Prostatitis
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Prostatitis

(Prostadynia)

En Español (Spanish Version)

Definition

Prostatitis is inflammation of the prostate gland. The prostate is a walnut-sized gland in men that surrounds the urethra. The prostate produces a fluid that is part of semen.

Anatomy of the Prostate Gland

© 2008 Nucleus Medical Art, Inc.

There are four types of prostatitis:

  • Category 1: acute bacterial (least common of the four types, but the most common in men under 35)
  • Category 2: chronic bacterial (not very common, but affects mostly men between 40-70)
  • Category 3: chronic nonbacterial/prostadynia (most common type, chronic pelvic pain)
    • Note: Prostadynia (also known as chronic pelvic pain syndrome) is a condition associated with similar symptoms as chronic nonbacterial prostatitis, but which has no evidence of prostatic inflammation.
  • Category 4: asymptomatic inflammatory prostatitis

Causes

Acute and some chronic bacterial prostatitis are caused by bacteria that infect the prostate gland. The bacteria usually come from the urinary tract or rectum. The causes of nonbacterial prostatitis can be difficult to identify, but some feel this may be caused by nonbacterial pathogens such as chlamydia , virus, fungus, or mycoplasma.

The causes of prostatodynia can be even more difficult to identify. But, the condition can be associated with stress and/or disorders of pelvic floor muscle tension or conditions such as interstitial cystitis . Asymptomatic inflammatory prostatitis is found during a prostate biopsy . The cause is not clearly understood.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:

  • Medical procedures that involve inserting a catheter or other tubing into your urethra or rectum
  • Anal intercourse
  • Recent bladder infection
  • Abnormalities in the anatomy of the urinary tract
  • Diabetes
  • Suppressed immune system
  • Something obstructing the bladder (eg, a tumor, a kidney stone , or enlargement of the prostate gland itself)

Symptoms

Symptoms of prostatitis can come on slowly or suddenly. They can be mild or quite severe. In nonbacterial prostatitis, symptoms often come and go.

Symptoms may include:

  • Needing to urinate frequently and/or urgently (especially at night)
  • Pain or burning while urinating
  • Difficulty urinating
  • Blood in the urine
  • Psychological stress
  • Lower abdominal pain or pressure
  • Rectal or perineal discomfort
  • Lower back pain
  • Fever or chills
  • Painful ejaculation
  • Impotence (due to inflammation around the gland)

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Diagnosis of prostatitis is usually based on the symptoms and massaging the prostate gland. In this test, the doctor places a lubricated, gloved finger into the rectum to feel the back wall of the prostate. In prostatitis, the prostate is usually tender and soft.

Other tests may include:

  • Analysis of urine and prostate fluid expressed after massaging the prostate gland
  • Bladder function tests

Treatment

Treatment depends on the type of prostatitis:

Infectious Prostatitis

Acute bacterial prostatitis is treated with oral antibiotics for 1-2 weeks. The commonly used drugs include quinolones (norfloxacin, ciprofloxacin, levofloxacin) or trimethoprim. In severe cases, treatment with intravenous antibiotics may be necessary. Chronic bacterial prostatitis is also treated with oral antibiotics for 4-12 weeks. Other medications include:

  • Stool softeners
  • Anti-inflammatory medications
  • Other analgesics or pain medications
  • Alpha-blockers such as Flomax
  • 5-alpha reductase inhibitors such as Proscar or Avodart

Your doctor may recommend that you alcohol and caffeinated beverages.

Noninfectious Prostatitis

Often patients are initially given a course of antibiotics. This is just in case an infectious cause was missed. Other treatments include:

  • Alpha-blockers such as Flomax
  • 5-alpha reductase inhibitors such as Proscar or Avodart
  • Anti-inflammatory medications such as ibuprofen
  • Pain killers
  • Warm sitz baths
  • Repeated prostate massages

Prevention

There are no guidelines for preventing prostatitis.

RESOURCES:

American Foundation for Urologic Disease
http://www.afud.org

The Prostatitis Foundation
http://www.prostatitis.org

CANADIAN RESOURCES:

Canadian Urological Association
http://www.cua.org/

Men's Health Centre
http://www.menshealthcentre.net/

References:

American Academy of Family Physicians website. Available at: http://www.aafp.org .

The Merck Manual of Medical Information—Home Edition . Simon and Schuster, Inc; 2000.

National Kidney and Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/ .

Propert KJ, McNaughton-Collins M, Leiby BE, et al. A prostpective study of symptoms and quality of life in men with chronic prostatitis/chronic pelvic pain syndrome: The National Institutes of Health Chronic Prostatitis Cohort Study. J Urol . 2006;175:619-623.



Last reviewed February 2008 by Miguel Antelo, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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