Prostatitis

PROSTATITIS

The prostate is a small, walnut-shaped gland that forms part of the male reproductive system. It sits under the bladder and in front of the rectum. The prostate is surrounded by muscles and nerves. The tube that carries urine and semen out of the body (the urethra) passes through the prostate.

The main job of the prostate is to help make fluid for semen. Semen protects and energizes sperm as they travel to the female egg.

Prostatitis is inflammation of the prostate gland. The inflammation can be due to an infection as well as other causes. Up to twelve percent (12%) of all men experience prostatitis symptoms at various times in their lifetime.

Prostatitis is the most common prostate problem in men under the age of 50.

Prostatitis can be an acute illness or a chronic condition, the definitions by consensus and classification of prostatitis are;

Acute bacterial prostatitis: Caused by a bacterial infection, it typically begins suddenly and may include flu-like symptoms. It is the least common of the four types of prostatitis.

Chronic bacterial prostatitis: This is described by recurrent bacterial infections of the prostate gland. In between attacks, the symptoms might be minor or the patient may even be asymptomatic; however, its treatment can be difficult.

Chronic prostatitis/chronic pelvic pain syndrome: Even though it is the least understood, most cases of prostatitis fall into this category. Chronic prostatitis/chronic pelvic pain syndrome can be described as inflammatory or noninflammatory, depending upon the presence or absence of infection-fighting cells in the urine, semen, and prostatic fluid. Often no specific cause can be identified. The symptoms can come and go or persist.

Asymptomatic inflammatory prostatitis: Individuals with this form of prostatitis do not complain of symptoms or discomfort, but they will have the presence of infection-fighting cells present in semen/prostatic fluid. This type is often diagnosed incidentally during the workup for infertility or prostate cancer.

TYPES OF PROSTATITIS

There are four types of prostatitis:

Acute bacterial prostatitis: This type is the least common and lasts for only a short period. It can be life-threatening if left untreated. This is the easiest type of prostatitis to diagnose.

Chronic bacterial prostatitis: Symptoms are mild and develops over several years. It commonly affects young and middle-aged men and cause recurring urinary tract infections (UTIs).

Chronic prostatitis, or chronic pelvic pain syndrome: This condition causes pain and discomfort around the groin and pelvic area. It can affect men of any age.

Asymptomatic inflammatory prostatitis: The prostate is inflamed but there are no symptoms. It's usually discovered when a doctor is diagnosing another problem.

CAUSES

• Acute bacterial prostatitis

Acute bacterial prostatitis is an infection of the prostate that is caused by bacteria. Acute implies that the symptoms develop very quickly. It isn't common, but it can be serious and may need hospital treatment.

What causes it - Acute bacterial prostatitis can develop when certain types of bacteria manages to get into the prostate, and infecting it.

Bacteria that normally live in the bowel may spread to the tip of the penis and to the tube through which men urinate (the urethra). From here, the bacteria might reach the prostate. Bacteria can also spread to the prostate from the bladder or bloodstream.

Acute bacterial prostatitis can happen if:

• The person has had a prostate biopsy
• One has a urine infection
• The person has difficulty emptying the bladder
• One regularly uses a thin tube called a catheter to drain urine from the bladder.

• Chronic bacterial prostatitis

Chronic bacterial prostatitis is an infection of the prostate that can last for quite a long time. Chronic connotes long-lasting. Its tendency is to come and go, causing episodes or flare-ups. It is rare.

What causes it - Chronic bacterial prostatitis is caused by a bacterial infection. It commonly affects men who have had lots of urine infections or an inflamed urethra in the past, or who have a damaged or narrow urethra (a stricture). The episodes are caused by the same bacteria, which also cause the urine infections.

It can develop from acute bacterial prostatitis if antibiotics that was used for its treatment does not get rid of all the bacteria. This could be because the bacteria were resistant to the antibiotics or because the treatment was truncated too early.

• Chronic pelvic pain syndrome (CPPS)

CPPS is the most common of the types of prostatitis. It is sometimes called chronic non-bacterial prostatitis, chronic abacterial prostatitis or prostate pain syndrome. Chronic means long-lasting

Men with CPPS usually have the symptoms for three months or longer. Even after treatment, people may still have prostatitis for a long time. It might come and go, causing occasional episodes of severe pain known as flare-ups.

What causes it - The cause CPPS in unknown, but unlike other types of prostatitis it isn't usually caused by a bacterial infection. There could be multiple number of causes, which makes it difficult to diagnose and treat.

There are also a number of things that might trigger CPPS, including:

• Infections that don't show up in tests
• Previous infections in or around the prostate
• Stress, anxiety or depression
• Urine getting into the prostate
• Problems with nerves, so that they send pain signals to the brain even when there's nothing physically wrong
• Problems with the pelvic floor muscles (the muscles that support the bladder and bowel and help to control urination).

Certain studies show a link between stress, anxiety, depression and CPPS. This doesn't mean that CPPS is in the head. Being stressed or depressed, may cause physical symptoms that trigger CPPS, or make symptoms worse.

There's credible evidence that CPPS may be linked to other conditions such as chronic fatigue syndrome (which causes severe tiredness), and irritable bowel syndrome (IBS), (which causes bowel problems).

Some men with CPPS have symptoms of these conditions too. There's also some evidence that in a small number of men, CPPS may possibly be caused by a sexually transmitted infection.

• Asymptomatic inflammatory prostatitis

This is prostatitis that doesn't have any symptoms whatsoever as the name implies (the word asymptomatic means there are no symptoms). It is usually detected by chance when tests are conducted for other conditions, such as prostate cancer.

SYMPTOMS

A person may have no symptoms, or symptoms that appears so suddenly and severely that emergency medical care becomes necessary.

Symptoms of prostatitis include:

• Frequent urination
• Difficult urination
• Pain or burning during urination
• Chills and fever
• Pain in the lower abdomen, around the anus, in the groin, or in the back that comes and goes
• Painful ejaculation
• Pain during sexual intercourse

In addition, the prostate may swell, causing a less powerful urine stream.

RISK FACTORS

Risk factors for prostatitis include:

• Having had a prostate biopsy
• Being young or middle-aged
• Having had prostatitis previously
• Having an infection in the bladder or the urethra
• Having pelvic trauma, such as an injury from bicycling or horseback riding
• Using a urinary catheter to drain the bladder
• Having HIV/AIDS

COMPLICATIONS

Complications of prostatitis can include:

• Bacteremia (Bacterial infection of the blood)
• Epididymitis (the Inflammation of the coiled tube attached to the back of the testicle)
• Prostatic abscess (Pus-filled cavity in the prostate)
• Abnormalities with semen and infertility (which usually occurs with chronic prostatitis).

There's yet no direct evidence to even suggest that prostatitis can lead to prostate cancer

WHEN TO SEEK MEDICAL CARE

A person may have urinary symptoms unrelated to prostatitis that are caused by bladder problems, UTIs, or benign prostatic hyperplasia. Symptoms of prostatitis also can signal more serious conditions, including prostate cancer.

Men with the following symptoms should seek immediate medical care:

• Blood in the urine
• Complete inability to urinate
• Painful, frequent, and urgent need to urinate, with fever and chills
• Discomfort or pain in the lower abdomen and urinary tract

DIAGNOSING PROSTATITIS

A doctor will normally diagnose prostatitis based on the patient's;

• A physical exam
• Personal and family medical history
• Medical tests

A doctor would necessarily have to rule out other conditions that cause similar signs and symptoms before diagnosing prostatitis.

• Physical Exam

A physical exam may help diagnose prostatitis. During a physical exam, a health care provider usually will examine a patient's body, which can include;

• Checking for enlarged or tender lymph nodes in the groin
• Checking for a swollen or tender scrotum
• Checking for Discharge from the urethra
• Performing a digital rectal exam

A digital rectal exam, or rectal exam, is a physical exam of the prostate. To perform the exam, the patient will need to bend over a table or lie on his side while holding his knees close to his chest. The health care provider slides a gloved, lubricated finger into the rectum and feels the part of the prostate that lies next to the rectum. The patient is likely to feel slight, brief discomfort during the rectal exam. This exam is usually performed in the doctor's office, and does not need anesthesia.

A lot of doctors perform rectal exam as part of a routine physical exam for men age 40 and above, whether or not they have urinary problems.

Personal and Family Medical History

Taking a personal and family medical history is one of the first things a health care provider may resort to help diagnose prostatitis.

Medical Tests

A doctor may refer a patient to a doctor who specializes in the urinary tract and male reproductive system (a urologist). A urologist uses medical tests to help diagnose lower urinary tract problems related to prostatitis and recommend treatment. Medical tests may include

• Biopsy
• Semen analysis
• Urinalysis
• Blood tests
• Urodynamic tests
• Cystoscopy
• Transrectal ultrasound

Biopsy. Usually performed in an outpatient center or a hospital, biopsy involves the taking of a small piece of prostate tissue for examination with a microscope. The urologist will give the patient light sedation and local anesthetic. In some cases however, the patient might require general anesthesia. The urologist may use imaging techniques such as ultrasound, a computerized tomography scan, or magnetic resonance imaging to guide the biopsy needle into the prostate. A doctor who specializes in examining tissues to diagnose diseases (A pathologist), will examine the prostate tissue in a lab. The test will show whether prostate cancer is present.

Semen analysis. Semen analysis is a test to measure the amount and quality of a man's semen and sperm. The patient collects a semen sample in a special container. A health care provider will analyze the sample during an office visit or sends it to a lab for analysis. A semen sample can show blood and signs of infection.

Urinalysis. Urinalysis involves the testing of a urine sample. The patient collects a urine sample in a special container. A health care provider tests the sample during an office visit or sends it to a lab for analysis. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the urine. Patches on the dipstick will change color to indicate signs of infection in urine. The health care provider can diagnose the bacterial forms of prostatitis by examining the urine sample with a microscope. The doctor may also send the sample to a lab to perform a culture (this is the process in which a lab technician places some of the urine sample in a tube or dish with a substance that encourages any bacteria present to grow), once the bacteria have multiplied, a technician can identify them.

Blood tests. Blood tests involve a health care provider drawing blood and sending the sample to a lab for analysis. Blood tests can show signs of infection and other prostate problems, such as prostate cancer.

Urodynamic tests. Urodynamic tests include a variety of procedures that look at how well the bladder and urethra store and release urine. Some urodynamic tests do not require anesthesia, others may require local anesthesia. Most urodynamic tests focus on the bladder's ability to hold urine and empty steadily and completely.

It may include the following:

• Uroflowmetry (the measurement of how rapidly the bladder releases urine).
• Postvoid residual measurement (the evaluation of how much urine remains in the bladder after urination)

Cystoscopy. Cystoscopy is a procedure that makes use of a tube-like instrument, called a cystoscope, to look inside the urethra and bladder. A urologist inserts the cystoscope through the opening at the tip of the penis and into the lower urinary tract. The doctor will give the patient local anesthesia. In some cases, the patient may require sedation and regional or general anesthesia. An urologist may use cystoscopy to look for narrowing, blockage, or stones in the urinary tract.

Trans rectal ultrasound. Trans rectal ultrasound uses a transducer, a device that bounces safe, painless sound waves off organs to create an image of their structure. The doctor can move the transducer to different angles to make it possible to examine different organs. This is performed by a specially trained technician. A doctor who specializes in medical imaging (a radiologist) will interpret the images. For this test, the patient does not require anesthesia. Urologists most often use transrectal ultrasound to examine the prostate. In a transrectal ultrasound, the technician inserts a transducer slightly larger than a pen into the man's rectum next to the prostate. The ultrasound image shows the size of the prostate and any abnormalities, such as tumors. Please note that the transrectal ultrasound cannot reliably diagnose prostate cancer.

TREATMENT

The treatment for prostatitis depends on the type.

Acute Bacterial Prostatitis

For acute bacterial prostatitis, one will need to take antibiotics for at least 14 days. Occasionally some men may be admitted to the hospital and given antibiotics into a vein (through an IV). Almost all infections that start quickly are cured with this treatment. Sometimes, a person will need to remain on the antibiotics for as long as four weeks. If one antibiotic doesn't work, others will be tried.

Chronic Bacterial Prostatitis

A patient will need to take antibiotics for 4 to 12 weeks for chronic bacterial prostatitis. Most chronic bacterial prostatitis cases clear up with this treatment. Sometimes the symptoms return and antibiotics may be needed again. Long-term, low dose antibiotics are used to ease the symptoms of cases that don't react to this treatment.

CP/CPPS

Because the exact cause of CP/CPPS is not known, some doctors may give antibiotics even if the tests don't prove that bacteria were the cause. Other times doctors will recommend anti-inflammatory or medicines which reduce painful nerves.

Antibiotics

If an antibiotic is prescribed, it is important that the medicines are taken at the same time(s) each day and to take all of them, even if the condition improves.

Alpha-blockers

Some doctors order drugs called alpha-blockers to help the patient feel better. These drugs help relax the muscles around the prostate and the base of the bladder.

Anti-inflammatory agents

Nonsteroidal anti-inflammatory drugs (NSAIDs) might make a person more comfortable. These are pain medicines (aspirin, ibuprofen, etc.) and muscle relaxers.

Prostatic Massage

Prostatic massages can also help to ease pressure in the prostate. It is done by draining fluid from the prostate ducts while specialized physiotherapy may relax the nearby muscles.

Home Remedies and Techniques to Reduce Pain

• Hot baths, hot water bottles, or heating pads may help ease pain. If sitting is painful, an inflatable cushion or a specialized pillow may help.
• Relaxation exercises and dietary changes may also ease some of the symptoms.

• A doctor may suggest that a patient stays away from eating and drinking certain foods. These may include spicy or acidic foods, and caffeinated, fizzy or alcoholic drinks.
• People must aim to drink more water, and eat more fresh/unprocessed foods and less sugar. The doctor may also suggest that one stops doing things like bicycle riding that can worsen the pain.
• Some men use acupuncture to reduce pain. Acupuncture involves inserting very thin needles through the skin at different depths and points on the body.

RECURRING PROSTATITIS

It is important to take all the medication the doctor prescribes to eliminate the bacteria. But bacterial prostatitis may still recur even with antibiotics. This may be because either the antibiotics are not effective or does not destroy all the bacteria.

Outlook

In the case of an infection, bacterial prostatitis will clear up with proper treatment. Chronic prostatitis may require several different treatments.

Complications of acute prostatitis include:

• Bacteria in the bloodstream
• Formation of abscess
• Inability to urinate
• Sepsis
• Death, in extreme cases

Complications of chronic prostatitis may include:

• Difficulty urinating
• Sexual dysfunction
• Chronic pelvic pain
• Chronic pain with urination

It's possible to have elevated PSA levels with a prostate infection. Levels typically return to a normal range within one to three months. If the levels don't decrease, the doctor may recommend a longer course of antibiotics or a prostate biopsy to look for prostate cancer.

FACTS

• Prostate infections, even chronic ones, have nothing to do with prostate cancer.
• Nor do they increase the risk for prostate cancer.
• A prostate infection is also not contagious or caused by a sexual partner.
• One can continue to have sexual relations as long as there is no discomfort

Men should talk to their doctor if they experience symptoms such as discomfort when urinating or pain around the groin or lower back. It's best to get an early diagnosis so as to begin appropriate treatment soon enough.