Prostatitis is an inflammation or infection of the prostate gland. It can affect men of any age. The most common urological problem in men aged 50 and older, prostatitis is not contagious and is not transmitted during sex. The prostate is a walnut-sized organ found only in men. Its main function is to produce semen, the fluid that carries sperm during ejaculation. Part of the male urinary system, it lies next to the bladder. Prostatitis often causes urinary symptoms because the prostate surrounds the urethra, the tube carrying urine out of the body.
The four types of prostatitis are:
- Asymptomatic inflammatory prostatitis - patients don't have symptoms but their doctors find infection-fighting cells in the semen when checking for other problems such as prostate cancer or enlargement
- Chronic Pelvic Pain Syndrome (CPPS) - affects about 90% of men with prostatitis (Chronic Non-Bacterial Prostatitis)
- Acute bacterial prostatitis - the least common but easiest to treat
- Chronic bacterial prostatitis - also not common
Please note that an enlarged prostate (benign prostatic hyperplasia or BPH) does not increase your risk of prostate cancer.
Symptoms vary depending on the type of prostatitis. Acute bacterial prostatitis comes on suddenly and is often accompanied by fever, severe burning during urination, inability to empty the bladder, low back or groin pain. You should seek immediate medical care. If left untreated, acute bacterial prostatitis may cause problems with sterility, inability to urinate, and even bacteremia (bacteria in your blood).
In chronic bacterial prostatitis, you experience less intense symptoms but for a longer period of time, and you may have frequent urinary tract infections.
Men with CPPS may have many of the same symptoms as bacterial prostatitis, but without fever. Ejaculation may be painful. CPPS is distinguished by pelvic pain that can last months without evidence of inflammation or bacterial infection. Bladder and rectal pressure or pain is common.
Bacterial prostatitis is caused by bacteria from infected urine that backs up into the prostate ducts. Men who have had catheterization, injury to the area or a recent bladder infection are at greater risk.
Doctors are not entirely certain what causes CPPS and in most cases no cause is found. Possible contributing factors include:
- Infections not found during standard tests
- Sexually transmitted diseases (STDs)
- Persistent bladder infections
- Pelvic muscle spasm
- Physical activity such as biking or heavy lifting when your bladder is full
Diagnosing prostatitis involves ruling out other problems such as prostate cancer or an enlarged prostate, then determining which type of prostatitis you have. Your doctor will perform a history and physical exam, including a digital rectal exam (DRE), where your prostate is checked for size, tenderness and the possibility of cancer by inserting a gloved finger into the rectum.
Your doctor also may test your urine and semen for infection. If you have an infection, you will get a culture to identify which bacteria is involved. Cystoscopy (viewing the urethra, bladder and prostate with a tiny telescope-like instrument) and urine flow studies also may be ordered.
CPPS is diagnosed after other probable causes have been eliminated and when the prostatitis has lasted for three or more months. Often, it is a diagnosis of exclusion.
Acute and chronic bacterial prostatitis can be treated effectively with antibiotics. You must take the entire dose even if your symptoms improve, to prevent re-infection. Treatment can last several weeks to several months.
Treatments that may help relieve CPPS symptoms:
- Alpha blockers such as Flomax may improve urinary symptoms by relaxing bladder muscles.
- Muscle relaxants
- Pain relievers such as ibuprofen or naproxen
- Herbal remedies such as Quercetin or bee pollen
- Physical therapy, including pelvic exercises or biofeedback
- Warm baths and relaxation techniques
- Dietary changes - discontinue caffeinated, spicy and acidic foods and beverages
- Experimental treatments with heat (microwave) therapy are being evaluated.