Prostatitis is a condition involving the inflammation or infection of the prostate gland, a small gland located below the bladder in men. The prostate produces seminal fluid, which nourishes and transports sperm.
Prostatitis can cause significant discomfort and a variety of urinary and genital symptoms. Understanding the different types, causes, symptoms, and treatments of prostatitis is crucial for effectively managing and preventing this condition.
Types of prostatitis
Chronic Non-Bacterial Prostatitis/Chronic Pelvic Pain (CP/CPPS)
This is the most common form of prostatitis, accounting for approximately 90% of cases. The inflammation causes urinary and genital pain, but there is no sign of infection.
Acute Bacterial Prostatitis
This is the least common form of prostatitis. It is a sudden bacterial infection marked by inflammation of the prostate. The symptoms are severe: increased urinary frequency and urgency, increased urination during the night and a high degree of pain in the pelvis and genitals.
Often, this is accompanied by typical infection symptoms such as fever, chills, nausea, vomiting, and burning when urinating. This needs fast treatment in order to prevent further infections or abscesses.
Chronic Bacterial Prostatitis
This condition results from recurrent urinary tract infections that have entered the prostate gland. It is thought to exist for several years in some men before producing symptoms. The symptoms are similar to acute bacterial prostatitis, but are less severe and can fluctuate in intensity.
Common symptoms of prostatitis
Prostatitis can present with a wide range of symptoms, which can be mild to severe and vary depending on the type of prostatitis:
- Pelvic and Genital Pain: Pain or discomfort in the pelvic region, lower back, genitals, or perineum (the area between the scrotum and rectum). This pain can be constant or intermittent and can significantly impact daily activities.
- Urinary Symptoms: Difficulty urinating, pain during urination (dysuria), increased frequency and urgency of urination, and nocturia (frequent urination at night). These symptoms can mimic those of a urinary tract infection.
- Sexual Dysfunction: Painful ejaculation, reduced libido, and erectile dysfunction can occur, impacting sexual health and relationships.
- Flu-like Symptoms: In cases of bacterial prostatitis, symptoms can include fever, chills, and malaise, resembling those of the flu.
Severe symptoms or complications
In more severe cases, particularly with acute bacterial prostatitis, symptoms can escalate and include:
- High Fever and Chills: A sudden high fever accompanied by chills can indicate a severe bacterial infection.
- Severe Pelvic Pain: Intense pain in the pelvic region that can radiate to the lower back and genitals.
- Nausea and Vomiting: These gastrointestinal symptoms can occur alongside severe pain and fever.
- Burning Sensation During Urination: Intense burning or stinging sensation while urinating, indicating severe inflammation or infection.
- Blood in Urine or Semen: Hematuria (blood in urine) or hematospermia (blood in semen) can be alarming and indicate significant inflammation.
- Complications: Potential complications include urinary retention (inability to urinate), prostatic abscesses (pockets of pus within the prostate), and sepsis (a life-threatening response to infection). These require immediate medical intervention.
What causes prostatitis?
The causes of prostatitis can vary depending on the type:
Causes of Chronic Non-Bacterial Prostatitis/Chronic Pelvic Pain Syndrome
The exact cause of CP/CPPS is often unknown, but it is believed to involve a combination of factors, including:
- Psychological Stress: Stress and anxiety can exacerbate symptoms.
- Immune System Dysfunction: An abnormal immune response might cause inflammation without infection.
- Nerve Damage: Nerve irritation or damage in the pelvic area can contribute to chronic pain.
- Lifestyle Factors: Diet, physical activity, and other lifestyle choices can influence the condition.
Causes of Acute Bacterial Prostatitis
Acute Bacterial Prostatitis is caused by a sudden bacterial infection, often from bacteria such as E. coli, Klebsiella, and Proteus species. The infection can occur due to:
- Urinary Tract Infections (UTIs): Bacteria from a UTI can spread to the prostate.
- Catheter Use: Indwelling catheters can introduce bacteria into the urinary tract.
- Sexual Activity: Certain sexual activities can increase the risk of bacterial introduction.
Chronic Bacterial Prostatitis
Chronic Bacterial Prostatitis results from recurrent UTIs that infiltrate the prostate gland. It can be caused by:
- Persistent Bacterial Infection: Bacteria that persist in the prostate tissue despite treatment.
- Incomplete Antibiotic Treatment: Inadequate or incomplete antibiotic courses can allow bacteria to survive.
- Underlying Prostate Issues: Structural abnormalities or stones in the prostate can harbour bacteria.
How is prostatitis diagnosed?
If your doctor suspects that you have prostatitis or another prostate problem, they may refer you to a urologist (a doctor who specialises in diseases of the urinary tract and the male reproductive system) to confirm the diagnosis.
Physical examination
Patients typically undergo a comprehensive exam, including a digital rectal exam. A digital rectal exam (DRE) is performed to assess the prostate for tenderness, enlargement, or irregularities.
If the doctor is still not sure what you have, more tests may be done, such as…
Urine tests
Urinalysis and urine culture are conducted to detect bacteria or signs of infection.
Prostate fluid analysis
A sample of prostate fluid obtained during a DRE can be examined for white blood cells and bacteria.
Blood tests
Blood tests can check for signs of infection or inflammation.
Imaging tests
Ultrasound or MRI may be used to evaluate the prostate and surrounding structures for abnormalities.
Treatments for prostatitis
Treatment for prostatitis depends on the type and severity of the condition.
Chronic Non-Bacterial Prostatitis/CPPS
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) and alpha-blockers can help relieve pain and urinary symptoms.
- Physical Therapy: Pelvic floor physical therapy can address muscle tension and improve symptoms.
- Stress Management: Techniques such as relaxation exercises, meditation, and counselling can help manage stress-related symptoms.
- Dietary Changes: Avoiding irritants like caffeine, alcohol, and spicy foods can reduce symptoms.
- Alternative Therapies: Acupuncture and biofeedback may provide symptom relief for some individuals.
Acute Bacterial Prostatitis
- Antibiotics: Prompt antibiotic therapy is crucial. The choice of antibiotic depends on the bacteria identified.
- Pain Management: NSAIDs and other pain relievers can help manage pain.
- Hydration: Increased fluid intake helps flush bacteria from the urinary tract.
- Hospitalisation: Severe cases may require hospitalisation for intravenous antibiotics and monitoring.
Chronic Bacterial Prostatitis
- Prolonged Antibiotic Therapy: A long course of antibiotics, typically lasting 4 to 12 weeks, is necessary.
- Pain Management: NSAIDs and alpha-blockers can help manage chronic pain and urinary symptoms.
- Suppressive Antibiotic Therapy: In some cases, low-dose, long-term antibiotics are prescribed to prevent recurrence.
- Supportive Therapies: Physical therapy, stress management, and lifestyle modifications can aid in symptom management. Supportive therapies also include stool softeners and prostate massage.
Can you prevent prostatitis from occurring?
While some forms of prostatitis cannot be entirely prevented, certain measures can reduce the risk:
- Good Hygiene: Regular washing and proper genital hygiene can prevent bacterial infections.
- Hydration: Drinking plenty of fluids helps maintain urinary health and flush out bacteria.
- Safe Sexual Practices: Using condoms and practising safe sex can reduce the risk of sexually transmitted infections.
- Regular Medical Check-ups: Routine check-ups can help monitor and manage urinary tract health.
- Avoiding Prolonged Sitting: Regular breaks and movement can prevent pressure on the prostate and pelvic area.
- Healthy Diet: A balanced diet rich in fruits, vegetables, and whole grains can support overall health and reduce inflammation.
- Exercise: Regular physical activity can improve overall health and reduce stress, which may help manage symptoms.
Frequently asked questions
Can prostatitis affect fertility?
Yes, prostatitis, especially chronic forms, can affect fertility by impacting sperm quality and function. Inflammation and infection can alter the composition of seminal fluid and negatively affect sperm motility and viability.
Is prostatitis contagious?
No, prostatitis itself is not contagious. However, the bacteria causing bacterial prostatitis can be transmitted through sexual contact, so practising safe sex is important.
Can diet influence prostatitis symptoms?
Yes, certain dietary choices can influence symptoms. Avoiding irritants like caffeine, alcohol, spicy foods, and acidic foods can help reduce urinary and pelvic discomfort. A healthy diet rich in anti-inflammatory foods can support overall health.
Is prostatitis linked to prostate cancer?
Prostatitis is not a form of prostate cancer and does not increase the risk of developing prostate cancer. However, the symptoms of prostatitis can sometimes mimic those of prostate cancer, so proper medical evaluation is essential.
How long does it take to recover from prostatitis?
Recovery time varies depending on the prostatitis type and treatment effectiveness. Acute bacterial prostatitis may resolve within weeks with proper antibiotic treatment. Chronic forms, such as CP/CPPS and chronic bacterial prostatitis, may require long-term management, and symptoms can fluctuate over time. Consistent medical follow-up and adherence to treatment plans are crucial for recovery.
