Prostatitis: Causes, Symptoms and Treatments

Doctor holding a medical file with the words "Diagnosis: Prostatitis"

All men possess a prostate gland, comparable in size to a walnut, situated beneath the bladder and in front of the rectum. Its primary function is to produce the seminal fluid that carries and safeguards sperm on their journey to an egg.

Should the prostate become inflamed and sore, indicating swelling, the condition is known as prostatitis. This condition is non-cancerous issue and is a distinct  issue from having an enlarged prostate.

What is Prostatitis?

Prostatitis is an inflammation of the prostate gland, which can result in pain during urination and discomfort in the groin and pelvic areas. Not all cases are due to bacterial infections. The prostate, roughly walnut-sized, sits below the male bladder, encircling the urethra and contributes to semen production.

Types of Prostatitis

Prostatitis manifests in four different forms:

  • Acute bacterial prostatitis, characterized by a sudden and intense bacterial infection in the prostate that lasts for a short time. Bacterial infections can occur when bacteria travel from the urethra into the prostate.
  • Chronic bacterial prostatitis, a persistent or recurrent bacterial infection with milder symptoms, which goes on for a prolonged period of time, often years.
  • Chronic prostatitis/chronic pelvic pain syndrome, marked by persistent pelvic pain and urinary issues without infection. The cause remains a mystery to scientists who suspect it may be triggered by a microorganism distinct from bacteria. It could also be linked to toxins in the urine, the body’s immune reaction to past UTIs, or nerve damage within the pelvic region.
  • Asymptomatic inflammatory prostatitis, where the prostate is inflamed but presents no symptoms.

Prevalence of Prostatitis

Prostatitis is a prevalent urinary tract issue, particularly for men under 50, ranking as their top urinary complaint. For men over 50, it’s the third most common.

This condition leads to approximately two million doctor visits annually in the US. Among the various forms, chronic prostatitis or chronic pelvic pain syndrome is the predominant and yet least understood type, affecting 10-15% of men across all age brackets in the US.

Who is at Risk for Developing Prostatitis?

Certain men are at a higher risk for developing prostatitis, and the risk factors vary by prostatitis type. Men who have sustained nerve damage to the lower urinary tract from surgery or injury, or those experiencing psychological stress, are at an increased risk for chronic prostatitis/chronic pelvic pain syndrome.

On the other hand, those suffering from lower urinary tract infections (UTIs), especially recurrent or hard-to-treat ones, are more susceptible to both acute and chronic bacterial prostatitis.

Prostatitis Signs and Symptoms

Because prostatitis can manifest in any of four different types, each will have unique signs, symptoms and underlying causes. These are:

Acute Bacterial Prostatitis

Acute bacterial prostatitis begins rapidly and is an infection caused by urinary tract bacteria entering the prostate. Symptoms include:

  • A sudden, intense urge to urinate with minimal output.
  • A quick need to reach a toilet to avoid incontinence.
  • High fever and chills.
  • Difficulty urinating.
  • Pain at the base of the penis or behind the scrotum.
  • Cloudy urine.

This serious condition requires immediate medical attention if you experience these symptoms.

Chronic Bacterial Prostatitis

Chronic bacterial prostatitis primarily affects older men and is a persistent, milder bacterial infection that can last for months. It might follow a urinary tract infection or an episode of acute bacterial prostatitis.

Symptom flare-ups of chronic bacterial prostatitis can be intermittent, leading to them being overlooked. When present, symptoms might include:

  • Frequent nighttime urination urges.
  • Pain during urination.
  • Discomfort post-ejaculation.
  • Lower back ache.
  • Rectal pain.
  • A sensation of fullness beneath the scrotum.
  • Seminal blood presence.
  • Urinary obstruction, evident in difficulty urinating or a weakened urine flow.

Chronic prostatitis

Also known as chronic pelvic pain syndrome (CP/CPPS), chronic prostatitis is the predominant form of prostatitis, presenting symptoms similar to its bacterial counterpart but without bacteria detected through testing.

The etiology of CP/CPPS is uncertain, but possible factors include stress, adjacent nerve damage, injury, prior urinary tract infections, urine chemicals, and links to disorders such as chronic fatigue syndrome and irritable bowel syndrome.

The primary indicator of CP/CPPS is persistent pain for over three months in one or more of the following areas:

  • Tip of the penis.
  • Scrotum.
  • Perineum (the area between scrotum and rectum).
  • Lower abdomen.

Additional symptoms may involve painful urination or ejaculation, urinary incontinence, increased urinary frequency (over eight times daily), and a diminished urine stream.

Asymptomatic Prostatitis

Asymptomatic prostatitis is a condition where the prostate is inflamed yet presents no symptoms. It’s often discovered incidentally during blood tests for prostate health. While treatment isn’t necessary for asymptomatic prostatitis, it may contribute to infertility issues.

Risk Factors For Prostatitis

The likelihood of prostate issues increases under certain conditions, including:

  • Previous urinary tract infections (UTIs)
  • Groin injuries
  • Urinary catheter use
  • Past prostate biopsies
  • HIV/AIDS diagnosis
  • Presence of an enlarged prostate or urination difficulties
  • Prior instances of prostatitis

Prostate inflammation or infection is prevalent across various age groups in men.

Potential Complications

Prostatitis can lead to several serious issues, such as bloodstream bacterial infections, prostate abscesses, sexual dysfunction, and inflammation of nearby reproductive organs. Medical attention should be sought if a person experiences urinary symptoms that might not be related to prostatitis but could be due to bladder disorders, UTIs, or benign prostatic hyperplasia.

These symptoms can also indicate conditions like prostate cancer.

It’s advisable for men with prostatitis symptoms to consult a healthcare provider. Immediate medical care is essential for those who cannot urinate at all, have a frequent and urgent need to urinate accompanied by fever and chills, notice blood in their urine, or feel severe discomfort or pain in the lower abdomen and urinary tract.

Diagnosing Prostatitis

To diagnose prostatitis, healthcare providers rely on a combination of the individual’s personal and family medical history, a physical examination, and various medical tests. They often need to exclude other conditions with similar symptoms before confirming a prostatitis diagnosis.

Medical History

Collecting a thorough personal and family medical history is a standard initial step in the diagnostic process for prostatitis.

Physical Examination

A physical examination is crucial in diagnosing prostatitis. In this exam, the healthcare provider might:

  • Inspect the patient’s body, checking for any urethral discharge, swollen or sensitive lymph nodes in the groin, or inflammation and tenderness of the scrotum.
  • Conduct a digital rectal exam, wherein the man either bends over the examination table or lies on his side, drawing his knees to his chest. The provider then inserts a lubricated, gloved finger into the rectum to assess the size, tenderness, or any irregularities of the prostate that can be felt against the rectal wall. This procedure can be slightly uncomfortable but is quick and doesn’t require anesthesia.

Healthcare providers often include the digital rectal exam in routine physical check-ups for men over 40, regardless of urinary symptoms.

Medical Testing

If a healthcare provider suspects prostatitis, they may direct the patient to a urologist, who is an expert in urinary and male reproductive health. The urologist will use a series of medical tests to diagnose issues associated with the lower urinary tract and determine a treatment strategy. These tests could include:

  • Urinalysis, where a patient provides a urine sample for in-office testing with a dipstick or sent out for lab analysis.
  • Blood tests to detect infection signs and other prostate-related concerns, including possible indications of prostate cancer.
  • Urodynamic tests to measure the urine flow and bladder pressure.
  • Cystoscopy for a visual inspection of the bladder lining and urethra.
  • Transrectal ultrasound to get detailed images of the prostate.
  • Biopsy to sample prostate tissue for closer examination.
  • Semen analysis to evaluate the health of sperm.

For a urinalysis, the patient delivers a urine sample which a healthcare professional tests using a chemical dipstick or microscope examination. In some instances, the sample undergoes a urine culture in a lab where bacteria, if present, are allowed to grow for identification.

Blood test samples are analyzed in a lab to reveal any infection and prostate health markers that might also suggest prostate cancer.

Urodynamic tests assess the bladder and urethra’s functionality regarding urine storage and release. These tests can be conducted in an office, outpatient center, or hospital, and may not always necessitate anesthesia, while some require local anesthesia. Key assessments include:

  • Uroflowmetry, to measure the speed of urine flow from the bladder.
  • Postvoid residual measurement, to determine the amount of urine remaining in the bladder post-urination.

Cystoscopy is a procedure employing a cystoscope to view the urethra and bladder internally. During this procedure, performed in a medical office or facility, a urologist inserts the cystoscope through the penis. Local anesthesia is typically used, but sedation or other forms of anesthesia may be necessary for some cases.

The purpose of cystoscopy is to diagnose issues such as strictures, obstructions, or stones within the urinary tract.

Transrectal ultrasound employs a transducer to emit harmless, pain-free sound waves that reflect off body organs to create an image. The healthcare provider can reposition the transducer for various organ views.

A trained technician performs this non-invasive procedure in a medical office, outpatient center, or hospital. A radiologist then analyzes the images; no anesthesia is needed for the patient. This ultrasound is often used to assess the prostate by inserting a transducer, roughly the size of a pen, into the rectum adjacent to the prostate.

The resulting image details the prostate’s size and any irregularities, such as potential tumors. However, transrectal ultrasound is not a definitive method for diagnosing prostate cancer.

A biopsy involves removing a small section of prostate tissue for microscopic examination. Urologists typically conduct biopsies in outpatient centers or hospitals. Patients may receive light sedation and local anesthesia, though some cases necessitate general anesthesia.

The procedure is guided by imaging methods such as ultrasound, CT scans, or MRI to accurately place the biopsy needle into the prostate. The extracted tissue is then analyzed by a pathologist, a specialist in disease diagnosis through tissue evaluation, to determine the presence of prostate cancer.

A semen analysis evaluates both the quantity and the quality of a man’s semen and sperm. To conduct this test, the man provides a semen sample using a specialized container supplied by the clinic, which he can use at home, in a healthcare provider’s office, or at a commercial site.

The sample is then examined by the healthcare provider or sent to a laboratory for detailed testing. Analysis of the semen can reveal the presence of blood or indicators of infection.

Prostatitis Treatments

Managing prostatitis involves symptom relief and pain control, which your doctor can guide you through. Treatment options may include:

  • Antibiotics for bacterial infections, potentially starting with an IV in severe cases, followed by an oral course lasting up to a month. Long-term, low-dose antibiotics may be recommended for recurring issues.
  • Alpha-blockers to ease urinary tract tension and reduce obstruction risks.
  • NSAIDs available over-the-counter to alleviate discomfort and inflammation.
  • Prescription pain medications, including antidepressants or anti-seizure drugs, for chronic prostate pain management.
  • Supplements like quercetin and cernilton, which may reduce inflammation, though consultation with a doctor is crucial to avoid interactions with other medications.
  • Medications that enhance sexual function, such as sildenafil (Viagra), if prostatitis affects sexual health.

In certain cases, alternative treatments might be necessary:

  • Urinary catheter: For urinary retention, a catheter can be inserted by a nurse to empty the bladder.
  • Prostate massage: Regularly emptying prostate ducts through massage or frequent ejaculation may be beneficial.
  • Physical therapy: When prostatitis stems from pelvic floor muscle issues, a physical therapist can teach exercises and habits to strengthen the muscles and prevent further damage.
  • Mental health support: Addressing stress, depression, or feelings of helplessness that may influence prostatitis symptoms with a mental health professional can be effective for managing mental well-being.

Implementing lifestyle adjustments can contribute to symptom improvement:

  • Modify your intake by avoiding spicy foods, caffeine, and alcohol, which could exacerbate symptoms.
  • Regularly take sitz baths, where sitting in warm water covering the hips can offer symptom relief.
  • Use a cushion to reduce discomfort if your job requires prolonged sitting.
  • Engage in consistent exercise to potentially diminish pain and boost mental health.

Ongoing research on prostatitis causation is anticipated to advance treatment options.

Prevention

There are currently no definite measures to prevent prostatitis, as the causes are not fully understood and researchers are investigating potential prevention strategies.

As for the impact of diet on prostatitis, no concrete evidence suggests that dietary choices cause or prevent the condition. Nevertheless, during bacterial prostatitis treatment, increased fluid consumption is often recommended, along with limiting bladder irritants. Men should consult with their healthcare provider or a dietitian to personalize their dietary plan.

References
  1. https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostatitis-inflammation-prostate#:~:text=Prostatitis%20is%20a%20frequently%20painful,chronic%20bacterial%20prostatitis
  2. https://www.ncbi.nlm.nih.gov/books/NBK459257/
  3. https://www.merckmanuals.com/home/men-s-health-issues/benign-prostate-disorders/prostatitis
  4. https://aacrjournals.org/cebp/article/28/10/1594/71744/A-Systematic-Review-and-Meta-analysis-of
  5. https://aacrjournals.org/cebp/article/30/2/255/72306/Why-Do-Epidemiologic-Studies-Find-an-Inverse
  6. https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostatitis-inflammation-prostate
  7. https://www.urologyhealth.org/urology-a-z/p/prostatitis-(infection-of-the-prostate)
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