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Prostatitis- Urology

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Untreated urinary tract problems can cause a lot of pain, discomfort, and inconvenience. Prostatitis, an inflamed prostate condition, is one of the most common health concerns that can cause trouble in the urinary tract in men.

Prostate inflammation can be caused by a bacterial infection that’s sudden (acute bacterial prostatitis) or recurring (chronic bacterial prostatitis). Rarely, the prostate can become inflamed even without an infection causing chronic pelvic pain syndrome. Some men might experience prostatitis with no symptoms at all (asymptomatic prostatitis).

The treatment for prostatitis may involve an antibiotic course, painkillers, muscle relaxants, and the management of associated psychological stresses.

Consult with your health care provider or urologist if you’re experiencing pain in the pelvis, trouble with urinating, or other prostatitis symptoms, including fever and chills.

What is Prostatitis?

Prostatitis is defined as an inflammation of the prostate gland. It can cause pain in the pelvis, groin, or genitals, or it can be asymptomatic.

The prostate gland is a walnut-shaped gland that’s part of the male reproductive system. It is located just below the bladder and surrounds the top portion of the urethra (the tube that drains urine from the bladder). The prostate and other sex glands produce semen, the fluid which carries sperm during ejaculation.

Prostatitis is the most common urinary tract disorder in men under 50 and the third most common one in men over 50. However, it is often misdiagnosed due to its common symptoms with other health problems.

Types of Prostatitis

There are four types of prostatitis:

  • Acute bacterial prostatitis: This type happens when a urinary tract infection (UTI) causes a bacterial infection of the prostate. This leads to sudden severe symptoms, including fever, chills, and burning when urinating, which usually require immediate medical attention.
  • Chronic bacterial prostatitis: This is a recurring bacterial infection that happens because the bacteria become trapped in the prostate gland. It causes less severe symptoms that start to develop slowly over the course of weeks. Chronic prostatitis can be challenging to diagnose since the symptoms develop gradually.
  • Chronic prostatitis or chronic pelvic pain syndrome (CPPS): This is the most common type of prostatitis. Men with CPPS experience chronic pelvic pain in the pelvis, groin, and genitals and urinary tract problems with no evidence of prostate bacterial infection.
  • Asymptomatic inflammatory prostatitis: You may find out you have this type of prostatitis while getting tested for other urinary or reproductive tract disorders (e.g: semen test for infertility). Asymptomatic prostatitis involves an inflamed prostate gland but without symptoms and doesn’t require treatment.

Symptoms of Prostatitis

50% of all men get prostatitis symptoms at some point in their lives. The symptoms of prostatitis will vary depending on the type of prostate inflammation you have. On the other hand, people with asymptomatic inflammatory prostatitis don’t experience any symptoms at all.

If you have chronic prostatitis or chronic bacterial prostatitis, you may experience:

  • Pain or discomfort in the penis, testicles, or perineum (area between scrotum and rectum) that may radiate to reach the lower back
  • A frequent urge to urinate, particularly at night (nocturia)
  • Difficulty urinating or urine that leaks out of the bladder (dribbling urine)
  • Painful burning sensation while urinating (dysuria)
  • Pain during intercourse or painful ejaculation
  • Bloody or cloudy urine
  • Bloody semen (hematospermia)
  • Erectile dysfunction

If you get acute bacterial prostatitis, you may have chills, fever, muscle aches, and other flu-like symptoms.

Prostatitis is diagnosed based on the symptoms and lab results, including blood tests, urine analysis, and blood and urine cultures. Sometimes, imaging tests or a prostate biopsy might be needed to further confirm the diagnosis in unclear cases.

Treatment of Prostatitis

Prostatitis treatment depends on whether your prostate inflammation is chronic or acute, bacterial or non-bacterial. It will also be based on the symptoms you’re experiencing.

Treatment of infection

Acute and chronic bacterial prostatitis will almost always require antibiotic treatment.

For acute prostatitis:

  • You’ll be given intravenous (IV) antibiotics for 4-6 weeks or a little longer sometimes.
  • You may have to take IV treatment at the hospital for a short period of time.

The treatment for chronic prostatitis may be more challenging:

  • You might need up to 3 months of antibiotics to completely get rid of the bacteria causing infections.
  • In case the prostate isn’t completely cleared of the pathogens, your doctor may prescribe low-dose antibiotics used long-term to prevent recurring infections.

It’s important that you take the entire prescribed medication to completely eliminate the infection and reduce the risk of recurring bacterial prostatitis.

Treatment of urinary problems

Men with chronic prostatitis experience frequent urinary pain and discomfort. Medications called alpha-blockers, such as Flomax and Uroxatral can be prescribed to relax the urinary tract muscles. This helps improve the urinary flow and ease painful or difficult urination.

Alpha-blockers are usually prescribed for chronic pelvic pain syndrome but can also be prescribed for prostate bacterial infections.

Pain treatment

Your doctor can prescribe pain medications, such as Elavil and Gralise, to relieve the pain in the pelvis, groin, and scrotum. Prescribed painkillers can also relieve fibromyalgia (pain that extends to the arms, legs, and back).

Your doctor may also recommend off-the-counter pain drugs such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin IB).

Surgical intervention

Prostatitis cannot be treated with surgery. Nevertheless, some men might need surgery to drain an abscess on the prostate or remove a prostate stone or scar tissue on the urethra. However, this is not common.

Moreover, in rare cases, surgeons might remove a part of or the entire prostate gland (prostatectomy), but this can not guarantee a cure for prostatitis symptoms.

Managing the psychological symptoms

If your prostatitis is causing you chronic pain and discomfort, you might start experiencing stress, anxiety, or depression. In this case, your health care provider may refer you to a mental health care professional to manage the psychological symptoms associated with chronic pain.

The management of the psychological symptoms of prostatitis can include stress management, counseling, and prescribed antidepressants or anxiety medication.

Home remedies

There are a few tips that can help relieve some of the discomforts from prostatitis:

  • Use a heating pad on your pelvis or soak in a shallow warm bath (a sitz bath).
  • Avoid food and drinks that may irritate the bladder (alcohol, caffeine, spicy or acidic food).
  • Stay hydrated. Drinking plenty of water helps you urinate more and eliminate some of the bacteria from your bladder.

In addition, physical therapy for the pelvic floor can reduce or eliminate muscle spasms. Gentle pelvic massage can help ease the tension on the tight pelvic floor muscles.

When to See a Doctor

Prostatitis has signs and symptoms that overlap with several other health conditions. Therefore, when you experience any unusual symptoms, it’s important to consult with a healthcare professional to get a proper diagnosis and start early treatment.

Seek immediate medical care if you start experiencing:

  • An inability to urinate
  • Burning on urination
  • Unexplained fever
  • Painful, difficult urination accompanied by fever
  • Bloody urine
  • Severe pain or discomfort in the genitals or pelvic area

Your health care provider will assess the symptoms and perform a physical exam before reaching a diagnosis and starting you on the right treatment.

The early diagnosis and treatment of a urinary tract infection can keep it from spreading further and reaching the prostate. If you’re experiencing pain in your pelvic area or have urinary issues, consult with a doctor for a diagnosis and treatment.

About the Author:
Dr. Mersad is a medical doctor, author, and editor based in Germany. He's managed to publish several research papers early in his career. He is passionate about spreading medical knowledge. Thus, he spends a big portion of his time writing educational articles for everyone to learn.

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