Prostatitis is the inflammation of the prostate gland, often resulting in swelling or pain. There are four main classifications of prostatitis.
Acute bacterial prostatitis is an acute infection of the prostate gland, usually occurs in men aged 40 to 60 years. Caused by a bacterial infection and comes on suddenly. There is often blood in the urine and the PSA blood test result may be higher than normal.
Chronic bacterial prostatitis is a recurrent infection of the prostate, occurs in men aged 50 to 80 years. It is associated with chronic urinary infection and, commonly, calcifications in the prostate (prostatic stones). In the cases of bacterial prostatitis, the culprit usually is a bacterium known as Escherichia coli. The cause of bacterial prostatitis is not well defined, but one theory suggests a reflux of urine from the bladder into prostatic ducts. This reflux of urine may lead to prostatitis. The most common symptom is recurrent bladder infections.
Chronic prostatitis is the most common yet least understood form. Found in men of any age, the symptoms include pain in the groin or bladder, and come and go without warning.
Asymptomatic inflammatory prostatitis this is a form of prostatitis has no symptoms, and is often found when undergoing tests for other conditions.
Symptoms of Prostatitis: Each form of prostatitis has a slight variation in signs and symptoms.
Acute bracterial prostatitis:
-Sudden onset of fever and chills.
-Pain in lower back or rectum.
-Irritative or obstructive urinary symptoms.
-Prostate is warm, swollen, and tender upon examination.
Chronic bacterial prostatitis:
-Relapsing urinary tract infections.
-Painful urination or other voiding problems.
-Pelvic or genital pain.
-Some men may not have any symptoms.
-Chronic pelvic pain (testicular, penile, lower abdominal, ejaculatory)
-Persistent inflammation of the prostate
-Absence of infectious bacteria in urine
Diagnosis of Prostatitis
The gold standard for diagnosing prostatitis would be to perform a biopsy of the prostate, but this is rarely done. Instead, doctors may diagnose prostatitis by examining prostatic secretions for bacteria. To do this, a "four-cup" test may be conducted. To start, the patient must have a full bladder. The doctor will clean the penis with soap and water and will then collect two cups of urine. Next, the prostate will be massaged by a digital rectal examination (DRE) to allow prostatic fluid to travel through the urethra. Two more cups of urine will be collected, and the expressed prostatic secretion (EPS) in the urine is examined for the presence of bacteria. Some physicians may not perform the "four-cup" test, and may just obtain urine before and after massaging the prostate. Sometimes EPS secretions from the urethra can be collected from the tip of the penis after massaging the prostate. After the physician collects these secretions, they can be examined under a microscope. Nonbacterial prostatitis is more difficult to diagnose. With these patients, the EPS will have evidence of inflammation, but bacteria will not be present. The lack of recurrent urinary tract infections distinguishes nonbacterial prostatitis from chronic bacterial prostatitis.
Treatment Options for Prostatitis
- Anti-inflammatory drugs along with warm baths.
- Antibiotics for infectious prostatitis. These drugs are not effective treatments for noninfectious prostatitis.
- For chronic infectious prostatitis, antibiotics are taken for a longer period of time. About 75% of all cases of chronic infectious prostatitis clear up with this treatment. For cases that don't, taking antibiotics at a low dose for a long time may be recommended to relieve the symptoms.
- Pain medications.
- Muscle relaxants.
- Surgical removal of the infected portions of the prostate. A doctor may advise this treatment for severe cases of chronic prostatitis or for men whose swollen prostate is blocking the flow of urine.
- Supportive therapies for chronic prostatitis, including stool softeners and prostate massage.