Prostatitis

Prostatitis is the most common problem for men under the age of 50, almost one-half of adult men will be treated for it in their lifetime.

Prostatitis is an inflammation or infection of the prostate gland.

This can occur at any age but is the most common problem for men under the age of 50; so common that almost one-half of adult men will be treated for it in their lifetime. Prostatitis can occur in several different forms: bacterial, non-bacterial, and chronic pelvic pain disorder. Prostatitis is usually not a life-threatening condition (unless a severe infection goes untreated), but it can be a very troublesome disorder.

Although it may be acquired through sexual contact, often prostatitis develops for no apparent reason. Most cases of prostatitis are the result of a bacterial infection. Some sexually transmitted infections can increase the risk of developing bacterial prostatitis. Unprotected sexual intercourse can let bacteria into the urethra, which can travel up to the prostate. Other cases of bacterial prostatitis can be caused when the muscles of the pelvis or bladder do not work properly and urine flows back into the urethra and enters the prostate, causing infection or inflammation. In older men with enlarged prostates, infections may occur because of failure to empty all urine from the bladder.

Studies have suggested that for men with long-term prostatitis, there could be a relationship with prostate cancer. Although a definite link has not been shown, men with long-term prostatitis should have regular prostate checks. Prostate cancer is the most common cancer diagnosed in North American men (other than skin cancer). One out of every six or seven men will develop this disease.

The exact cause of prostate cancer is still unknown, but a combination of genetic, nutritional, and environmental factors appear to play a role. Prostate cancer is usually diagnosed with a blood test and digital rectal exam. Common treatments for prostate cancer: active surveillance, surgery, radiation, and hormone therapy. Prostate cancer treatments often lead to side effects like urinary problems and erectile dysfunction. Food and nutrition intake is an important part of prostate cancer treatment. An overall healthy diet will benefit all patients.

There are many symptoms of prostatitis. It is possible to have only some of the symptoms or many, so be sure to see a doctor if you have a combination of any of the following:

• painful urination (dysuria)
• urgency, the feeling of urgently needing to urinate
• frequent urination
• painful ejaculation or blood in semen
• lower back pain, muscular pain
• perineal pain, where there is pain at the base of the scrotum and penis
• chills, fever
• general lack of energy
• sexual difficulties
• low sperm count

The National Institutes of Health Chronic Prostatitis Symptom Index may be useful in grading the degree of symptoms and for monitoring response to treatments.

Bacterial Prostatitis

Acute bacterial prostatitis represents only 5% of all prostatitis. It is caused by bacteria and is the easiest to diagnose and effectively treat, although severe complications may develop if not treated quickly. Acute bacterial prostatitis is diagnosed by rapid and severe urinary symptoms (including the inability to urinate), associated with fever, chills, muscle aches, back pain, and malaise. It can usually be confirmed by urine and blood culture tests to identify bacteria. Antibiotics and drainage of the bladder result in quick relief, but treatment should persist for many weeks to prevent a more serious situation from arising.

Chronic bacterial prostatitis is slow to develop but persistent, lingering for months and reappearing over years. It is a common form of prostatitis and is often caused by an underlying problem in the prostate that becomes the focus for bacteria in the urinary tract. It commonly causes frequent urinary tract infections in men. Chronic bacterial prostatitis is a bit more difficult to confirm. One must prove that there are signs of infection, either by finding bacteria in prostate fluid or urine collected immediately after prostate massage. In addition, there must be signs of white blood cells (leukocytes) in these fluids. Antibiotics can be used to treat this condition, but it may take many courses and many years to completely clear up.

Non-Bacterial Prostatitis

Chronic nonbacterial prostatitis is an inflamed prostate without bacteria and is the form of prostatitis least understood. Urinary tract infections are not experienced by men with this form of prostatitis. Chronic prostatitis develops more slowly than acute prostatitis and its symptoms are more annoying than dangerous and may disappear and then reappear later on. These include frequent and strong urges to urinate (“frequency” and “urgency”), some slowing of the urinary stream, and an ache or pain in the genitals, rectum, lower abdomen, or lower back. Nonbacterial prostatitis is diagnosed when no bacteria are found in the urine or prostate fluid, but white blood cells may be present as an indicator of inflammation.

Treatment of chronic nonbacterial prostatitis includes long-term antibiotics and anti-inflammatory drugs. In addition, some men have found that avoidance of irritants of the urinary tract (caffeine, alcohol, spicy foods, and smoking) may speed their recovery. Frequent ejaculation (even if uncomfortable) may be helpful for some men.
For each individual with this form of prostatitis, there may be a different treatment. Stress often aggravates this condition, and measures to reduce stress, including pelvic floor physiotherapy or relaxation, are often needed.

Chronic pelvic pain disorder (CPPD) seems like chronic non-bacterial prostatitis, but the prostate is usually normal on examination and there are no signs of infection or inflammation in prostate fluid or urine. CPPD can often be confused with or made worse by, spasms in the pelvic floor muscles (similar to a headache related to neck muscle pain) or pelvic/hip malalignment. CPPD may be associated with nerve type of pain. Treatment of this situation often involves anti-inflammatory medications, regular ejaculation, dietary modification, prostate or pelvic massage, pelvic floor exercises, physiotherapy, nerve pain medication (e.g. gabapentin or pregabalin), hot baths (or, if heat does not work, applying ice packs to the area between your testicles and anus), and by avoiding constipation, as large, hard bowel movements can press on the sore prostate and can be quite painful.

It is very important for a man with CPPD to understand that his prostate is not infected and he should not be labeled as having “chronic prostatitis”. Slow or limited recovery and many different treatments may lead to depression and lower libido, with the pain of the disorder making it difficult to enjoy sexual relations.