Prostatitis is the inflammation of the male-only prostate gland. Although prostatitis is thought to be associated with prostate cancer, it is actually non-cancerous. Prostatitis may cause much swelling and pain, thus ensued by much distress. Prostatitis can bother a man’s daily living and badly affect his quality of life, therefore it is important to properly prevent and treat prostatitis.
What is Prostatitis?
Prostatitis is the inflammation of the prostate gland that only exists in the male reproductive system. Prostate is a walnut-shaped endocrine gland inferior to the urinary bladder and anterior to the rectum, with the urethra running through the centre of it. The prostate is an accessory gland producing alkaline and milky fluid as part of semen. Such prostatic secretion allows a longer lifespan of sperms and helps them travel further up in the female vagina and genital tract. Besides, the prostate gland also aids the switch between ejaculation and urination.
In the case of prostatitis, the prostate gland may be swollen to cause much pain. Occasionally, prostatitis may occlude part of the urinary tract, making urination difficult.
Causes of Prostatitis
Prostatitis means the prostate gland is inflamed. Such inflammation can be caused by many reasons apart from infection. The professionals usually classify prostatitis into 4 major categories:
- Acute prostatitis (Acute bacterial prostatitis): Urinary tract infection (UTI) may spread upward to infect the prostate gland, causing chills, fever, intense pain and difficult urination . Urgent medical treatment is required as acute prostatitis can develop into sepsis which could be fatal.
- Chronic bacterial prostatitis: Its prevalence is relatively low. Bacteria are trapped in the prostate gland, leading to intermittent UTIs that are not easy to treat. Sometimes, chronic bacterial prostatitis is not associated with pain.
- Chronic pelvic pain syndrome (CPPS) (Chronic non-bacterial prostatitis): CPPS is, by far, the most prevailing prostatitis. As indicated by its name, CPPS causes chronic pelvic, genital and perianal pain without bacterial infection. It is not necessarily combined with inflammation. The causes of CPPS are not yet well-established, it may be related to psychological stress which leads to uncontrolled pelvic floor muscle movements.
- Asymptomatic inflammatory prostatitis: This category is the inflammation of the prostate gland without obvious symptoms like pain or urinary symptoms. It is often detected while undergoing tests for other health issues, such as prostate biopsy for raised PSA (prostate-specific antigen) . It does not require medical treatment as it rarely causes complications.
Risk Factors of Prostatitis
Regarding prostatitis, there are different sets of risk factors corresponding to chronic pelvic pain syndrome and bacterial prostatitis:
- Acute bacterial prostatitis
– Recent urinary tract infection (UTI)
– Urinary catheter: Urinary catheter may potentially induce bacteria infection to the urinary tract as well as prostate gland.
– Prostate biopsy
– A sexually active lifestyle with numerous sexual partners
– HIV infection
– Anal sex
– Pelvic injury
- Chronic bacterial prostatitis
– Recurrent urinary tract infection
– Medical history: History of prostatitis increases the chance of recurrence.
– History of being sexually abused
- Chronic pelvic pain syndrome (CPPS)
– Autoimmune diseases: The immune system attacks the prostate gland and causes inflammation.
– Other painful abdominal conditions: For example, irritable bowel syndrome (IBS) and celiac disease.
– Psychological stress: Psychological stress can potentially cause CPPS, as a result leading to prostatitis.
– Pelvic floor muscle spasms
Signs and Symptoms of Prostatitis
Depending on the causes and types of prostatitis, its signs and symptoms will be different. For asymptomatic inflammatory prostatitis, there are no symptoms at all. For acute prostatitis, the signs and symptoms include:
- Intense pain: The intense pain is at the genital, perineal, pelvic and lower back. It can make defecation and ejaculation painful.
- Acute urinary retention: Acute prostatitis can make one unable to urinate and lead to urinary retention. Immediate medical treatment for such acute urinary retention is a must.
For CPPS and chronic bacterial prostatitis, the signs and symptoms can last for more than 3 months as the following:
- Chronic pain: The chronic pain is at the genital, perineal and pelvic area, which may then radiate to the lower back.
- Enlarged or tender prostate: This can be checked by rectal examination by physicians.
- Frequent and painful urination
- Difficulty in urination
- Nocturia (frequent urination at night)
- Pain during sexual intercourse and ejaculation
- Blood in semen
- Erectile dysfunction
Complications of Prostatitis
If prostatitis is not properly treated, severe or even fatal complications may occur, such as:
- Infertility: chronic inflammation can cause infertility due to reduced ejaculate and sperm count.
- Sepsis: This is particularly relevant in those with acute bacterial prostatitis. Sepsis is the condition when the bacteria enter the bloodstream and cause severe body inflammatory response. This is a life-threatening condition that needs immediate medical care.
- Epididymitis: Epididymis is the coiled tube which transports sperms from the testicle to the vas deferens. Epididymitis is the inflammation of epididymal tissues.
- Prostatic abscess: Prostate is filled with pus.
Diagnosis of Prostatitis
Prostatitis is assessed based on the signs and symptoms. To make the diagnosis and identify the category and cause of prostatitis, physical examination and the following tests are usually conducted by physicians:
- Rectal examination: Healthcare professional inserts a finger into the rectum to examine the prostate gland for any sign of pain, swelling and tenderness. Prostate fluid may also be collected through massaging the prostate gland.
- Urine test: Urine and its culture are analyzed to check for the presence of bacteria and UTI.
- Blood test: The major parameter in this kind of blood test is PSA (prostate-specific antigen). The prostate gland produces a protein named PSA. A high level of PSA indicates a possibility of prostatitis, benign prostate hyperplasia or even prostate cancer.
- Cystoscopy: A fine tube with a camera or lens, called a cystoscope, is applied during cystoscopy to observe the internal structure of the bladder and urethra. It cannot make the diagnosis of prostatitis directly but is complementary.
- CT scan: CT scan may be indicated in selected cases to rule out prostate abscess which may require drainage. It can also allow doctor to assess other causes of urinary tract infection.
Treatments for Prostatitis
Prostatitis is treated according to its type and severity. For asymptomatic inflammatory prostatitis, treatment is often unnecessary since medical complications are usually rare.
Clinical treatments for CPPs (Chronic Non-Bacterial Prostatitis)
However, for CPPS, management of symptoms and treatments are necessary. The signs and symptoms of chronic non-bacterial prostatitis can be treated according to the following 6 classes (acronym as UPOINT).
- “U – Urinary”: Urinary symptoms like poor urine flow is treated with alpha-blockers like tamsulosin and alfuzosin to relax the smooth muscle of the prostate gland.
- “P – Psychosocial”: Since CPPS is usually caused and exacerbated by psychological stress, stress management can facilitate the treatment of prostatitis. Feasible measures include counseling or medications relieving anxiety and depression like buspirone and sertraline.
- “O – Organ”: The word, organ, stands for the prostate gland in this case. Prostate swelling and inflammation can be relieved by quercetin and bee pollen supplements.
- “I – Infection”: Antibiotics like doxycycline and ciprofloxacin kill bacteria that infect the prostate gland.
- “N – Neurologic”: This refers to the symptoms caused in the nervous system like pain, that can be treated with analgesics such as amitriptyline and gabapentin.
- “T – Tenderness”: Physical therapy is utilized with the aim to reduce muscle spasms of the pelvic floor.
Clinical treatments for bacterial prostatitis
For bacterial prostatitis, it is usually treated with antibiotics.
- For acute prostatitis, the patients will first be sent to the hospital and be administered Intravenous antibiotics. The antibiotic treatment usually lasts for 14 to 30 days. In rare cases, prostatic abscesses might need to be drained.
- For chronic prostatitis, prolonged course upto 6-8 weeks of antibiotic treatment is often needed to sterilize the prostate. If the course fails to cure prostatitis, a low dose of antibiotics will be consistently prescribed to circumvent future recurrence.
- In the worst cases, prostate stones, or even the entire prostate gland might need to be removed through surgeries.
Lifestyle modifications to treat prostatitis
Besides the medical treatments mentioned above, lifestyle modifications are also important to relieve the signs and symptoms of prostatitis:
- Keep the body and prostate gland warm: It can be done by soaking in a warm bath or using a heating pad under your seat.
- Diet: Avoid alcohol, caffeine, spicy and acidic foods.
- Avoid irritating the prostate gland: For example, prolonged sitting and cycling are irritants to the prostate gland.
- Exercise more and be physically active
- Biofeedback training: It can help to better control the muscle, especially muscles for urination.
This article was medically reviewed by Dr. Vera Chung 鍾楊醫生. Dr. Chung is a female urologist practicing at the Hong Kong Urology Clinic. She qualified in 2003 from the University of Hong Kong and was trained as a urologist in Queen Elizabeth Hospital and obtained the Fellowship of Royal College of Surgeons of Edinburgh in 2011. Dr. Chung was promoted to associate consultant in Pamela Youde Nethersole Eastern Hospital in 2012. From 2013 to 2015 she has completed a two-year European Board of Urology (EBU) Fellowship in endourology and laparoscopy at Nuffield Department of Surgical Sciences, University of Oxford. In Oxford, Dr. Chung also consolidated her training in the management of continence and prolapse problems in the Department of Gynecology.
The rate to cure prostatitis depends on the type of prostatitis. If it is caused by bacterial infection, antibiotics will be the most effective and fastest way to eliminate prostatitis. For CPPS, it is a bit more complicated as each symptom is treated differently. Relieving psychological stress can speed up the rate to get rid of prostatitis caused by CPPS.
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This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.