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Prostatitis

Prostatitis

The prostate gland is a part of a man's reproductive system, secreting fluids that help transport sperm. The gland lies just below the bladder and surrounds the urethra-the tube that drains the bladder.

 

Infection that irritates the prostate can inflame the gland, causing swelling. Prostate infections or prostatitis occurs most often in men aged 30-50 years but can occur in older men.

 

  • Prostatitis is classified into 4 types. Of these, infection causes the first 2 syndromes listed. No one is sure what causes the other syndromes.
  1. Acute bacterial prostatitis.
  2. Chronic bacterial prostatitis.
  3. Chronic abacterial prostatitis.
  4. Prostatodynia (pain in the prostate gland).
  • A recent Wisconsin survey estimated the incidence of prostatitis at 6%. A population-based study found the prevalence rate to be higher than 8%.
  • Half of all men are estimated to develop symptoms of prostatitis at some time in their lives. In 1985, more office visits occurred for prostatitis than for eitherbenign prostatic hypertrophy or prostate cancer. In the early 1990s, prostatitis resulted in 2 million office visits per year in the United States. It is the most common urologic diagnosis in men younger than 50 years. 
  • In spite of it being a common and an important problem, prostatitis is poorly studied and not well understood.

Symptoms

Prostate infections can be acute or chronic.

 

  • Acute bacterial prostatitis: Because acute prostate infection often is associated with infections in other parts of the urinary tract, symptoms include the following:
  1. Increased urinary frequency.
  2. Urgency to pass urine.
  3. Pain with urination.
  4. Difficulty producing a normal stream.
  5. Pain in your genital area.
  6. Pain with ejaculation.
  7. Generalized symptoms that should not be ignored include the following: 

 - High fever and chills.

 - Generalized malaise and fatigue.

  1. Examination reveals an enlarged, tender, warm, firm, and irregular prostate. 
  2. The doctor should not perform a vigorous digital exam of your prostate to prevent possible spread of the infection to your bloodstream.
  • Chronic bacterial prostatitis: This disease is a common cause of recurrenturinary tract infections (UTIs) in men. Typically, the same strain of bacteria in prostatic fluid or urine will cause the same infection to persist or recur. 
  1. Symptoms may be similar to acute bacterial prostatitis but are less intense.

 

They include the following: 

 - Increased urinary frequency along with pain and difficulty urinating.

 - Pain in your lower back, testes, epididymis, or penis.

 - Sexual dysfunction.

 - Low-grade fever, joint pains, and muscle aches.

 - Examination may reveal urethral discharge and tender testes, or epididymis.

  1. Stress and depression are very common in men with this condition. It is not clear whether psychological concerns cause this problem or vice versa.

Causes

Bacterial infections cause only 5% of cases of prostatitis. In the other 95%, the cause is not known.

  • Different organisms, fungi, genital viruses, and parasites have been implicated. Some have familiar names such as Escherichia coli (E coli).
  • Rarely staphylococcal and streptococcal organisms have been found to be the cause.
  • The disease can reach the prostate in 2 ways.
  1. The bacteria from a previous urethral infection move through prostatic ducts into the prostate.
  2. Movement of infected urine into the glandular prostate tissue can infect via ejaculatory and prostatic ducts.

Treatment

Prostatitis treatments vary depending on the underlying cause.

 

They can include:

  • Antibiotics. This is the most commonly prescribed treatment for prostatitis. Your doctor will base the choice of medication 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. Take all of the prescribed drugs as directed even if you're feeling better. Otherwise, treatment may not work. Your doctor may have you try one or more antibiotics even if the cause of your prostatitis can't be identified. If antibiotics don't help, your prostatitis is most likely caused by something other than a bacterial infection.
  • Alpha blockers. These medications help relax the bladder neck and the muscle fibers where your prostate joins your bladder. This treatment may lessen symptoms, such as painful urination. Examples include tamsulosin (Flomax), terazosin (Hytrin), alfuzosin (Uroxatral) and doxazosin (Cardura). Common side effects include headaches and a decrease in blood pressure.
  • Pain relievers. Pain medications such as aspirin or ibuprofen (Advil, Motrin, others) may make you more comfortable. You should discuss with your doctor what doses you can safely take. Overusing these medications can cause problems.
  • 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. Other potential treatments for prostatitis are being studied. These treatments include heat therapy with a microwave device and drugs based on certain plant extracts.
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