Chronic Prostatitis

Definition

Infection or inflammation of the prostate gland. Prostatitis is considered chronic if it lasts more than three months.

Just 5% to 10% of cases are caused by bacterial infection. It does not raise the risk of getting prostate cancer. Prostatitis can affect men of all ages. In fact, chronic prostatitis is the number-one reason men under the age of 50 visit a urologist. In some cases, chronic prostatitis follows an attack of acute prostatitis. Chronic prostatitis may also be related to other urinary tract infections.

The primary symptom of chronic infectious prostatitis is usually repeated bladder infections.

Causes/Risk Factors

• Chronic bacterial prostatitis
  This condition is the result of recurrent urinary tract infections that have entered the prostate gland although it is often difficult to find the bacteria in the urine.
• Chronic nonbacterial prostatitis/chronic pelvic pain syndrome.
  This is the most common form of the disease, accounting for 90% of the cases. The condition is marked by urinary and genital pain for at least three of the past six months. Patients have no bacteria in their urine, but may have other signs of inflammation.

How the prostate becomes infected in prostatitis is not clear. The bacteria that cause prostatitis may get into the prostate from the urethra by backward flow of infected urine or stool from the rectum. At one time, prostatitis was believed to be a sexually transmitted disease, but more recent research suggests that only a small number of cases are passed on through sex. Certain conditions and medical procedures increase the risk of developing prostatitis.

• Recent medical instrumentation, such as a urinary catheter (a soft, lubricated tube used to drain urine from the bladder) inserted during a medical procedure
• Engage in rectal intercourse
• Have an abnormal urinary tract
• Have had a recent bladder infection
• Have an enlarged prostate

Warning Signs/Symptoms

There may be no symptoms of prostatitis.

• Frequent urge to urinate
• Difficulty urinating
• Pain or burning during urination
• Chills and fever
• Pelvic pain, pain around the anus, in the groin, or in the back.
• Groin pain if bacteria get into the vas deferens (the tube that carries sperm from the testicles to the urethra), or infect the epididymis (area near the testicles where sperm mature and are stored).
• Less forceful urine stream if the prostate swells
• Blood in the urine
• Pain with sexual intercourse / painful ejaculation

Diagnosis

• Physical exam, including a digital rectal exam. The doctor will be able to evaluate whether the prostate gland is enlarged or tender.
• Prostate fluid analysis for signs of infection
• Transrectal ultrasound of prostate
• Voiding studies involve the collection and analysis of urine to determine which part of the urinary system is infected.

Treatment Options

Correct diagnosis is crucial and treatments vary.

• Anti-inflammatory medicines along with warm sitz baths This is the most conservative treatment for chronic prostatitis.
• Antibiotics taken for four to 12 weeks. About 75% of all cases of chronic infectious prostatitis clear up with this treatment. For cases that don't, taking antibiotics at a low dose for a long time may be recommended to relieve the symptoms.
• Pain medications
• Muscle relaxants
• Surgical removal of the infected portions of the prostate
• Supportive therapies stool softeners and prostate massage, exercise, myofascial trigger point release, progressive relaxation, and counseling.
• Alpha blocker drugs (Flowmax, Uroxatral,Hytrin). These drugs relax the muscles of the prostate and bladder to improve urine flow and decrease symptoms. Other drugs that lower hormone levels, such as Proscar, may help to shrink the prostate gland in some men.
• Foods to avoid include spicy foods and caffeinated or acidic drinks.
• Activities to avoid include bicycling may need to be eliminated as well.