Prostatitis - Causes, Symptoms, Diagnosis, and Treatment

What is prostatitis?

Prostatitis is the inflammation of the prostate gland, a walnut-sized gland located directly below the bladder in men. Common size of prostatitis is 432, men with larger size may have a bigger gland. The prostate gland produces fluid (semen) that nourishes and transports sperm. Prostatitis often causes painful or difficult urination. Other symptoms of prostatitis include pain in the groin, pelvic area or genitals, and sometimes, flu-like symptoms.
 

What are prostatitis types?

There are four types of prostatitis:

Acute bacterial prostatitis is a bacterial infection of the prostate gland that requires urgent medical treatment. It is the least common of the four types and its potentially life-threatening. Fortunately, it is the easiest to diagnose and treat effectively.

Chronic bacterial prostatitis is a bacterial infection that occurs repeatedly, it occurs when bacteria find a spot on the prostate where they can survive. Treatment with antimicrobials do not always cure this condition.

Chronic nonbacterial prostatitis is the most common form of prostatitis. It may be found in men of any age. Its symptoms go away and then returns without warning, and it may be inflammatory or noninflammatory.

Chronis prostate pain syndrome(CPPS) is the diagnose given when the patient does not complain of pain or discomfort but has infection-fighting cells in his prostate fluid and semen. It usually is found in prostate cancer tests.
 

What are prostatitis causes?

Bacterial infections cause only about 5%-10% of cases of prostatitis. In the other 90%-95%, due to chronic pelvic pain syndrome or asymptomatic inflammatory prostatitis described above, the cause is not known. Prostate infectious agents are as follows for both acute and chronic infectious prostatitis:

- Escherichia coli (E coli) is the bacterium most often the cause of prostate infections and approximately 80% of the bacterial pathogens are gram-negative organisms (for example, Escherichia coli, Enterobacter, Serratia, Pseudomonas, Enterococcus, and Proteus species).

- Sexually transmitted disease-causing organisms also may cause infectious prostatitis especially in sexually active men under 35 years of age; the most usually identified organisms are Chlamydia, Neisseria, Trichomonas, and Ureaplasma.

- Rarely staphylococcal and streptococcal organisms have been found to be the cause, and infrequently different organisms such as fungi, genital viruses, and parasites have been implicated.

- The infectious agent (usually bacteria) may invade the prostate in two main ways.
The bacteria from a previous urethral infection move through prostatic ducts into the prostate (occasionally termed retrograde infection).

- Movement of infected urine into the glandular prostate tissue can infect via ejaculatory ducts (occasionally termed antegrade infection).

Infectious organisms, as previously stated, cause two of the four main types of prostatitis; acute infectious prostatitis and chronic infectious prostatitis.

You are at higher risk for getting prostatitis if you:
- Recently have had a medical instrument, such as a urinary catheter (a soft, lubricated tube used to drain urine from the bladder) inserted during a medical procedure
- Engage in rectal intercourse
- Have an abnormal urinary tract
- Have had a recent bladder infection
- Have an enlarged prostate
 

What are prostatitis symptoms?

Prostatitis can cause many symptoms, including the following:
- Difficult or painful urination
- Frequent/urgent urination
- Fever
- Low-back pain
- Pain in the penis, testicles or perineum (the area between the testicles and the anus)
- Pain with/after ejaculation
- Inability to get an erection
- Decreased interest in sex
 

How is prostatitis diagnosed?

Diagnosing prostatitis involves ruling out other conditions that may be causing your symptoms and determining what kind of prostatitis you have. Diagnosis may include the following:

Questions from your doctor. Your doctor will want to know about your medical history and your symptoms. You may be asked to fill out a questionnaire that can help your doctor make a diagnosis and see whether treatment is working.

Physical examination. Your doctor will examine your abdomen and genitals and will likely preform a digital rectal examination (DRE). During a digital rectal exam, your doctor will gently insert a lubricated, gloved finger into your rectum. Your doctor will be able to feel the surface of the prostate and judge whether it is enlarged, tender or inflamed.

Blood culture. This test is used to see whether there are signs of infection in your blood.
Urine and semen test. Your doctor may want to examine samples of your urine or semen for signs of infection. In some cases, the doctor may take a series of samples before, during and after massaging your prostate with a lubricated, gloved finger.

Examination with a viewing scope (cystoscopy). Your doctor may use an instrument called a cystoscope to examine the urethra and bladder. A cystoscope is a small tube with a light and magnifying lens or camera that's inserted through the urethra and into the bladder. This test is used to rule out other conditions that could be causing your symptoms.

Bladder tests (urodynamic tests). Your doctor may order one or more of these tests, which are used to check how well you can empty your bladder. This can help your doctor understand how much prostatitis is affecting your ability to urinate.
 

How is prostatitis treated?

Treatments vary among urologists and are tailored to the type of prostatitis you have. Correct diagnosis is crucial and treatments vary. It's important to make sure your symptoms are not caused by urethritis (inflammation of the urethra) or some other condition that may lead to permanent bladder or kidney damage.

Treatments can include:

- Anti-inflammatory medicines along with warm sitz baths (sitting in two to three inches of warm water). This is the most conservative treatment for chronic prostatitis.

- Antibiotic medicine for infectious prostatitis. These drugs are not effective treatments for noninfectious prostatitis. For acute infectious prostatitis, patients usually need to take antibiotic medicine for 14 days. Almost all acute infections can be cured with this treatment.

- For chronic infectious prostatitis, antibiotic medicine is taken for a longer period of time, usually four to 12 weeks. 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.

- Alpha blockers. These medications help relax the bladder neck and the muscle fibers where your prostate joins your bladder. This treatment may lessen symptoms, such as painful urination. Examples include tamsulosin (Flomax), terazosin (Hytrin), alfuzosin (Uroxatral) and doxazosin (Cardura). Common side effects include headaches and a decrease in blood pressure.

- 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.

- Herbal medicines.

- Supportive therapies for chronic prostatitis, including stool softeners and prostate massage.

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