Prostatitis is inflammation of the prostate. It is often painful and can affect both sexual function and the ability to urinate. Prostatitis is one of the commonest causes of urinary symptoms in men under 50 years of age. A bacterial infection may cause it, but the condition's cause is unknown in many cases.
Prostatitis can produce uncomfortable symptoms such as burning during urination, a frequent need to urinate, and pain in the genitals, lower abdomen and back.
Prostatitis can be acute or chronic:
Acute prostatitis usually comes on suddenly with severe symptoms, often accompanied by fever or chills. It generally lasts only days or a few weeks and usually responds well to antibiotic treatment.
Prostatitis is considered chronic if the symptoms continue for three months or more. There are two main types of chronic prostatitis:
Chronic bacterial prostatitis:
Chronic bacterial infection may develop following a urinary tract infection or following a bout of acute bacterial prostatitis. Often a person who has previously had an acute infection might notice that their symptoms get better but do not go away completely. This is usually a sign that they have developed chronic inflammation.
Chronic non-bacterial prostatitis, or chronic pelvic pain syndrome:
Chronic pelvic pain syndrome can have many potential causes and is generally harder to treat. Patients who have had previous bacterial infections of the prostate seem to be more at risk of developing this type of prostatitis.
The main symptoms of chronic prostatitis are pelvic or genital pain. For some people, the pain feels like a gnawing ache. For others, it is intense and sharp. The level of pain typically fluctuates and comes and goes.
Other symptoms of chronic prostatitis include:
- A constant urge to urinate frequently, including getting up several times at night to use the bathroom.
- Pain or burning during urination.
- Difficulty starting urinating with a stop-start flow
- Feeling that the bladder hasn't fully emptied after urination
- Pain in the perineum, the region between the rectum and scrotum
- Lower back, rectal, or scrotal pain.
- Pain when or after ejaculating
- A change in the consistency of the ejaculate
- Blood in the urine
To diagnose prostatitis, we will usually begin by taking a complete medical history and performing a digital rectal exam of the prostate to check for swelling and tenderness.
Other tests might be necessary, such as:
Urine, semen, or blood tests to look for signs of infection. The presence of bacteria is considered conclusive, but often no bacteria are present in the urine with chronic prostatitis.
An ultrasound of the bladder and prostate is often helpful to check for the presence of bladder stones, bladder growths and if the bladder is emptying fully.
A pelvic MRI may be recommended to view the prostate anatomy, rule out prostate cancer as the cause of the symptoms and detect areas of prostate inflammation.
A cystoscopy using a small telescope to look inside the bladder or urethra is occasionally warranted.
Treatment for chronic prostatitis depends on the cause. For bacterial prostatitis, we will usually recommend a long-term course of oral antibiotics. 75% of chronic bacterial prostatitis cases clear up or improve significantly with antibiotic treatment.
Other treatment options include:
- Muscle relaxants to relieve any pelvic muscle spasm.
- Anti-inflammatory painkillers.
- Alpha-blocker medication to ease passing urine.
- In some cases, prostate massage can help drain prostate fluid that's causing the inflammation.
- Hot baths and heat therapies such as perineal heat pads can also help relieve discomfort.
- Dietary modification avoiding spicy foods and acidic beverages.
- Pelvic floor exercises to strengthen the muscles around the bladder and prostate.
- Other alternative remedies that may provide symptom relief include acupuncture, biofeedback, relaxation exercises and hypnotherapy.