Prostatitis

Prostatitis Evaluation at Southland Urology

Prostatitis is the swelling and inflammation of the prostate gland, a small, walnut-shaped gland located below the bladder in men. The condition can be caused by a bacterial infection or other factors and is often characterized by painful or difficult urination, as well as pain in the groin, pelvic, or genital area. While the symptoms can be distressing, the condition is highly treatable, and various options are available depending on the type and severity of the prostatitis.

Understanding Prostatitis

What is Prostatitis?

Prostatitis is a medical condition characterized by inflammation of the prostate gland. It is not a single disease but rather a term for several different syndromes that can be acute or chronic. The condition can affect men of any age, but it is most common in men aged 50 or younger. The symptoms, which can range from mild to severe, can have a significant impact on a man’s quality of life. Unlike benign prostatic hyperplasia (BPH) or prostate cancer, prostatitis is a non-cancerous condition, though its symptoms can sometimes overlap with those of other prostate diseases.

Types of Prostatitis

Prostatitis is classified into four main types. Acute bacterial prostatitis is a severe and sudden bacterial infection of the prostate, often accompanied by a high fever, chills, and painful urination. Chronic bacterial prostatitis is a recurrent or persistent bacterial infection of the prostate that can cause recurring urinary tract infections. It is often less severe than the acute form but can be difficult to treat. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most common and least understood type. It is not caused by a bacterial infection and involves chronic pain in the pelvic area, often with urinary symptoms. The final type is asymptomatic inflammatory prostatitis, which has no symptoms and is often discovered incidentally during an exam for another condition, such as infertility.

Causes and Risk Factors

The causes of prostatitis vary depending on the type. Acute and chronic bacterial prostatitis are caused by bacteria entering the prostate, often from a urinary tract infection. The bacteria can be the same type that cause bladder or kidney infections. The cause of CP/CPPS, the non-bacterial type, is still being researched, but it is believed to be linked to a combination of factors, including nerve inflammation, muscle tension in the pelvic floor, and autoimmune or psychological factors. Risk factors for prostatitis include a history of a urinary tract infection, a prior prostate biopsy, using a catheter, having a physical injury to the pelvis, or having an STI.

Symptoms

The symptoms of prostatitis can be wide-ranging and depend on the type. Common symptoms include pain in the groin, genitals, lower abdomen, or lower back. Many men experience painful, frequent, or urgent urination, as well as a burning sensation. Other signs can include difficulty emptying the bladder, a weak urinary stream, pain with ejaculation, and sometimes blood in the urine or semen. Acute bacterial prostatitis is often accompanied by flu-like symptoms, such as fever, chills, and body aches.

Diagnosis

Diagnosing prostatitis typically starts with a physical examination, including a digital rectal exam (DRE) to feel for a swollen or tender prostate. The doctor will also review your symptoms and medical history. A urinalysis and urine culture are crucial for detecting a bacterial infection. The doctor may also order a semen culture to check for bacteria in the semen. For chronic prostatitis/CPPS, a diagnosis often involves ruling out other conditions, such as bladder cancer or interstitial cystitis. In some cases, a cystoscopy (a procedure to look inside the bladder with a thin scope) or urodynamic studies may be performed.

Non-Surgical Treatment Options

The primary treatment for bacterial prostatitis is antibiotics. For acute cases, a course of antibiotics for two to four weeks is often prescribed, while chronic cases may require a longer course of treatment, sometimes for several months. For non-bacterial prostatitis (CP/CPPS), treatment focuses on symptom management. This can include alpha-blockers to relax the muscles around the bladder and prostate, over-the-counter pain relievers, and lifestyle adjustments like avoiding caffeine, alcohol, and spicy foods. Pelvic floor physical therapy and stress-management techniques can also be very effective for managing chronic pain.

Surgical Treatment Options

Surgery is generally considered a last resort for prostatitis and is not a common treatment for most cases. It is typically reserved for severe, chronic, or recurrent cases that have not responded to other treatments, or for those with underlying anatomical issues. One such procedure is a transurethral resection of the prostate (TURP), which can be performed in rare cases of chronic prostatitis that are related to a prostate obstruction. The surgery involves removing part of the prostate to relieve pressure and improve urinary flow. For men with severe, refractory symptoms, other procedures to remove prostatic stones or address blockages may be considered, but these are rare.