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Prostatitis

Prostatitis

Prostatitis is an inflammation of the prostate. However, not all men with prostatitis actually have an inflamed prostate.

Prostatitis is most commonly complained involving the urinary system in men aged 18 to 50.

Symptoms of Prostatitis

  • Pain in lower back
  • Pain in the penis and/or testicles
  • Pain in the perineum (area between the anus and scrotum)
  • Pain in the prostate, rectum or inner thighs
  • Chills and fever
  • Urinary frequency or urgency
  • Not voiding (urinating) to completion
  • Pain during or after ejaculation
  • Occasionally blood in the semen

Types of Prostatitis

Acute Bacterial Prostatitis

This is caused by bacteria such as E.Coli or Klebsiella usually as a result of urinary tract infection. It is less common and the easiest form to diagnose. Symptoms are usually of a severe and sudden onset. There is usually evidence of white blood cells and bacteria present in the urine.

Chronic Prostatitis

This is also caused by bacterial infection, but continues for a long period of time. It generally develops gradually and the symptoms are less severe than an acute infection but they tend to recur. The urine will show white blood cells and bacteria.

Chronic prostatitis can affect your quality of life and may cause anxiety and depression.

Chronic Non-bacterial Prostatitis

This is the most common and least understood form of prostatitis. It is also known as chronic pelvic pain syndrome. The symptoms are of a sudden and severe onset, but tend to disappear and recur unexpectedly. It may be inflammatory or non-inflammatory. The inflammatory form will show white cells in the urine with no bacterial growth whereas the non-inflammatory form will show neither white cells nor bacteria in the urine.

Some studies have suggested that inflammation may be caused by urine being forced up the prostatic ducts during urination.

Asymptomatic Inflammatory Prostatitis

This form of prostatitis causes no symptoms, but white cells are found in the urine usually when investigations are being carried out for other reasons.

Diagnosis of Prostatitis

The treatment is different for each type of prostatitis. It is therefore important that a correct diagnosis is made. It is important to ensure the symptoms are not being caused by other conditions such as enlarged prostate, cystitis or cancer.

  • Digital rectal examination is used to determine whether there is swelling or tenderness of the prostate gland or pain/discomfort is experienced when the muscles of the pelvic floor and perineum are pressed.
  • A simple urine test to check for white cells and bacteria.
  • A stamey localisation test involves the collection of 2 urine samples and a sample of prostatic fluid following a prostate massage. These samples can help determine whether infection or inflammatory is present.
  • TRUS (transrectal ultrasound of the prostate)

Other tests may include a cystoscopy (to look at the urethra, prostate and bladder) and flow test, under local or general anaesthetics.

Risk Factors

  • Previous history of prostatitis
  • Urinary tract infections
  • Long-term catheterisation

Treatment

Acute Prostatitis is treated with antibiotics, usually 4-6 weeks. Over the counter pain medications can be used for pain relief.

Chronic Prostatitis is treated with a 6-8 week course of antibiotics as the infection may lie deep within the prostate. Anti-inflammatory drugs may be used for pain relief and to reduce the swelling in the prostate.

Occasionally, an abscess can form in the prostate. This may need to be drained under anaesthetics.

Chronic Non-inflammatory Prostatitis is more difficult to treat. In this case, the aim is to treat the symptoms.

A schedule of prostate massage has proven to be beneficial to some men. The consultant or preferably, the urology clinical nurse specialist performs the prostate massage when your symptoms flare up.

Self-Help Measures

  • Eating a healthy diet and maintaining a good fluid intake may be beneficial.
  • Emptying your bladder completely and frequently going to the loo may reduce urgency and UTIs.
  • Reduce caffeine, alcohol intake and spicy foods as these may irritate the bladder and alleviate symptoms.
  • Warm baths may relieve pelvic pain.
  • Good hygiene prevents contamination of the penis/urethra.
  • Activities such as cycling may worsen symptoms.
  • Avoid stress and try relaxation techniques such as yoga.