Prostatitis
Basic Information
Prostatitis is the inflammation or infection of the prostate. The prostate is a part of the male sexual anatomy, and more specifically it is the gland surrounding the urethra (the "duct" thru which urine travels from the bladder to the penis). A walnut-sized gland located 2 inches in from the anus, it is composed of several tiny glands grouped in tight clusters. There are anywhere from 20 to 60 of these small glandular groupings and they are called ancini. It is suggested that the clogging of these ancini with prostatic secretions is a part of the problem with prostatitis.
Prostatitis is a common problem, usually occuring in younger men. It is surmised that somewhere near 50% of all men will experience prostatitis at least once in their lives. It is not contagious, and only rarely does it happen simultaneously with more severe prostate conditions, such as cancer. Currently, no effective cure exists. Even after the symptoms are treated and go away, it is common for the problem to recur. Prostatitis can be an extremely frustrating condition to have, particularly because it often takes so long to go away. Some people cite that it takes months to go into remission, but it has been known to trouble some people for up to a year. The problem is that antibiotics, the usual form of treatment, can not efficiently reach the the ancini (the tiny sacs in the prostate where the bacteria reside), and hence cannot kill the contagions. Medical practitioners separate prostatitis into four different conditions:
Acute bacterial prostatitis: An attack of ABP typically involves fever with chills, lower back and perineal pain, urinary frequency and urgency, and difficulty with urinating. Upon rectal examination the gland is tender, and sometimes an examination can push harmful bacteria into the bloodstream, causing septic shock. ABP is a serious condition and can require hospitalization.
Chronic bacterial prostatitis: CBP is very like ABP, only its symptoms generally do not include fever with chills. Someone with CBP can expect to suffer from irritative voiding of excretive waste, lower back and perineal pain, ejactulatory pain, and relapsing urinary tract infections. When doctors take a urinalysis in order to make a diagnosis, the culture will reveal both white blood cells and malignant bacteria. Unlike ABP, the prostate gland is not necessarily tender. Another possible cause of CBP is prostate stones in the gland, a condition that can be detected by a transrectal ultrasound.
Non-bacterial prostatitis: When a person with NBP undergoes testing, their urinalysis will reveal white blood cells but no traces of harmful bacteria. Some doctors suggest that chlamydia has a causing role in NBP. Others surmise that NBP is the same thing as bacterial prostatitis, only the bacteria are much deeper in the glands and more difficult to detect.
Prostatodynia: A person with prostatodynia will have a urinalysis that comes up completely negative. Otherwise, the symptoms are like those of NBP. It is suggested that an abnormal tension in the smooth muscle surrounding the prostate can actually make urine flow back into the prostate gland. This is called urinary reflux, and it can induce inflammation or infection as possibly bacteria-carrying urine enters the prostate. Psychological stress and deep-lying bacteria are also considered causes of prostatodynia.
Doctors currently debate the cause of prostatitis. That prostatitis is apparently comprised of four different conditions makes it all the more difficult to come to a consensus. It may also be the case that each episode of prostatitis is a unique phenomenon caused by a mixture of the various possible causes.
Regardless, the majority of doctors suggest that prostatitis has bacterial origins. These bacterial infections may enter the prostate through the bloodstream or the lymphatic system. Another probable causative scenario is a urinary tract infection that travels through the urethra into the prostate gland. In the case of nonbacterial infection, if indeed it is not simply bacteria too deep for detectoin, the exact cause remains unknown.
Other doctors propose that prostatitis can be caused by sexual contact with a person who has a genital infection, zinc deficiency, poor hygiene, contamination during surgery, or swimming in polluted waters. In the past prostatitis was called "monk's disease" because of the link between prostatitis and a sudden reduction in ejaculations a person is used to having in a given period. Likewise, there is a high incidence of prostatitis among training soldiers, most likely because separation of the sexes and lack of privacy in the training camp situation limit the opportunity for sexual relief. There is some speculation that urinary stricture (a tightening of a muscle), prostate stones, and a uric acid disorder can all play a part in the contraction of prostatitis.
Symptoms
There are a wide variety of signs and symptoms that indicate a person has prostatitis. A person does not need to have all of the signs to have the condition. Some of the symptoms are:
- urgency to urinate; frequent urination; burning with urination
- difficulty starting urination and feeling like bladder has not been emptyed after
- fever;chills
- pain between anus and penis; pain in lower back
- muscle and joint aches
- blood in semen or urine
- pain and discomfort during a rectal examination
- pain or feeling of relief with ejaculation
Each case of prostatitis exhibits a unique set of symptoms. Most of these symptoms are present in other medical problems, so it is necessary to see a doctor. Besides these immediately apparent symptoms, prostatitis can have other adverse effects on the individual. Besides the fact that certain popularly prescribed drugs (such as Hytrin) can have negative effects on a person's sex life, prostatitis itself can cause premature ejaculation and in some cases sexual partners complain that the semen causes a burning sensation. Prostatitis also affects a person's fertility. In some cases the semen merely has a pungent odor and turns yellowish in color, but at times the semen can have extremely low sperm counts and a high pH balance. The pressure on the urethra due to the enlarged prostate can also block passage of the sperm, reducing the sperm's mobility and concentration. Lastly, the condition itself, because it often recurs, lasts a long time, and sometimes does not respond to treatment, can have a negative effect on a person's psychology. Often people with prostatitis will suffer from bouts of depression, so it is a good idea that these people take some kind of antidepressant.
Diagnosis/Treatment
Because prostatitis has so many different symptoms, many of which resembling the signs of other medical problems, it can be difficult to properly diagnose. The symptoms are most often confused with those of benign prostrate hyperplasia, which is a non-cancerous enlargement of the prostrate. BPH typically affects men after the age of 50, while prostatitis happens to men much younger.
The first stage of diagnosis involves physical irritation and discomfort resulting in self-observation of the symptoms. Most of these symptoms occur in a fairly sensitive area so it is easy to detect that something is wrong. During a medical visit a doctor will perform a rectal examination in order to determine whether or not there is any swelling of the prostate. Doctors may also ask questions about your lifestyle or medical history. Infrequent sex, smoking, excessive alcohol consumption, or a recent urinary-tract infection all increase the risk of contracting prostatitis. More important, however, is the urinalysis and culture of the secretions obtained at the time of the prostate exam. Many doctors are not aware of the four different types of prostatitis, and hence, do not know how to correctly administer treatment and prescription drugs that meet the particular needs of each type. When a doctor knows exactly what virus or bacteria has affected the prostate, it helps their decision-making in regard to treatment. In order to isolate the specific harmful pathogen, a doctor can culture the "expressed prostatic secretion" over a span of 7 days. This culture can be extremely useful in determining which cycle of antibiotics to administer to the individual with prostatitis. In other scenarios, the doctor may need to perform an ultrasound to see whether or not the person suffers from prostate stones. Similarly, a urinary stricture (a tightening of the urinary tract) can be revealed by a urologist's examination.
Each recognized type of prostatitis has its own particular treatment. Acute bacterial prostatitis can be extremely dangerous because of the fever involved, and sometimes requires hospitalization in serious cases. Antibiotics are typically used to break the fever, after which a doctor will adminster an oral antibiotic for a 30-day cycle in order to cure the symptoms. If the antibiotic treatment is not carried through the duration of the month, the short course may not work and can result in recurrence. Plenty of rest and fluid intake are also suggested.
The treatment of chronic bacterial prostatitis involves a 3 month cycle of antibiotics, often septra, cipro, or floxin. Although the discontinuation of antibiotics can result in a return of the symptoms, treatment with antibiotic has only a 40-50% success rate. In the case of CBP, the bacteria can be so deeply-stored within the ancini that the bacteria cannot reach them. Another problem is that the long-duration of antibiotic use can allow the bacteria to form an immunological resistance. In rare episodes, CBP may require surgery to drain the abscess of the prostate.
Non-bacterial prostatitis treatment begins with a 4 week cycle of doxycycline, which, if not effective, should signify to the doctor that no more antibiotics should be used in treatment. In the event that drugs do not work, prostate massages and frequent ejaculation can either relieve or remove symptoms. Some doctors who think that uric acid in the urine causes NBP often use allopurinal (an antibiotic that reduces uric acid levels). Hot sitz baths and ibuprofen (anti-inflammatory medication) can also be helpful.
Allopurinal, alpha-blockers (particularly Hytrin for its tension-releasing effect on the smooth muscle of the prostate), sitz baths, and stress therapy are all common therapies for people suffering from prostatodynia. It must be recognized that with prostatitis the effectiveness of antibiotics is uncertain at best.
Besides the specific treatment methods for each type, there are some basic therapies that help in all cases of prostatitis. Frequent water intake dilutes the urine, which decreases the risk of further infection. This may seem strange considering more water intake will make the already excessive urges to urinate even more frequent, but it is a necessary health precaution. If a person has this condition, they should remove caffiene, alcohol, and spicy or acidic foods from their diet. As far as therapeutic activities, rest, hot sitz baths (sit in a tub with 6 to 8 inches of 106F water for 15 minutes 3 times a day), regular exercise and frequent ejaculations (about 2-3 times a week) can be helpful. Some people suggest that homeopathic remedies such as saw palmetto extract and zinc supplements can also relieve symptoms.
For the most part, prostatitis is curable with treatment, but recurrence is common. It is necessary to contact your doctor if you notice any of these symptoms, if you already have them and they are getting worse, or if your symptoms recur after a remission.
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