Prostatitis is an inflammation or infection of the prostate gland, a walnut-sized gland located directly below the bladder in men. It affects at least half of all men at some time in their lives, and occurs typically in young to middle-aged men. Symptoms include painful urination, urinary frequency and urgency, and pain in the lower back and genital area. There are four main types of this condition -- some of which resolve with antibiotics. However, other forms do not respond to antibiotics and require a different treatment approach.
The prostate is a small organ located at the base of the bladder and wrapped around the urethra, the tube that empties the bladder through the penis. It sits in front of the rectum, and the back portion of the organ can be felt during rectal examination by a health care practitioner.
The prostate's purpose is to help with the male reproductive system. It makes up to 70% of the fluid that is ejaculated during intercourse, mixing its secretions with the sperm that are made in the testicles. The prostate also contracts at the time of ejaculation to prevent retrograde (or backward) flow of semen into the bladder.
Because of its location, the symptoms of any prostate problem tend to be associated with the bladder and can include urgency to urinate, frequency of urination, burning with urination (dysuria), poor urine flow, or inability to begin a urine stream.
There are four types of prostatitis:
Acute bacterial prostatitis
Chronic bacterial prostatitis
Chronic prostatitis without infection
Asymptomatic inflammatory prostatitis
The acute and chronic bacterial forms are relatively uncommon. Chronic prostatitis is the most common.
Prostatitis symptoms vary depending on the cause. They may include:
Pain or burning sensation when urinating (dysuria)
Difficulty urinating, such as dribbling or hesitant urination
Frequent urination, particularly at night (nocturia)
Urgent need to urinate
Pain in the abdomen, groin or lower back
Pain in the area between the scrotum and rectum (perineum)
Pain or discomfort of the penis or testicles
Painful ejaculations
Flu-like symptoms (with bacterial prostatitis)
Based on your symptoms and laboratory tests, your doctor may conclude that you have one of the following types of prostatitis:
Acute bacterial prostatitis. This type of prostatitis may cause flu-like symptoms associated with the sudden onset of infection, such as fever, chills, nausea and vomiting. It can usually be treated with antibiotics.
Chronic bacterial prostatitis. This is bacterial prostatitis that lasts for at least three months due to recurring or difficult-to-treat infections. Urinary tract infections are common with this type of prostatitis. Between bouts of infection, chronic bacterial prostatitis may not cause symptoms or may cause minor symptoms that become severe when infection flares up.
Chronic prostatitis not caused by bacteria. This condition is often referred to as chronic abacterial prostatitis or chronic pelvic pain syndrome. It lasts for at least three months. Most cases of prostatitis fall into this category. For some men, symptoms remain about the same over time. For others, the symptoms go through cycles of being more and less severe. Symptoms sometimes improve over time without treatment.
Prostatitis that doesn't cause symptoms. This type of prostatitis is called asymptomatic inflammatory prostatitis, and it doesn't cause any symptoms that you notice. It's found only by chance when you're undergoing tests for other conditions. It doesn't require treatment.
When to see a doctor
If
you experience pelvic pain, difficult or painful urination, or
painful ejaculations, see your doctor. If left untreated, some types
of prostatitis can cause worsening infection or other health
problems.
In some cases, prostatitis is caused by bacterial infection. These cases are treated with antibiotics to kill off the infection. But the more common forms of prostatitis are not associated with any known infecting organism. Antibiotics are, therefore, often ineffective in treating these forms of prostatitis.
The four main types of prostatitis and their causes are described in the following sections.
Acute bacterial prostatitis comes on suddenly (acute) and is caused by bacteria. This is the least common of the four types of prostatitis, yet it's the easiest to diagnose and treat. The treatment includes a high dose of antibiotics, taken for 7 to 14 days, and then lower doses for several weeks.
Chronic bacterial prostatitis is also caused by bacteria. Though this condition doesn't come on suddenly, it can still be bothersome. In some men with this condition, the only prostatitis symptoms they have are bladder infections that keep coming back (chronic). Chronic bacterial prostatitis treatment includes antibiotics over a long period of time. This type of treatment lasts from 4 to 12 weeks and clears up about 60 percent of these cases.
This disorder is the most common form of prostatitis, yet it is the least understood. Found in men of any age from late teens to the elderly, the symptoms of chronic pelvic pain syndrome go away and then return without warning. With this form of the disease, there can be pain or discomfort in the groin or bladder area.
The exact causes of chronic prostatitis are not known.
Men with asymptomatic inflammatory prostatitis usually don't have any symptoms. It is often discovered when the doctor is looking for other conditions, like infertility or prostate cancer. The PSA (prostate-specific antigen) tests for men with this condition often show a higher number than normal. This, however, does not necessarily mean that prostate cancer is present.
The causes of asymptomatic inflammatory prostatitis are not known.
Risk factors for prostatitis include:
Being a young or middle-aged man
Having a past episode of prostatitis
Having an infection in the bladder or the tube that transports semen and urine to the penis (urethra)
Having a pelvic trauma, such as injury from bicycling or horseback riding
Not drinking enough fluids (dehydration)
Using a urinary catheter, a tube inserted into the urethra to drain the bladder
Having sex
Having HIV/AIDS
Being under psychological stress
Having certain inherited traits — particular genes may make some men more susceptible to prostatitis
Several tests, such as a digital rectal exam (DRE) and a urine test, can be done to see if you have this condition. Getting an accurate diagnosis of your exact type of prostatitis is the key to getting the best prostatitis treatment. Even if you have no symptoms, you should follow your doctor's suggestion to complete treatment.
There are two types of prostatitis, inflammatory prostatitis and infective prostatitis. If prostatitis is contagious depends on what type you have.
Inflammatory prostatitis cannot be spread through sexual intercourse directly, so your marital partner cannot catch this infection from you.
But in cases of infective prostatitis, the infection can spread to your sexual partner. And the inflammation and infection of prostate can both spread to nearby organs in your urinary and genital system. So if you are suffering from a prostatitis, take prompt 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.
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.
Treatment for acute bacterial prostatitis is a prescription for antibiotics by mouth, usually ciprofloxacin (Cipro) or tetracycline (Achromycin). Home care includes drinking plenty of fluids, medications for pain control, and rest.
If the patient is acutely ill or has a compromised immune system (for example, is taking chemotherapy or other immune suppression drugs or has HIV/AIDS), hospitalization for intravenous antibiotics and care may be required.
Chronic bacterial prostatitis treatment is with long-term antibiotics, up to eight weeks, with ciprofloxacin (Cipro, Cipro XR), sulfa drugs [for example, sulfamethoxazole and trimethoprim, (Bactrim)], or erythromycin. Even with appropriate therapy, this type of prostatitis can recur. It is uncertain as to why, but it may be due to a poorly emptying bladder. A small amount of stagnant urine allows the potential for recurrent infection to occur. This situation can be caused by benign prostatic hypertrophy (BPH), bladder stones, or prostate stones.
Chronic prostatitis without infection treatment addresses chronic pain control and may include physical therapy and relaxation techniques as well as tricyclic antidepressant medications.
Other medication possibilities include alpha-adrenergic blockers. Tamsulosin (Flomax) and terazosin (Hytrin) are drugs that block the non-heart adrenaline receptors and are used in treating BPH and bladder outlet obstruction. Allowing better bladder emptying may help minimize symptoms.
Treatment is not required for this type of prostatitis.
In patients undergoing infertility assessment, this inflammation may be treated with a course of either a nonsteroidal anti-inflammatory medication (ibuprofen, Motrin, Advil) or antibiotics.
The following lifestyle changes and home remedies may lessen some symptoms of prostatitis:
Soak in a warm bath (sitz bath).
Limit or avoid alcohol, caffeine, and spicy or acidic foods.
Sit on a pillow or inflatable cushion to ease pressure on the prostate.
Avoid bicycling, or wear padded shorts and adjust your bicycle to relieve pressure on your prostate.
Alternative therapies that show some promise for reducing symptoms of prostatitis include the following:
Biofeedback. This is a method for teaching you to use your thoughts to control your body. A biofeedback specialist uses signals from monitoring equipment to teach you to control certain body functions and responses, including relaxing your muscles. Some small studies have suggested the benefit of this process to manage pain associated with prostatitis.
Acupuncture. This type of treatment involves the insertion of very thin needles through your skin, to various depths at certain points on your body. A few small studies have shown that acupuncture may help with prostatitis symptoms.
Herbal remedies and supplements. There's no evidence that herbs and supplements improve prostatitis, although many men take them. Some herbal treatments for prostatitis include cernilton (rye grass), quercetin (a chemical found in green tea, onions and other plants) and extract of the saw palmetto plant. Prostate supplements combine minerals and vitamins, particularly zinc, selenium and vitamins E and D. Depending on the formulation, some supplements may be harmful, so talk to your doctor before using them.