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Prostatitis

Introduction

Prostatitis is a general term that is used to refer to inflammation, or infection, of the prostate gland. Symptoms of prostatitis include:

  • pelvic pain,
  • pain when urinating, and
  • pain when ejaculating semen.

The prostate gland

The prostate is a small gland in the pelvis that is found only in men. It is located between the penis and the bladder and surrounds the urethra (the tube that carries urine from the bladder to the penis).

The main function of the prostate is to help with the production of semen. The prostate produces a thick white fluid that is liquefied by a special protein known as prostate-specific antigen (PSA). The fluid is then mixed with sperm, produced by the testicles, to create semen.

Types of prostatitis

There are three main types of prostatitis:

  • acute prostatitis,
  • chronic bacterial prostatitis, and
  • chronic non-bacterial prostatitis.

Acute prostatitis

Acute prostatitis is a bacterial infection of the prostate.

Acute prostatitis should be regarded as a medical emergency. Without prompt treatment using antibiotics, damage to the prostate and surrounding areas can occur.

Chronic bacterial prostatitis

In cases of chronic bacterial prostatitis, a chronic (long-lasting) bacterial infection develops inside the prostate. The bacteria can also spread out of the prostate and into the urinary tract.

The urinary tract is made up of:

  • the kidneys,
  • the ureters (the tubes that carry urine from the kidneys to the bladder),
  • the bladder, and
  • the urethra (the tube that passes from the bladder through the penis).

Therefore, many men with chronic prostatitis also develop repeated urinary tract infections (UTIs), such as a bladder, or urethra, infection.

Chronic non-bacterial prostatitis

Chronic non-bacterial prostatitis is a poorly understood condition of unknown origin. It shares many of the symptoms of chronic bacterial prostatitis except upon diagnosis, no trace of a bacterial infection (or any other type of infection) can be found.

Some experts have argued that in cases of chronic non-bacterial prostatitis there may not actually be any inflammation or infection of the prostate, so the condition should be known as ‘chronic pelvic pain syndrome’.

How common is prostatitis?

Acute prostatitis is an uncommon condition. For example, it is estimated that only 1 in every 10,000 men will develop acute prostatitis.

Chronic bacterial prostatitis is also uncommon, affecting 1-2% of all men.

Chronic non-bacterial prostatitis is the most common form of prostatitis. In England, and Wales it is estimated that as many as 15% of men will experience the condition at some point in their life .

Unlike other types of prostate disease, such as prostate cancer, or prostate enlargement, which usually affects older men, prostatitis can develop in men of all ages.

Outlook

If treated with antibiotics, the outlook for acute prostatitis is very good. Most men will make a full recovery within two weeks.

Chronic bacterial prostatitis can also be treated with antibiotics, but an estimated 50% of men will experience a relapse of symptoms at some time in the future and will require further treatment.

Chronic non-bacterial prostatitis can be a challenging condition to treat. This is because so little is known about the causes of the condition that it can be difficult to identify effective treatments for all cases.

However, many men with chronic non-bacterial prostatitis will experience periods where their symptoms are not particularly troublesome.

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Symptoms

Acute prostatitis

The symptoms of acute prostatitis usually develop suddenly. Symptoms include:

  • high temperature (fever) - 38C (100.4F) or above,
  • severe pain in the pelvis, genitals, lower back, and buttocks,
  • pain when urinating,
  • frequent need to urinate,
  • difficult urinating, such as problems starting, or intermittent (‘stop-start’) urination, and
  • pain when ejaculating.

Chronic prostatitis

The symptoms of chronic prostatitis (both bacterial and non-bacterial) are the same as acute prostatitis, although the pain is not as severe.

The symptoms of chronic prostatitis can also fluctuate from day to day. For example, some days the symptoms can be particularly troublesome, while on other days they can be mild, or virtually non-existent.

Other symptoms of chronic prostatitis that some people experience include:

  • tiredness,
  • joint pain, and
  • muscle pain.
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Causes

Acute prostatitis

Acute prostatitis is caused by bacteria that are present in the urinary tract (usually in the urethra) that manage to find their way up into the prostate.

The bacteria that are responsible for acute prostatitis cannot be spread during sexual intercourse, so there is no risk of contaminating your sexual partners.

Chronic bacterial prostatitis

In cases of chronic bacterial prostatitis, it is unclear exactly how bacteria infect the prostate. One theory is that bacteria spread from the urethra, or bowel, and then create what is known as a biofilm on the surface of the prostate.

A biofilm is a small, but highly concentrated, colony of bacteria that is covered by a sticky, protective surface. Another example of a biofilm is the plaque that can sometimes develop on teeth.

Chronic non-bacterial prostatitis

The exact cause of chronic non-bacterial prostatitis is unknown. However, a number of factors have been suggested such as:

  • underlying problems with the immune system,
  • underlying problems with the nervous system, and
  • an infection with a virus or bacteria that has not yet been identified.
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Diagnosis

Acute prostatitis

Your GP will be able to diagnose acute prostatitis by asking you about your symptoms, before taking a sample of your urine which will be checked for the presence of bacteria.

Your GP may also perform a digital rectal examination (DRE). During a DRE, your GP will insert a finger into your rectum (back passage). As the rectum is close to the prostate gland, your GP will be able to determine whether your prostate is inflamed and tender to the touch.

Chronic prostatitis

Chronic prostatitis is diagnosed by asking about your symptoms, and ruling out other conditions that could be the cause of your symptoms, such as bowel, or prostate, cancer.

In order to rule out these types of conditions, you may be given a DRE and blood tests. Instruments, such as a cytoscope and a colonoscope, can be used to look at your bladder and bowel. Both instruments are flexible tubes that have a light and a camera at the end.

A cytoscope is placed up into your urethra, and is used to look at your bladder. A colonscope is placed into your anus (back passage) and is used to look at your bowel.

A confident diagnosis can usually be made if:

  • you have symptoms of pain in your pelvis, genitals, and /or buttocks,
  • you experience pain when urinating,
  • you experience pain when ejaculating,
  • you are having problems with urinating, such as a frequent need to urinate, or a feeling that you have not emptied your bladder properly after urinating,
  • the symptoms have persisted for three months or more, and
  • other possible causes of your symptoms have been ruled out.

A urine test can be used to determine whether you have bacterial, or non-bacterial, chronic prostatitis.

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Treatment

Acute prostatitis

Acute prostatitis can be treated with antibiotics tablets (oral antibiotics). Most people will require a four week course of antibiotics. Your symptoms should pass within two weeks, but it is very important that you finish the course in order to prevent the infection returning.

Symptoms of pain can be treated using paracetamol and /or ibuprofen. If your symptoms of pain are particularly severe, you may be given codeine (a mild opiate-based painkiller).

Chronic bacterial prostatitis

Chronic bacterial prostatitis is also treated with a four week course of oral antibiotics. You may also be prescribed a type of medication that are known as alpha blockers.

Alpha blockers help relax the bladder muscles and therefore can improve problems with urination, such as problems passing urine.

The possible side effects of alpha-blockers include:

  • dizziness,
  • headaches,
  • weakness, and
  • a decrease, or total lack, of sperm when you ejaculate.

If you experience symptoms of dizziness, you should avoid driving, or operating heavy machinery, until the dizziness has passed.

Once you have completed your course of antibiotics, you will be given a urine test to check whether there is any bacteria left in, or near to, your prostate. If the test proves positive, a further course of antibiotics may be required.

As with acute prostatitis, paracetamol and /or ibuprofen can be used to help relieve any symptoms of pain.

Chronic non-bacterial prostatitis

Chronic non-bacterial prostatitis is also treated with alpha blockers, paracetamol, and ibuprofen.

A number of other medications have been used to treat chronic non-bacterial prostatitis, but there is only limited evidence that they are effective.

These medications include:

  • finasteride - a medication that is usually used to treat prostate enlargement,
  • fluoxetine - a medication that is usually used to treat depression (anti-depressant), and
  • mepartricinm - a medication that is usually used to treat fungal infections.
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