that aggravate the condition, such as bicycling, may need to be eliminated, as well.

Many cases of abacterial (nonbacterial) prostatitis (also considered chronic pelvic pain syndrome) respond to a mix of treatments that include exercise, myofascial trigger point release, progressive relaxation, and counseling.

Prostatitis is a treatable disease. Even if the problem cannot be cured, you can usually get relief from your symptoms by following the recommended treatment. Be sure to follow the full course any prescription you are given, even if you no longer have any symptoms. With infectious prostatitis, for example, the symptoms may disappear before the infection has completely cleared.

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What Are the Long-Term Effects of Chronic Prostatitis?

Chronic prostatitis affects men differently, with varying degrees of discomfort or pain.

Prostatitis is not a contagious disease. You can live your life normally and continue sexual relations without passing it on.

Having prostatitis does not increase your risk of developing prostate cancer or any other prostate or kidney disease. But even if your prostatitis is cured, you should continue to have regular exams to detect prostate cancer.



WebMD Medical Reference Reviewed by Stuart Bergman, MD on September 14, 2015

Sources

SOURCES: 

American Urological Association. National Kidney and Urologic Diseases Information Clearinghouse. American Family Physician.

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