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Urology Health - What are Prostatitis and Related Chronic Pelvic Pain
Conditions?
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STATEMENT ON UKRAINE
1.
2. Urology A-Z
PROSTATITIS (INFECTION OF THE PROSTATE)
In This Section
PROSTATITIS (INFECTION OF THE PROSTATE)
* Symptoms
* Causes
* Diagnosis
* Treatment
* After Treatment
* More Information
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WHAT ARE PROSTATITIS AND RELATED CHRONIC PELVIC PAIN CONDITIONS?
Prostatitis is a common, often painful condition that can happen to men of all
ages. Pelvic pain in and around the prostate may be from:
* An infection caused by bacteria
* Inflammation (painful, red, swollen tissue) from an injury or infection
* Some other problem
If you think you have prostatitis or have long-term or sharp pelvic pain, talk
to a doctor so you can get help.
THE PROSTATE
DIAGRAM OF PROSTATE ANATOMY
ENLARGE
The prostate is a small, walnut-shaped gland that is part of the male
reproductive system. It sits under the bladder and in front of the rectum. The
prostate is surrounded by muscles and nerves. The urethra (the tube that carries
urine and semen out of the body) passes through the prostate.
The prostate helps make fluid for semen. Semen protects and energizes sperm as
they travel to the female egg.
DIAGRAM OF THE MALE REPRODUCTIVE SYSTEM
ENLARGE
SYMPTOMS
How you feel (your symptoms) will help your doctor diagnose you.
There are 4 types of prostatitis:
* Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)
* Chronic Bacterial Prostatitis (CBP)
* Acute (Sudden) Bacterial Prostatitis (ABP)
* Nonbacterial Prostatitis
CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME (CP/CPPS)
CP/CPPS is the most common type of prostatitis. It is an inflammation of the
prostate or the nerves which supply this area. Pain from CP/CPPS can last for
weeks to months to years. This pain may also be due to the muscles in the
pelvis. This is NOT an infection but symptoms may be like those in men with CBP.
Some of the symptoms are:
* Trouble passing urine (and sometimes with pain)
* Pain in the bladder, testicles and penis, and between these and the anus
* Trouble and pain with ejaculation
CHRONIC BACTERIAL PROSTATITIS (CBP)
Chronic bacterial prostatitis occurs from a bacterial infection. Symptoms are
often more gradual and may take longer to treat. Fever and chills are not common
but pain in the pelvis is still felt along with urinary symptoms and/or
ejaculatory pain.
Some of the symptoms are:
* A burning feeling while passing urine
* The need to urinate often
* Pain in the bladder, testicles and penis, and between the sex organs and anus
* Pain with ejaculation
ACUTE (SUDDEN) BACTERIAL PROSTATITIS (ABP)
Acute bacterial prostatitis is an infection of the prostate due to bacteria.
Symptoms can come on quickly and include fever, chills, urinary changes,
ejaculatory pain and pain in the pelvis or nearby zones. Treatment with
antibiotics often leads to quick relief.
They are:
* Chills
* Fever
* Very painful burning while passing urine
* Trouble draining your bladder
NONBACTERIAL PROSTATITIS
Nonbacterial Prostatitis is inflammation of the prostate that causes pain. It is
not due to a bacterial infection and may be from stress, nerve irritation,
injuries or past urinary tract infections. This form of prostatitis has no signs
of bacteria in the urine or semen.
CAUSES
The cause for prostatitis or pelvis pain is not always known. Some things can
raise the risk of a bacterial infection of the prostate like a bladder
infection, a catheter, an infection from sex, or a problem in the urinary tract.
It may take a few tests to figure out exactly why you feel pain. It's important
to try to find the cause.
Bacterial prostatitis is caused by a bacterial infection in the prostate.
Bacteria can get into the prostate when infected urine flows backwards from the
urethra. A sex partner cannot "catch" this type of infection. Bacteria can be
found in urine, prostate fluid or blood tests.
Nonbacterial prostatitis may be linked to stress, nerve inflammation or
irritation, injuries or prior urinary tract infections. Or it may occur if your
body reacts to an infection or injury that happened in the past. This form of
prostatitis has no signs of bacteria in the urine or seminal fluid.
Other possible causes for pelvic pain may also be from:
* Pelvic muscle tightness
* Prostate or bladder stones
* Prostate abscess
* Benign prostatic hyperplasia (BHP)
* Urethral stricture
* Prostate cancer
* Bladder cancer
WHAT ARE THE RISK FACTORS FOR PROSTATITIS?
The causes of most cases of prostatitis are not fully understood. But there are
certain things that can raise the risk of getting prostatitis caused by
bacteria. For example, bacteria can enter the body if you've had:
* A catheter (a tube to drain fluid from the body) or something else placed in
your urethra
* An abnormality found in your urinary tract
* A recent bladder infection
CAN PROSTATITIS BE PREVENTED?
Most cases of prostatitis cannot be prevented. Having safe sex can lower your
chance of getting prostatitis caused by some infections.
DIAGNOSIS
Your health care provider may start by asking you questions about your pain to
find out what’s wrong. A digital rectal exam (DRE) may be done to check the
prostate. Your doctor may do a transrectal ultrasound to look at your prostate
or do a test called cystoscopy to check your urinary system.
You may also be asked to get lab tests to look for bacteria in your urine or
prostate fluid. A urine flow study or urodynamics test may be done to look for a
block in your urinary system.
If your health care provider suspects a problem with your prostate or nearby
tissues, he/she may send you to a urologist. A urologist is a doctor who treats
problems of the urinary tract and male reproductive systems.
Each type of prostatitis calls for a different treatment. Your doctor will want
to know exactly what is causing your symptoms. To find the answers, more than
one type of test may be used.
PHYSICAL EXAM
Your health care provider may do a digital rectal exam (DRE). This is done by
putting a lubricated, gloved finger into your rectum. Your doctor will press and
feel the prostate to see if it is enlarged or tender. Lumps or firmness can
suggest prostate cancer. He/she will ask you how much pain you feel during this
test. If you have prostatitis, this exam may hurt a bit. But it doesn't cause
any harm or lasting pain.
DIAGRAM OF DIGITAL RECTAL EXAM OF THE PROSTATE
ENLARGE
TESTS
ULTRASOUND
To get a closer look at the prostate gland, your health care provider may order
a transrectal ultrasound. An ultrasound uses sound waves to show a picture of
the prostate. To "see" the prostate, the ultrasound probe is placed in the
rectum.
URINE AND PROSTATE FLUID TESTS
Your doctor may test your urine and fluid from your prostate gland. When the
prostate is massaged during the DRE, a fluid called expressed prostatic
excretion (EPS) comes out of the penis. Urine and EPS are checked for signs of
inflammation and infection. The test results may tell the doctor if the problem
is in your urethra, bladder, or prostate.
Your blood and semen may also be tested for bacteria, white blood cells, or
other signs of infection. Because it can be hard to get good samples, health
care providers can sometimes have trouble telling if prostatitis is caused by
bacteria. Also, if you have been treated with antibiotics in the recent past,
this can change the results.
If you are at risk for cancer, your health care provider may order a blood test
to check your prostate specific antigen (PSA) level. But if you have a prostate
infection, your PSA can be falsely raised. Because of this, doctors are careful
about how they read your PSA test results.
CYSTOSCOPY
Your urologist may look inside your urethra, prostate, and bladder with a
cystoscope. A cystoscope is a long, thin telescope with a light at the end.
First, your urologist will numb your urethra. Then, he or she will gently guide
the cystoscope through your urethra into the bladder.
DIAGRAM OF MALE CYSTOSCOPY
ENLARGE
URINE FLOW STUDIES (URODYNAMICS)
Your urologist may also order urine flow studies or urodynamics. These help
measure the strength of your urine flow. These tests also spot any blockage
caused by the prostate, urethra, or pelvic muscles.
TREATMENT
Your treatment will depend on your symptoms, lab tests and findings during your
visit. Patients may need many treatments. The treatment for prostatitis depends
on the type you have.
ACUTE BACTERIAL PROSTATITIS
For acute bacterial prostatitis, you'll need to take antibiotics for at least 14
days. Occasionally some men may be admitted to the hospital and given
antibiotics through an IV (into your vein). If you have trouble urinating, your
health care provider may use a tube (a catheter) to drain your bladder.
Almost all infections that start quickly are cured with this treatment.
Sometimes, you'll need to stay on the antibiotics for as long as four weeks. If
one antibiotic doesn't work, your doctor will try others.
CHRONIC BACTERIAL PROSTATITIS
For chronic bacterial prostatitis, you'll need to take antibiotics longer, most
often for 4 to 12 weeks. About three in four of chronic bacterial prostatitis
cases clear up with this treatment. Sometimes the symptoms return and
antibiotics are needed again. For cases that don't react to this treatment,
long-term, low dose antibiotics are used to ease the symptoms.
CP/CPPS
Because the exact cause of CP/CPPS is not known, some doctors may give
antibiotics even if your tests don't prove that bacteria are the cause. Other
times anti-inflammatory or medicines which reduce painful nerves will be tried.
ANTIBIOTICS
Antibiotics are often used as a first step to kill any bacteria. If an
antibiotic is prescribed, it is important to take your medicine at the same
time(s) each day and to take all of them, even if you start to feel better.
ALPHA-BLOCKERS
Some health care providers order drugs called alpha-blockers to help you feel
better. These drugs may help relax the muscles around the prostate and the base
of the bladder.
ANTI-INFLAMMATORY AGENTS
Anti-inflammatory drugs are non-steroidal drugs to reduce pain from inflammation
in the prostate or muscles. These are pain medicines (aspirin, ibuprofen, etc.)
and muscle relaxers.
PROSTATIC MASSAGE
Prostatic massages can help ease pressure in the prostate. It is done by
draining fluid from the prostate ducts while specialized physiotherapy may relax
the nearby muscles.
PELVIC FLOOR PHYSICAL THERAPY
Pelvic Floor Physical Therapy is a way to learn how to relax certain muscles in
your pelvis. It is done with an expert to help you lessen tension in your pelvic
floor muscles.
HOME CARE
There are many things that can be done at home to help reduce pain. These
include hot baths, hot water bottles, heating pads and a donut-shaped pillow.
LIFESTYLE CHANGES
Lifestyle changes such as weight loss and diet changes, learning to relax and
exercises may ease symptoms. Your health care provider may suggest that you stop
eating and drinking some foods. These may include spicy or acidic foods, and
caffeinated, fizzy or alcoholic drinks. Aim to drink more water, and eat more
fresh/unprocessed foods and less sugar. Your health care provider may also
suggest that you stop doing things that can make your pain worse (like bicycle
riding).
Unfortunately, supplements have not helped when tested in medical studies. There
is no evidence that herbs and supplements improve prostatitis. Options which
have been tried and fail to help prostatitis include rye grass (cernilton), a
chemical found in green tea, onions and a saw palmetto extract. Supplements can
affect other treatments, so if you want to try herbal supplements, please tell
your doctor first.
ACUPUNCTURE
Acupuncture involves an expert placing very thin needles through the skin at
many depths and points on your body to help reduce pain. Some men use
acupuncture to reduce pain.
SURGERY
In rare cases, surgery on either the urethra or prostate may be needed. There
must be a trackable problem that could cause pain for surgery to work.
AFTER TREATMENT
Most cases of acute bacterial prostatitis are cured with treatment.
Sometimes prostatitis can come back even after you've been cured. Your health
care provider may use more than one treatment at a time. Some men have to manage
living with the symptoms until the inflammation goes away.
MORE INFORMATION
ADDITIONAL FACTS
* Getting the right diagnosis is the key to taking care of prostatitis.
* Prostatitis does not always involve the prostate. The problem may be in the
nearby tissues.
* Prostatitis can't always be cured, but its symptoms can be managed.
* Treatment should be followed even if you feel better.
* Patients with prostatitis aren't at higher risk for getting prostate cancer.
* There's no reason to stop normal sex unless it bothers you.
November 2021
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