Dr. Tariq Jagnraine
Fam Med, Endocrinology/Diabetes
Prostatitis is inflammation of the prostate, a small gland located just under the bladder in men.
The prostate is responsible for producing seminal fluid, which transports sperm and makes up 50 to 75 percent of semen. Although prostatitis begins in the prostate gland, the inflammation may spread to the area around your prostate.
Types of prostatitis include the following:
• Chronic prostatitis. This is the most common type of prostatitis, and it often lasts for months. Any chronic prostatitis without bacteria presents falls into this category.
• Acute bacterial prostatitis. This is the most severe and least common form of prostatitis. It’s caused by a bacterial infection. It appears suddenly with severe symptoms, such as fever, chills, and bloody semen. This type requires immediate treatment.
• Chronic bacterial prostatitis. This is a milder and less common infection that may come and go over time. Symptoms may be like acute bacterial prostatitis but notably less severe.
• Asymptomatic prostatitis. Doctors will occasionally discover prostate inflammation while conducting an unrelated exam. Without symptoms, treatment is not necessary.
RISK FACTORS
Prostatitis can occur at any age, though incidence peaks in people between ages 20 and 40 and people over age 70. For men under 50, prostatitis is the most common urinary tract problem.
Other factors can also increase your risk, including having:
• Urinary catheter inserted
• Bladder infection
• Pelvic trauma
• Past bouts of prostatitis
• Enlarged prostate
Having sex without a condom or other barrier methods and being HIV-positive also increase your chances of developing prostatitis.
CAUSES
Most prostatitis is caused by bacteria, which can also cause a bladder infection or UTI.
One of the more common bacteria involved in prostatitis, particularly in people over age 35, is Escherichia coli (E. coli). Sexually transmitted infections (STIs), including gonorrhea and chlamydia, can also cause bacterial prostatitis.
In many cases, the exact cause of chronic prostatitis is unknown, though it can be linked to prostate injuries or an immune system condition.
SYMPTOMS
The symptoms of prostatitis vary for each of the three symptomatic types. With acute bacterial prostatitis, persons may experience:
• Pain in your lower abdomen, lower back, or rectum
• Pain around your penis or scrotum
• Urgent need to urinate
• Difficulty urinating or emptying your bladder completely
• Pain when urinating
• Pain when ejaculating
• Chills
• a fever
• Nausea or vomiting
They may also have foul-smelling or cloudy urine. For chronic bacterial prostatitis, similar symptoms present, but they will be less severe.
In cases of both chronic and acute bacterial prostatitis, bacteria can also enter the urinary tract and cause a urinary tract infection (UTI).
The primary symptom of chronic prostatitis is pain or discomfort in:
• Lower back
• Abdomen
• Rectum
• Genital area
If you have asymptomatic inflammatory prostatitis, no symptoms will be observed.
DIAGNOSIS
Persons suspect to have prostatitis, make an appointment with a doctor. They’ll need to rule out other possible causes of the symptoms. For example, an enlarged prostate, cystitis, and some other conditions can cause similar symptoms.
Doctors will perform a physical exam, also known as a digital rectal exam (DRE). During this exam, which allows your doctor to feel around part of the prostate for swelling or tenderness, a prostate massage may also be performed.
Massaging the prostate causes the release of seminal fluid built up in the gland, which a doctor may want to test for bacteria.
In some cases, a doctor may recommend an additional diagnostic step. This could be:
• CT scan
• MRI, particularly if your rectal exam was atypical
• Transrectal ultrasound
• Cystoscopy, a procedure in which a small tube is inserted into the urethra to look at the bladder and prostate gland
Doctors will also likely want to take samples of blood, urine, or semen for laboratory testing. These can help determine the type of prostatitis you have or the specific bacteria causing it.
TREATMENT
With a diagnosis of bacterial prostatitis, a doctor will prescribe antibiotics. The type of antibiotic and length of treatment will vary, depending on the type of bacteria that’s causing the symptoms.
Doctors may also prescribe pain relievers or alpha-blockers. Alpha-blockers reduce muscle spasms of the urethral sphincter, which is the muscle that helps you control the flow of urine. The sphincter may spasm in response to the inflammation of prostatitis.
Doctors may also recommend anti-inflammatory medications, heat therapy, or regular prostate massages to reduce pain.
Treatment for nonbacterial prostatitis is generally intended to reduce discomfort and pain, and it can vary greatly depending on your specific symptoms.
If flare-ups are experienced of chronic prostatitis symptoms, talk with a doctor about alternative strategies such as physical therapy that may lessen their frequency and intensity.
PREVENTION
Many cases of prostatitis aren’t preventable because the cause is often unknown. However, there are ways to minimize the risk of bacterial prostatitis.
Maintaining good genital hygiene helps keep bacteria at bay. Because STIs can lead to prostatitis, practicing sex with a condom or other barrier method can also reduce the risk of developing this condition.
Most people respond well to treatment for acute bacterial prostatitis. Chronic prostatitis is harder to cure, but it can often be managed.
Ask a doctor about your specific condition, treatment plan, and outlook.
