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Prostatitis by Rick Alan

Definition

Prostatitis is inflammation of the prostate gland. The prostate is a walnut-sized gland in men that surrounds the urethra. The prostate produces a fluid that is part of semen.

Anatomy of the Prostate Gland

There are four types of prostatitis:

Category 1: acute bacterial (least common of the four types, but the most common in men under 35)
Category 2: chronic bacterial (not very common, but affects mostly men between 40-70)
Category 3: chronic nonbacterial/prostadynia (most common type, chronic pelvic pain)
- Note: Prostadynia (also known as chronic pelvic pain syndrome) is a condition associated with similar symptoms as chronic nonbacterial prostatitis, but which has no evidence of prostatic inflammation.
Category 4: asymptomatic inflammatory prostatitis

Causes

Acute and some chronic bacterial prostatitis are caused by bacteria that infect the prostate gland. The bacteria usually come from the urinary tract or rectum. The causes of nonbacterial prostatitis can be difficult to identify, but some feel this may be caused by nonbacterial pathogens such as chlamydia , virus, fungus, or mycoplasma.

The causes of prostatodynia can be even more difficult to identify. But, the condition can be associated with stress and/or disorders of pelvic floor muscle tension or conditions such as interstitial cystitis . Asymptomatic inflammatory prostatitis is found during a prostate biopsy . The cause is not clearly understood.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:

Medical procedures that involve inserting a catheter or other tubing into your urethra or rectum
Anal intercourse
Recent bladder infection
Abnormalities in the anatomy of the urinary tract
Diabetes
Suppressed immune system
Something obstructing the bladder (eg, a tumor, a kidney stone , or enlargement of the prostate gland itself)

Symptoms

Symptoms of prostatitis can come on slowly or suddenly. They can be mild or quite severe. In nonbacterial prostatitis, symptoms often come and go.

Symptoms may include:

Needing to urinate frequently and/or urgently (especially at night)
Pain or burning while urinating
Difficulty urinating
Blood in the urine
Psychological stress
Lower abdominal pain or pressure
Rectal or perineal discomfort
Lower back pain
Fever or chills
Painful ejaculation
Impotence (due to inflammation around the gland)

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Diagnosis of prostatitis is usually based on the symptoms, the exam. Massaging the prostate gland may be done in cases of chronic prostatitis to try to find the cause. In this test, the doctor places a lubricated, gloved finger into the rectum to feel the back wall of the prostate. In prostatitis, the prostate is usually tender and soft. The doctor will push on the prostate to release fluid from it.

Other tests may include:

Analysis of urine and prostate fluid expressed after massaging the prostate gland
Bladder function tests

Treatment

Treatment depends on the type of prostatitis:

Infectious Prostatitis

Acute bacterial prostatitis is treated with oral antibiotics for 4-6 weeks. The commonly used drugs include quinolones (norfloxacin, ciprofloxacin, levofloxacin) or trimethoprim. In severe cases, treatment with intravenous antibiotics may be necessary. Chronic bacterial prostatitis is also treated with oral antibiotics for 4-12 weeks. Other medications include:

Stool softeners
Anti-inflammatory medications
Other analgesics or pain medications
Alpha-blockers such as Flomax
5-alpha reductase inhibitors such as Proscar or Avodart

Your doctor may recommend that you alcohol and caffeinated beverages.

Noninfectious Prostatitis

Often patients are initially given a course of antibiotics. This is just in case an infectious cause was missed. Other treatments include:

Alpha-blockers such as Flomax
5-alpha reductase inhibitors such as Proscar or Avodart
Anti-inflammatory medications such as ibuprofen
Pain killers
Warm sitz baths
Repeated prostate massages

Prevention

There are no guidelines for preventing prostatitis.

RESOURCES:

American Urological Association Foundation http://www.urologyhealth.org/
The Prostatitis Foundation http://www.prostatitis.org

CANADIAN RESOURCES:

Canadian Urological Association http://www.cua.org/
Men's Health Centre http://www.menshealthcentre.net/

References:

American Academy of Family Physicians website. Available at: http://www.aafp.org .
The Merck Manual of Medical Information—Home Edition . Simon and Schuster, Inc; 2000.
National Kidney and Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/ .
Propert KJ, McNaughton-Collins M, Leiby BE, et al. A prostpective study of symptoms and quality of life in men with chronic prostatitis/chronic pelvic pain syndrome: The National Institutes of Health Chronic Prostatitis Cohort Study. J Urol . 2006;175:619-623.
Sharp VJ, Takacs EB, Powell CR. Prostatitis: diagnosis and treatment. Am Fam Physician . 2010 Aug 15;82(4):397-406.

Last reviewed September 2011 by Adrienne Carmack, MD

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