Prostatitis

Prostatitis literally means inflammation of the prostate. However this can be misleading as not all men with prostatitis actually have an inflamed prostate. Prostatitis is a poorly understood condition but is one of the most common complaints involving the urinary system in men aged 18 – 50.

Chronic prostatitis can affect quality of life and may cause anxiety and depression. Seeking medical attention and treatment of symptoms can help relieve this burden.

Risk Factors

Symptoms

The known risk factors include:

  • Previous history of prostatitis
  • Long-term catheterisation
  • Urinary tract infections
  • Prostate trauma
  • Prostate surgery
  • Pain in the lower back
  • Pain in the perineum (area between the anus and scrotum)
  • Pain in the penis and/or testicles
  • Pain in the prostate, rectum or inner thighs
  • Chills and fever
  • Frequency and urgency of voiding
  • An inability to completely empty the bladder
  • Pain during or after ejaculation
  • Occasionally blood in the semen

It may be necessary to have treatment in hospital if the symptoms are severe or there is an inability to pass urine.

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Prostatitis vs. BPH (Enlarged Prostate) Symptoms and Signs

Types of Prostatitis

If you do not have any signs or symptoms of BPH or any of the types of prostatitis, which can be the situation for some men, you may not be able to tell if you have either problem. Signs and symptoms of prostatitis and an enlarged prostate that are similar include, painful, difficult and/or frequent urination or blood in the urine.

However, there are some major differences between some symptoms and signs of these two problems. Prostatitis symptoms and signs like low back pain, fever, and chills do not occur with BPH (unless the BPH is complicated by infection). BPH symptoms and signs that do not occur in prostatitis include a weak stream of urine and a sense of not fully emptying the bladder.

This is caused by bacteria such as E.Coli or Klebsiella usually as a result of a urinary tract infection. It is less common than chronic bacterial prostatitis but is the easiest form to diagnose. Symptoms are usually of sudden onset and severe. The urine will show white blood cells and bacteria.

This is also caused by a bacterial infection but continues for a prolonged period of time. It generally develops gradually and the symptoms are less severe than an acute infection but they tend to recur. The urine will also show white blood cells and bacteria.

Also known as chronic pelvic pain syndrome, this is the most common and least understood form of prostatitis. The symptoms are generally the same as for bacterial prostatitis but tend to disappear and then return without warning. It may be inflammatory or non-inflammatory. The inflammatory form will show white cells in the urine with no bacterial growth whereas the non-inflammatory form will show neither white cells nor bacteria in the urine.

There are some studies which suggest that inflammation may be caused by urine being forced up the prostatic ducts during urination.

This form causes no symptoms but white cells are found in the urine, usually when investigations are being carried out for other reasons. This is generally harmless.

For more information regarding this speak to your consultant Urologist or the specialist urology nurse at the BUA.

Diagnosis

Treatment

The correct diagnosis is important as the treatment is different for each type of prostatitis. It is also important to ensure the symptoms are not being caused by other conditions such as enlarged prostate, cystitis or cancer.

  • Digital rectal examination is used to determine whether there is swelling or tenderness of the prostate gland or pain/discomfort is experienced by the patient when the muscles and ligaments of the pelvic floor and perineum are pressed
  • A simple urine test to check for white cells is done and the urine sample sent to the laboratory to check for the presence of bacteria
  • A Stamey Localisation Test involves the collection of 2 urine samples and a sample of prostatic fluid following a prostate massage. These samples can help determine whether infection or inflammation is present
  • TRUS (transrectal ultrasound of the prostate). This may show swollen ducts or calcification within the prostate.

Other tests may include a flow test, ultrasound of the bladder, a swab of the lining of the urethra or penis or a cystoscopy (a look at the urethra, prostate and bladder using a telescope

is treated with antibiotics, usually for 4 – 6 weeks. The antibiotics may be adjusted when the urine test results are available. It is important to complete the full course of antibiotics even when symptoms disappear to prevent the development of antibiotic-resistant bacteria and may reduce the risk of progressing to chronic bacterial prostatitis. A simple painkiller such as paracetamol can be used for pain relief. Rest and fluids are advisable and if passing stools causes discomfort a stool softener can be used.

It may be necessary to have treatment in hospital if the symptoms are severe or there is an inability to pass urine.

is treated with a 6 – 8 week course of antibiotics as the infection may lie deep within the prostate and the tissue of the prostate is difficult for antibiotics to penetrate. This means that sometimes an infection can persist or recur. An anti-inflammatory drug such as Voltarol (diclofenac) is used to reduce the inflammation in the prostate. Again a stool softener will help of discomfort is caused when passing stools.

Occasionally an abscess can form in the prostate. This may need to be drained which is usually done under anaesthetic. A catheter may be needed to drain urine if passing urine is difficult or impossible and antibiotics are used to clear the infection.

is more difficult to treat and the aim in to treat the symptoms. Sometimes a course of antibiotics may help, despite there being no evidence of infection. This is usually taken over 6 weeks. Anti-inflammatory drugs such as iboprufen, neurofen or voltarol can be used to help control pain caused by inflammation. It is usually more effective to use painkillers or anti-inflammatories on a regular basis, especially initially. Alpha-blockers or muscle relaxants can be used and have been found sometimes to alleviate symptoms, by relaxing the ‘tension’ in the prostatic capsule..

A schedule of prostatic massage has been shown to be beneficial to some men.

It is usually a matter of trying various forms and combinations of treatment to find the one that works best. Good general health and immunity also counteract the effects of Prostatitis.

is usually not treated.

Self-Help Measures

  • Eating a healthy diet and drinking enough fluids may be beneficial
  • Avoiding substances which irritate the bladder (alcohol, caffeine, citrus, hot/spicy foods) may alleviate symptoms
  • Emptying the bladder frequently and completely may decrease urgency
  • Relaxation techniques such as yoga or Pilates may help reduce pain
  • Good hygiene and hand washing to prevent contamination of the penis/urethra by bacteria from the rectal area. Wearing a condom during anal intercourse will help prevent infection
  • Warm baths may relieve pelvic pain
  • Some activities such as cycling may increase symptoms
  • Some men find acupuncture, meditation, massage therapy and chiropractic therapy to be helpful
  • Alpha-blocker treatment

There is a great deal more that needs to be learnt about prostatitis, its causes and treatments. However, it is beneficial to thoroughly investigate symptoms and commence treatment on presentation of symptoms.