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| Prostatitis |
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| What is prostatitis? |
- Prostatitis is inflammation of the prostate (a gland beneath the bladder
that produces components of semen). This inflammation can be acute (acute
prostatitis) when it is commonly due to infection, or persistent or
relapsing (chronic prostatitis).
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| Acute Prostatitis |
| What causes acute prostatitis? |
| Acute prostatitis is caused by bacterial infection
usually associated with spread from the bladder or urethra. For example
it may be due to lower urinary infection spreading from the bladder or any
sexually transmitted diseases (STDs) such as gonorrhoea or chlamydia. |
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| What are the symptoms? |
| Burning on passing urine with severe pain felt
deep between the legs is the most common symptom. There may be a penile
discharge if an STD is present. |
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| How is the diagnosis made? |
| The infection may be cultured from the urine, a
swab from the urethra or occasionally the doctor may obtain a specimen of
prostate secretions by massaging the prostate using a finger placed in the
rectum. |
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| What is the treatment? |
| Treatment is with the appropriate antibiotic, such
as trimethoprim or ciprofloxacin. |
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| Chronic prostatitis |
| Doctors are seeing increasing numbers of men, usually
aged 35-45 years, who have genital or pelvic pain that persists for weeks
or months. These symptoms have been blamed on chronic inflammation of the
prostate gland that in the past was presumed to be due to infection. However,
an infection will be found in less than 5% of such patients, so the term
Chronic Pelvic Pain Syndrome (CPPS) is now often used instead of chronic
prostatitis. |
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| What causes CPPS? |
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Definite chronic infection of the prostate is rare and usually associated
with infection elsewhere in the urinary tract or a surgical instrument.
A recent study suggests that in the majority of patients the condition
is a consequence of modern living. Psychological tests have demonstrated
higher than average scores for anxiety, depression and hypochondriasis
in men with CPPS.
Other studies have found physical abnormalities that could be the cause
of the inflammatory or infective process: excessive pressure on the external
urethral sphincter (responsible for voluntary control of urination) and
sometimes reflux of urine into the prostate gland from the urethra (urine
tube in the penis).
Attacks may be provoked by several triggering events, such as:
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- Urinary or sexual infections.
- Trauma, especially during sex or sport
(particularly cycling).
- Surgical instrumentation.
- Emotional factors including stress and depression.
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| What are the symptoms of CPPS? |
| The common symptoms are: |
- Penile, pelvic or rectal pain, often felt deep
between the legs, which is worse on sitting.
- Frequency or discomfort on passing urine.
- Pain on or after ejaculation.
- Quick, delayed or unsatisfactory ejaculation.
- Rarely, blood in semen (haemospermia), more likely if infection present.
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| How does the doctor make the diagnosis? |
A doctor will do a rectal examination of the prostate.
The gland can feel "spongy" to the doctor. Infection should be excluded
by examination of the urine.
A blood test may reveal a slightly raised PSA (prostate specific antigen)
level but examination and tests are frequently normal. Some urologists used
to attempt prostatic massage to produce a sample for examination, but this
is now rarely carried out. |
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| What is the treatment? |
| Unfortunately no single intervention has been shown
to work. As the patient may be excessively anxious about this and other
aspects of his health this makes the problem more difficult to treat. If
the patient expects a simple solution to the problem, he is often reluctant
to accept its relapsing nature. A full explanation of the nature of the
disorder often helps. |
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Antibiotics are frequently useful and are usually tried first even if
infection is not found, although they might be working by an anti-inflammatory
rather than an antibacterial effect.
Drugs that reach adequate levels in the prostate must be used and for
sufficient periods, at least one month. Tetracycline antibiotics, especially
doxycycline, erythromycin or ofloxacin are the drugs of choice.
Drugs, such as alpha-blockers (indoramin or alfuzosin), which act by
relaxing the urethral sphincter and easing spasm can be helpful, as can
finasteride, a drug known to "shrink" the prostate. The latter is more
likely to work in patients with an enlarged or tender prostate.
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Various self-help measures may be beneficial:
- Avoiding activities that provoke attacks
(especially cycling).
- Taking regular hot baths.
- Regular ejaculation through sexual intercourse or masturbation. This
encourages drainage of the prostate and assists clearance of infection.
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| The range of other treatments used is listed below
and probably reflects the lack of a single effective therapy: |
- Pain-killers and anti-inflammatory drugs.
- Anti-depressants.
- Psychological support and counseling.
- Pollen extracts.
- Microwave therapy.
- Transcutaneous electrical nerve stimulation (TENS) is a form of pain
relief using tiny electrical currents applied to the skin from a small
electronic pulse generator.
In recent years, there has been a resurgence of interest in this condition,
with most doctors preferring a more holistic approach to the problem that
takes into account all aspects of the patient's health.
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| This page was last modified on July 06, 2001 |
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