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Prostatitis

What is prostatitis?

Prostatitis is one of several benign (noncancerous), inflammatory conditions of the prostate gland. Acute prostatitis occurs suddenly, with sharp, severe symptoms. Chronic prostatitis develops gradually, recurs often, with the infection and lasts for prolonged periods of time. Chronic prostatitis is typically difficult to treat.

Prostatitis and other prostate problems are generally treated by a urologist. A urologist is a doctor who specializes in the treatment of conditions involving the urinary tract in both genders, and conditions involving the genital tract of the male reproductive system.

What are the different types of prostatitis?

The following classifications of prostatitis are offered by the National Kidney and Urologic Disease Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):

  • Acute bacterial prostatitis. Although the least common of all types of prostatitis, acute bacterial prostatitis occurs in men at any age and often with sudden onset and severe symptoms. It is important to seek treatment promptly as this condition is easy to diagnose. Men may find urination difficult and extremely painful. Other symptoms of acute bacterial prostatitis include fever, chills, lower back pain, pain in the genital (between the legs) area, urinary frequency, burning during urination, and/or urinary urgency at night, coupled with aches and pains throughout the body.

  • Chronic bacterial prostatitis. Although fairly uncommon, chronic bacterial prostatitis is a recurrent infection of the prostate gland that is difficult to treat. Symptoms of the infection are often similar to, but less intense than, acute bacterial prostatitis. However, symptoms of chronic bacterial prostatitis generally last longer and often fever is absent, unlike during an acute infection.

  • Chronic prostatitis/chronic pelvic pain syndrome. Chronic prostatitis/chronic pelvic pain syndrome is likely the least understood form of prostatitis, but the most common form of the disease. Symptoms may resolve and then reappear without warning. The infection may be considered inflammatory, in which urine, semen, and other secretions are absent of a known infecting organism, but do contain infection-fighting cells, or the infection may be considered noninflammatory, in which inflammation and infection-fighting cells are both absent.

  • Asymptomatic inflammatory prostatitis. Asymptomatic inflammatory prostatitis may be diagnosed when infection-fighting cells are present, but common symptoms of prostatitis, such as difficulty with urination, fever, and lower back and pelvic pain, are absent. A diagnosis of asymptomatic inflammatory prostatitis is made most often during an examination for other conditions, such as infertility or prostate cancer.

What causes prostatitis?

Prostatitis is an infection that likely occurs due to bacteria that have entered the prostatic ducts from the rectum and/or as a result of a backward flow of infected urine.

Prostatitis is not a contagious condition and is not considered a sexually transmitted disease. It can result, however, from several different sexually transmitted diseases.

Who is at risk for prostatitis?

Although any man can develop prostatitis at any age, there are some conditions that put a man at greater risk for developing this condition, including the following:

  • Recent bladder, urinary tract, or other infection elsewhere in the body

  • Injury or trauma to the perineum (the area between the scrotum and the anus)

  • Abnormal urinary tract anatomy

  • Enlarged prostate

  • Rectal intercourse

  • Recent procedure involving the insertion of a urinary catheter or cystoscope

What are the symptoms of prostatitis?

The following are the most common, general symptoms of prostatitis. However, each individual may experience symptoms differently. Symptoms may include:

  • Urinary frequency and/or urgency

  • Burning or stinging sensation during urination

  • Painful urination

  • Reduced stream volume during urination

  • Rectal pain and/or pressure

  • Fever and chills (usually present with an acute infection only)

  • Lower back and/or pelvic pain

  • Discharge through the urethra during bowel movements

  • Sexual dysfunction and/or loss of libido (sex drive)

  • Throbbing sensations in the rectal and/or genital area

The symptoms of prostatitis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is prostatitis diagnosed?

The most effective treatment for prostatitis depends heavily on an accurate diagnosis. In addition to a complete medical history and physical examination, diagnostic procedures for prostatitis may include the following:

  • Urine culture, including triple-void urine specimen collection (also called three-glass urine collection method). Often used in collaboration with the prostate stripping procedure, the three-glass urine collection method involves collecting and evaluating the prostatic fluid and urine for the presence of white blood cells and bacteria.

  • Digital rectal examination (DRE). A procedure in which the doctor inserts a gloved finger into the rectum to examine the rectum and the prostate gland for signs of cancer.

  • Semen culture

  • Prostate massage. A procedure in which prostate fluid is collected for examination. This procedure is usually performed during a DRE and involves the doctor "stripping" the prostate gland to drain fluid into the urethra. This fluid is then examined under a microscope to detect the presence of inflammation and/or infection.

  • Cystoscopy (also called cystourethroscopy). An examination in which a scope, a flexible tube and viewing device, is inserted through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones.

Treatment for prostatitis

Specific treatment for prostatitis will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Treatment may include:

  • Acute bacterial prostatitis. Treatment of acute bacterial prostatitis usually involves antimicrobial medication for several days, up to two weeks. Treatment is usually effective for this type of prostatic infection, but involves taking the full course of medication to prevent the development of antibiotic-resistant bacteria even when symptoms are absent. Analgesic (pain-relieving) medications may also be prescribed as needed and patients may be advised to increase fluid intake. Hospitalization may be necessary in the most severe cases.

  • Chronic bacterial prostatitis. Treatment of chronic bacterial prostatitis usually involves antimicrobial medication for four to 12 weeks. This type of prostatitis is difficult to treat and recurrence is possible. If the infection does not respond to the antimicrobial medication, then long-term, low dose antimicrobial medication may be prescribed. Surgery may become necessary.

Always consult your doctor for more information regarding the treatment of prostatitis.