Prostatitis is a painful inflammation of the prostate. It is the most common cause of urinary tract infections in men. Like benign prostatic hyperplasia (BPH), prostatitis symptoms are frequent urination, urgent urination and discomfort in the prostate area. Most men have areas of mild inflammation, or swelling, in their prostate glands. However, when the inflammation is severe or extensive, it can cause a rise in your prostate-specific antigen (PSA) level. The important thing to keep in mind about prostatitis is that it is not cancer, nor does it lead to cancer, Prostatitis is a benign ailment. While not always curable, it is almost always treatable.
An estimated 25% of men, who see their doctor for urological problems, show symptoms of prostatitis. However, fewer than 8% of men with prostatitis actually have a urinary tract infection. While bacteria or infections, tissue disruption after biopsy, or other factors can be the cause of some prostatitis, the cause of other kinds of prostatitis are not known. In its own way, prostatitis is just as challenging and frustrating as BPH, not only because of symptoms, but because there is not always a clear cause.
Men who have prostatitis experience painful conditions from an inflamed, swollen and tender prostate, which can include the following prostatitis symptoms:
- Pain the perineum (the area between the rectum and the testicles)
- Aches, pain in the joints or muscles, lower legs and and lower back
- Blood in the urine
- Pain or burning during urination
- Painful ejaculation
- Need to urinate frequently
- Incomplete emptying of the bladder
The Four Types of Prostatitis
Prostatitis is actually a general medical term for a range of conditions, which is why getting the right diagnosis is important. Four conditions or types fall under the umbrella of what is prostatitis:
- Acute bacterial prostatitis – Acute bacterial prostatitis is really an acute urinary tract infection (UTI). It is one of the two least common forms of prostatitis and the easiest to treat because it is caused by a bacterial infection, such as E. coli, a form of bacteria that is common in the colon. The symptoms of this prostatitis are characterized by extreme pain, chills and fever, severe burning on urination, and increased frequency of urination. Acute bacterial prostatitis can lead to more serious problems such as urinary retention, sepsis (a life-threatening infection in the bloodstream), and an abscess within the prostate. Obliterating acute bacterial prostatitis the first time around with extensive antibiotic treatment is the best way to avoid its chronic form.
- Chronic bacterial prostatitis - Chronic bacterial prostatitis is also caused by bacteria and treated with antibiotics. It can come back periodically for years after an initial episode of acute bacterial prostatitis. Its symptoms are usually milder versions of those seen in the acute form. This type of prostatitis is so closely linked to UTIs that many experts believe that if you don’t have a UTI and never had one, you don’t have chronic bacterial prostatitis. The hallmark of chronic bacterial prostatitis is that, when the infection returns, it is caused by the same type of bacteria that caused the previous infection. One theory for persistent bacterial prostatitis is that the infection may linger in tiny stones, called calculi, in the prostate.
- Chronic prostatitis/chronic pelvic pain syndrome – Chronic prostatitis is a nonbacterial prostatitis and the most challenging to treat. Men with chronic prostatitis/chronic pelvic pain syndrome may have many of the same symptoms as those men with chronic bacterial prostatitis. However, antibiotics have no effect. This category consists of two subgroups: inflammatory and non-inflammatory, based on whether any white blood cells, known as inflammatory cells, are found in the prostatic fluid. The prostatitis causes under this category still remain unknown, although recent evidence now seems to supports the theory that some nonbacterial prostatitis may actually be caused by an autoimmune condition which mimics symptoms of prostatitis. However, in some men, the prostate may not be the problem. Chronic prostatitis symptoms may be a result of spasms elsewhere in the pelvis, rectum or lower back.
- Asymptomatic inflammatory prostatitis- There is a type of prostatitis, known as asymptomatic inflammatory prostatitis, which produces no symptoms at all. Its cause is a still a mystery. It is usually found by chance, when inflammatory cells are found in the prostatic fluid or inflammation is detected on a prostate biopsy, or when prostate tissue is removed for other reasons, such as surgery for BPH or prostate cancer. Some experts wonder if there is any real need for concern when a prostatitis produces no symptoms. Others speculate that although it is not cancer, this type of prostatitis could have some relation or link to the formation of cancer, in that whatever causes the inflammation, may possibly cause cancer as well.
Understanding Your Prostatitis Treatment
- Acute bacterial prostatitis – This prostatitis form responds extremely well to a course in antibiotics, usually one of a class called fluoroquinolones. However, some men under-medicate because either they were not prescribed enough antibiotics to get rid of the prostatitis for good, or more commonly, they don’t end up taking all of their recommended antibiotics. A week to ten days of antibiotics often eases all signs of infection, and a man may feel that he has taken enough the prostatitis treatment. However, doctors have learned, from watching acute bacterial prostatitis return as chronic bacterial prostatitis, to cure this form of prostatitis, it actually takes about 6 weeks of antibiotics to completely get rid of the infection. The prostate is like a sponge, and if any trace of bacteria is not eradicated right away, the prostatitis becomes much more difficult to cure.
- Chronic bacterial prostatitis – For this type of prostatitis, treatment is also with antibiotics for six weeks. Men with this prostatitis are helped by low maintenance doses of antibiotics. Called chronic suppressive therapy, instead of treating new UTIs after the fact, it is designed to prevent new UTIs from developing. As its name suggests, chronic bacterial prostatitis may return several months later but will vanish again after another round of antibiotics.
- Chronic prostatitis/chronic pelvic pain syndrome – The treatment for chronic prostatitis is often trial and error and takes a lot of patience. It helps if you and your doctor work together to come up with the right plan. Since this prostatitis condition does not respond to antibiotics, the treatment is largely symptomatic, meaning that this prostatitis treatment is mainly designed to provide relief from the symptoms of prostatitis. If you have this form of prostatitis, your doctor may prescribe several medications, including alpha-blockers, 5-alpha reductase inhibitors and anti-inflammatory agents to ease muscle tension in the prostate and make urination easier. Some doctors also recommend sitz baths as well. The challenge with this prostatitis treatment is that it needs to be customized to the individual patient needs and responses. It often takes time and a lot of patience to figure out and fine-tune the various drug treatments available to come up with the best course of treatment for this type of prostatitis.
- Asymptomatic inflammatory prostatitis – There is no treatment or cure for this type of prostatitis.
High Risk Candidates for Prostatitis
Stress seems to play a role in prostatitis; however you are also at higher risk of developing prostatitis if you recently have had the following:
- A urinary catheter or other medical instrument inserted into your penis
- Engaged in rectal intercourse or oral sex
- Have had a recent bladder infection or other urinary problems, including BPH or an abnormal urinary tract
There is now exciting new research that may help in finding new ways to manage prostatitis. Many men have found that their symptoms improve when they change their diet and lifestyle, finding that their prostatitis symptoms improve when they eat a good balance of fruits and vegetables, drink enough water to keep their urine running clear, and avoid spicy foods, alcohol, caffeine and soft drinks that contain saccharine. A thirty minute hot bath or sitz bath, twice a day can sometimes relieve pain and make it easier to urinate. Also daily exercise (excluding riding a bike or an exercise bike) and resuming normal sexual activity may be helpful in treating prostatitis.
