Section 21. Men's Health Issues

Chapter 239. Prostate Disorders

Topics: Introduction | Benign Prostatic Hyperplasia | Prostate Cancer | Prostatitis

Prostatitis

Prostatitis is pain and swelling of the prostate gland.

Prostatitis usually develops for unknown reasons. Prostatitis can result from a bacterial infection that spreads to the prostate from the urinary tract or from bacteria in the bloodstream. Bacterial infections may develop slowly and tend to recur (chronic bacterial prostatitis) or develop rapidly (acute bacterial prostatitis). Rarely, fungal, viral, or protozoal infections can cause prostatitis.

Symptoms

Spasm of the muscles in the bladder and pelvis, especially in the perineum (the area between the scrotum and the anus), causes many of the symptoms of prostatitis. Prostatitis causes pain in the perineum, the lower back, and often the penis and testes. The man also may need to urinate frequently and urgently, and urinating may cause pain or burning. Pain may make obtaining an erection or ejaculating difficult or even painful. Constipation can develop, making defecation painful. Some symptoms tend to occur more often with acute bacterial prostatitis, such as fever, difficulty urinating, and blood in the urine. Bacterial prostatitis can result in a collection of pus (abscess) in the prostate or in epididymitis (inflammation of the epididymis). Chronic prostatitis can impair fertility.

Diagnosis and Treatment

The diagnosis of prostatitis is usually based on the symptoms and a physical examination. The prostate, examined through the rectum by a doctor, may be swollen and tender to the touch. Cultures are taken of urine and, sometimes, of fluids expressed from the penis after massaging the prostate during the examination. Urine cultures reveal bacterial infections located anywhere in the urinary tract. In contrast, when infection is found by culturing fluid from the prostate, the prostate is clearly the cause of the infection.

When cultures reveal no bacterial infection, prostatitis is usually difficult to cure. Most treatments for this kind of prostatitis relieve symptoms but may not cure the prostatitis. These treatments for symptoms can also help in chronic bacterial prostatitis.

Non-drug treatments include periodic prostate massage (done by a doctor by placing a finger in the rectum), frequent ejaculation, and sitting in a warm bath. Relaxation techniques (biofeedback) may relieve spasm and pain of the pelvic muscles. Among drug therapies, stool softeners can relieve painful defecation resulting from constipation. Analgesics and anti-inflammatory drugs may relieve pain and swelling regardless of its source. Alpha-adrenergic blockers that are used to treat prostate enlargement (such as doxazosin, terazosin, and tamsulosin) may help relieve symptoms by relaxing the muscles within the prostate. For reasons that are not understood, antibiotics sometimes relieve symptoms. If symptoms are severe despite other treatments, surgery, such as partial or complete removal of the prostate, may be considered as a last resort. Destruction of the prostate by microwave or laser treatments is another alternative.

When prostatitis results from a bacterial infection, an oral antibiotic that can penetrate prostate tissue (such as ofloxacin, levofloxacin, ciprofloxacin, or trimethoprim-sulfamethoxazole) is taken for 30 to 90 days. Taking antibiotics for less time may lead to a chronic infection. Chronic bacterial prostatitis can be difficult to cure. If a prostate abscess occurs, surgical drainage is usually necessary.