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The term prostatitis describes inflammation of the prostate gland. Unlike other prostatic conditions, prostatitis affects younger and older men alike. It is common, affecting up to 1 in 12 men in their lifetime and keeping urologists busy.
If you have symptoms of prostatitis, your physician will want to determine the severity and whether there is a bacterial cause while excluding other conditions.
Your doctor will begin with the following:
- Full medical history
- Physical examination, including a digital rectal examination
- Laboratory tests
Your doctor may feel it necessary to conduct specialized testing and recommend one or more of the following:
- Additional urine tests
- Screening for sexually transmitted infections
- Prostate-specific antigen (PSA) blood test
- Retrograde urethrography
- MRI) or CT can
- Prostatic biopsy
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Acute Bacterial Prostatitis
This is an acute bacterial infection of the prostate gland. Bacteria are usually those that colonize in the bowels: E. coli is present in 50 to 80 percent of cases. Gonorrhea and chlamydia may also cause ABP.
Among the risk factors are recent episodes of sexually transmitted disease or urinary tract infection; catheterization; laparoscopic investigation or treatment; starting and stopping during urination; immunodeficiency and unprotected sex (especially anal sex).
See your doctor immediately if you develop a combination of the following symptoms:
- Flu-like symptoms
- Pain in pelvis, lower abdomen, lower back, testicles, penis, or rectum
- Pain during urination, ejaculation or defecation
- Blood in urine or semen
- Foul smelling urine
- Difficulty urinating
- Pain or nodule detected on digital rectal exam
In most cases, acute bacterial prostatitis is curable with antibiotics. Left untreated, it can lead to serious infections in the form of septicemia or prostatic abscess. Such complications may also occur in men with diabetes or immunodeficiency.
Antibiotic treatment, guided by urine testing, for up to eight weeks usually clears infection. Testing at the end of treatment is advised to ensure that the infection has cleared.
Chronic Bacterial Prostatitis
Chronic bacterial prostatitis is infective prostatitis lasting three months or longer. It usually affects men 36 to 50 years of age.
Chronic prostatitis often begins with the mild, vague symptoms of a low-grade infection which worsen over time. However, in 5-10 percent of men, it follows an acute episode of prostatitis. The bacteria E. coli, Klebsiella, Proteus mirabilis, Enterococcus faecalis, and Pseudomonas aeruginosa have been firmly linked to bacterial prostatitis.
As for acute bacterial prostatitis, recurrent urinary tract infection and catheterization are notable risk factors.
Mild symptoms of acute bacterial prostatitis, but without flu-like symptoms, is a common sign of chronic bacterial prostatitis.
Four to six weeks of antibiotic treatment is standard, but some need a 12-week course. For men with difficult-to-manage cases, long-term prophylactic treatment of low-dose antibiotics and regular urine testing may be needed.
Generally, fluoroquinolones are effective, but when a resistant bacterium is present, netilmicin is useful. NSAIDs, anticholinergics and alpha-blockers may be prescribed for symptom relief.
Where there is underlying urinary obstruction, alpha-blockers may reduce the risk of recurrence.
Chronic Prostatitis/Chronic Pelvic Pain Syndrome
CP/CPPS is responsible for 90 to 95 percent of prostatitis cases, but in many men no cause is found. CP/CPPS describes a “syndrome” or group of symptoms rather than a specific disease.
The cause of CP/CPPS is not fully understood and likely varies between individuals. Frustratingly, in many men, no cause is found. It is most likely caused by a combination of factors or a cascade of events.
Patients present with mild symptoms of acute bacterial prostatitis, without the flu-like symptoms, is a common sign of the condition. Symptoms tend to persist for weeks, months, and even years.
CP/CPPS, like other causes of chronic pain, can lead to debilitating complications and seriously affect quality of life and ability to function at work and at home. Depression, anxiety, chronic stress, and sleep problems are common, and in turn can lead to other psychiatric, behavioral, relationship, and social difficulties.
Long-term use of pain-relief medications can cause further issues such as stomach problems in the case of nonsteroidal anti-inflammatory drugs, or addiction and misuse (in the case of opioid pain medications).
CP/CPPS is a diagnosis that is made only after other causes are excluded. Several diseases may mimic CP/CPPS, among them the following:
- Bowel: Irritable bowel, diverticulitis, and colon cancer
- Genitourinary: Cystitis (bladder inflammation), benign prostatic hyperplasia, bladder/prostate cancer, urinary tract stones, sexually transmitted diseases, foreign body and prostatic abscess
- Musculoskeletal: Pelvic floor dysfunction, pelvic injury, and trauma
- Neurologic: Neurogenic bladder and pudendal neuralgia.
In men with a recent onset of CP/CPPS first-line therapies include basic pain relief (acetaminophen or nonsteroidal anti-inflammatories), selective alpha-blockers and perhaps a trial of antibiotics.
Some doctors believe that in the absence of a positive bacterial culture (on urine or semen testing) that antibiotic treatment is unnecessary and may even be harmful, as it may increase future risk of antibiotic resistance. Where a urinary tract infection was detected prior to the development of CP/CPPS, a trial of antibiotics may be prudent.
If this simple approach fails to offer relief, a “multimodal” approach may be needed using these additional treatment options:
- Alpha-blockers, anticholinergics, amitriptyline, and phytotherapy to reduce symptoms
- Counseling, cognitive behavioral therapy, antidepressants, and mindfulness practice
- Antibiotic treatment
- Nerve and muscle treatment
Some patients swear that lifestyle changes help manage prostatitis symptoms. Although not proven by rigorous research, they are certainly worth a try. Changes include reducing tobacco usage, avoiding prolonged sitting or bouncing, taking warm baths, regularly engaging in aerobic exercise, and urinating frequently. Regular ejaculation may help to improve symptoms.
Dietary changes may help reduce symptoms: Reduce your intake of caffeine, alcohol, artificial sweeteners and spicy foods, which are prostatic irritants and cause dehydration. Avoid dehydration by increasing fluid intake.
For more information about diseases that affect to prostate, purchase Prostate Diseases at UniversityHealthNews.com.