The term “Prostatitis” means ‘inflammation of the prostate’. It’s a misnomer, because not every patient suffering from prostatitis actually has an inflamed prostate. It’s a very common problem effecting men with a prevalence of 2.2-13.8%.
Patients with prostatitis often suffer pain and discomfort in the lower Abdomen, perineal area, and Inner Thighs.
Perineal area means area around and between the anus and scrotum, and just above the pubic bone. Men with the condition may have to urinate frequently and this can be very inconvenient. There may also be a burning sensation at the time of urination and/ or some discomfort during or after ejaculation. Although prostatitis is often considered to be the result of a bacterial infection in the prostate, inflammation, when present, more commonly occurs spontaneously, without any infection. Some studies suggest that besides infection, inflammation may result from urine being forced backwards up the prostatic ducts at the time of urination. Recently, the question has been raised as to whether, in the long run, inflammation can lead on eventually to prostate cancer. This is a possibility because the inflammatory cells that infiltrate the prostate release chemicals that cause oxidative stress and thereby damage DNA in prostate cells.
Even when infection is the source of inflammation, it may be difficult to eradicate because the bacteria responsible tend to be reside deep inside the prostate, where antibiotics cannot reach.
- Previous history of the problem or long-term catheterization and those who have
- Untreated urinary tract infections.
- Unprotected anal intercourse
- Prostatitis most commonly affects men in the age range 30–50 years, but a man of any age can be affected. In fact, most men afflicted have no identifiable risk factors
Because prostatitis is often the result of a bacterial infection, your doctor will usually want to check a sample of your urine and prostatic secretions for bacteria.
Obtaining a sample of prostatic secretions
The patient will be asked to pass urine and provide a sample. Then doctor performs prostate massage to release prostatic secretions, which will be collected from the urethra into a sterile pot. Although this process is a bit uncomfortable, it is not actually painful. Next, a second urine sample will be collected. If there is a bacterial infection, bacteria can be grown on an agar plate in the laboratory from cultures of the prostatic secretions and the second urine sample. This method also allows the specific type of bacteria responsible to be identified, and an appropriate antibiotic to be prescribed.
Depending on your symptoms, your doctor may also check you for presence of BPH or Prostate Cancer. Remember that prostatitis, particularly when the inflammation is severe, may sometimes cause a temporary increase in blood PSA level. Prostatitis can also cause blood flow in the prostate to become increased, and this can show up when a transrectal ultrasound study of the prostate is performed using what is known as a colour Doppler probe.
If a prostatic abscess is suspected, a CT scan or MRI is done to confirm or exclude a collection of pus in the prostate.
If there is bacterial infection, you will be prescribed a course of appropriate antibiotics. They need to be taken for 4–6 weeks, and it is very important that you complete the full course. You may also be prescribed an anti-inflammatory drug, such as Voveron (diclofenac), to reduce the inflammation in the prostate. Remember that these drugs can cause indigestion and bleeding from the stomach, so you should always take them with a meal.
Some patients with prostatis have a reduced urinary flow and will be prescribed alpha –blockers like tamsulosin and alfuzocin.
Herbal Plant extract Saw Palmetto has also been shown to help few patients due to its anti-inflammatory effect on the prostate .
Severe pain and discomfort can be managed with Neuropathic Painkillers like Amitriptylline and Pregabalin.
If bacteria are not demonstrably present, you may be given an anti-inflammatory drug in isolation. You may also find that prostatic massage performed by your doctor helps. Antibiotics can still also be helpful in these circumstances, perhaps because the cultures do not tell the whole story, as the bacteria may be lurking within prostate stones or elsewhere deep within the gland. Some clinicians believe that frequent prostate massage can also be beneficial, though this remains unproven.
Prostatitis, though troublesome, is not a life-threatening condition and is not proven to be a precursor to either BPH or prostate cancer. You may find that, over the years, the prostatitis returns from time to time (particularly if the condition has a non-bacterial cause), but your doctor should be able to help alleviate the symptoms quite effectively, so do not suffer in silence. The condition can be frustrating for patient and doctor alike; however, there is some evidence that lifestyle improvements, particularly stress reduction, dietary modification and fitness enhancement, can increase natural immunity and reduce the risk of relapse.
Occasionally prostatitis with a bacterial cause can lead to the formation of an abscess within the prostate itself. If this is the case, your doctor may need to take a sample of fluid from the abscess and will do so using ultrasound for guidance. The sample can then be checked to see what type of bacteria has caused the infection, so that appropriate antibiotics can be given.
Prastate Abscesses sometimes have to be drained, which involves passing an instrument up through the penis under anaesthetic, making a small cut through to the abscess and then ‘nicking’ the abscess to allow pus to drain out. A course of antibiotics and a period of catheterization are also often necessary, as passing urine can be difficult or impossible because of the associated swelling.
Patients should avoid the risk factors for prostatitis where possible (for example, if you have symptoms of a urinary tract infection, such as a burning sensation when urinating, or cloudy smelly urine, visit your doctor and complete any prescribed courses of antibiotics). Also, maintain a healthy lifestyle, eat a diet low in saturated fats, exercise regularly and always be vigilant about avoiding a risk of infection, especially during anal intercourse.
Prostadynia – Pain but no inflammation
Some men feel pain that appears to come from their prostate or the surrounding area, but investigation does not reveal any inflammation or infection. What causes this condition, which is referred to as prostatodynia or pelvic pain syndrome, is not known, though it may result from spasm of the pelvic muscles brought on by stress and anxiety. Depending on your symptoms, you may be given alpha-blockers, which may have to be taken for some time, or the muscle relaxant diazepam. Much more research is needed into this disorder to identify the underlying cause of the problem, to improve the cure rate and enhance the quality of life of those affected. Reducing stress levels may be helpful.