Prostatitis
Prostatitis is one of the most common urologic diagnoses patients receive. It can have a number of different presentations and is sometimes a diagnosis of exclusion arrived at by ruling out more serious conditions. The spectrum of symptoms is very broad, beginning with minor irritative urinary symptoms all they way to severe urinary and body-wide symptoms.
To briefly review, the prostate gland is a male reproductive organ that is about the size of a walnut under normal, non-enlarged circumstances. It is situated at the lowest point in the male pelvis, at the base of the bladder. The urinary tube (urethra) passes from the bladder through the middle of the prostate gland, like a donut hole.
The primary function of the gland is reproductive. The prostate produces roughly 35-40% of the semen and is responsible for coordinating ejaculation.
Acute prostatitis
In its most acute form, prostatitis represents an acute bacterial infection of the prostate. The symptoms are usually quite severe and represent a definite change from the patient's normal urinary pattern. Significant pain with urination, inability to urinate, severe flu-like symptoms, and high fever (>101F) are common presenting signs. Left untreated, formation of a pocket of pus (abscess) within the prostate is a possible outcome. On examination, the prostate is exquisitely tender.
Acute prostatitis has a reasonably sudden onset. Patients are often able to pinpoint the day when their symptoms began.
The acute form is almost always bacterial in nature. It is not usually linked to sexual activity, although Chlamydia is occasionally implicated as a cause. Proper treatment usually entails taking antibiotics. Occasionally, hospital admission and intravenous antibiotics are necessary.
With appropriate antibiotic therapy, the symptoms of bacterial prostatitis usually resolve, however, residual symptoms and discomfort can persist for weeks to months.
Chronic Prostatitis
Chronic prostatitis is classified as non-bacterial and bacterial. Unlike the acute version, chronic prostatitis is episodic in nature and usually less intense. Presenting symptoms are often protean and can include testicular and penile pain, lower urinary tract symptoms, and pelvic discomfort.
Most men diagnosed with chronic prostatitis have the non-bacterial type, in that no active infection can be cultured from the urine. Even with vigorous prostate massage, the volume of prostate secretions expressed is usually too small an amount to culture.
Chronic prostatitis can be very frustrating for patient and physician alike. The symptoms are often times not severe enough to warrant emergency room attention or work absence, but significantly affect the patient's overall quality of life. Additionally, diagnostic tests such as urine cultures, bloodwork, and radiologic imaging are often unrevealing. Patients often feel as though their symptoms are discarded or their physician is not taking them seriously. Symptoms from chronic prostatitis can also be affected by work or emotional stress.
The ultimate cause of prostatitis, particularly the non-bacterial type, is unknown. Persistence of an acute infection, residual irritation from an infection, altered pain sensorium, auto-immune syndromes, and irritation from prostatic stones have all been implicated as potential causes.
The treatment regimen for chronic prostatitis usually includes both antibiotics and anti-inflammatories. Alpha-blockers, NSAIDs, urinary pain relievers, and homeopathic remedies can also help alleviate the symptoms of chronic prostatitis. Each patient responds differently and patience is required to figure out the most effective relief program.
Chronic prostatitis is believed to be a part of a larger syndrome called chronic pelvic pain syndrome (CPPS). Pelvic floor tightness is thought to contribute to this syndrome, and another focus of treatment is pelvic floor massage and biofeedback to loosen the pelvic musculature.
If you have questions or concerns or think you may have prostatitis, please schedule an appointment with one of our physicians.