Prostatitis : Causes, Symptoms, Diagnosis & Treatment
Medically Reviewed by Dr Sravya, MBBS, MS
Introduction
Prostatitis is the inflammation of the prostate gland. The prostate gland is a small walnut-sized gland placed below the urinary bladder in men.
What causes prostatitis?
This condition is caused mainly due to an infection and symptoms mirror that of an inflamed prostate. Since the presentation of prostatitis varies from person to person, NIH (National Institute of Health) has classified it into four types:
- Category 1: symptoms of this condition are severe and are usually accompanied by systemic and urinary tract infections (UTIs). This is commonly referred to as Acute bacterial prostatitis (ABP).
- Category 2: chronic bacterial infection of the prostate where symptoms of infection may or may not be present. You may experience recurrent UTI as a definite symptom. This category is also called Chronic bacterial prostatitis (CBP).
- Category 3: In Chronic prostatitis or Chronic pelvic pain syndrome (CPPS), the main symptom experienced is severe pelvic pain. UTI may not be present but voiding issues may persist.
- Category 4: Inflammation of the prostate without the presence of symptoms, commonly known as Asymptomatic inflammatory prostatitis (AIP).
What are the symptoms seen in prostatitis?
Symptoms of this condition are commonly experienced by men above the age of 50 years. The chances of experiencing prostate related infections in a man’s lifetime are about 50% whereas only 11-16% consult the doctor for their symptoms.
Symptoms: the symptoms may vary in each category and may also differ in every individual. But overall, commonly observed symptoms per category are as seen in the table.
Category 1 ABP | Category 2 CBP | Category 3 CPPS | Category 4 AIP |
|---|---|---|---|
● Sudden onset ● Fever ● Chills ● Pain in the lower abdomen ● Frequent urination ● Urgency while urinating ● Burning sensation while urination ● Nocturia – frequent urination at night ● Body pains | ● Symptoms presisting for over 3 months. ● UTI ● Blocked urine flow ● Frequent and urgent urination. ● Pain in the lower abdomen ● Nocturia ● Cloudy or bloody urine | ● Severe pain in the pelvic region including the groin, buttocks, anus, penis, scrotal sac, and lower back.
● Pain while urination
● Weak urine stream
● Increased urination frequency and urgency.
| ● No symptoms |
If you experience any of the above symptoms, it is best to consult the doctor immediately. If left unchecked, it may aggravate your condition and lead to irreversible complications and damage. Complications include:
- Inflammation or infection may spread to nearby reproductive organs.
- Development of pus over the prostate gland due to long-term infection.
- The infection may spread into the blood circulation.
- Erectile dysfunction or pain ejaculation
- Severe, long-term, and repetitive infections can eventually lead to prostate cancer.
How is prostatitis diagnosed?
- History: To diagnose this condition, it is essential to take a detailed history of the symptoms, their onset, and severity. The National Institute of Health has developed a tool called the Chronic Prostatitis Symptom Index (NIH-CPSI). This has proved to be a reliable tool in symptom assessment.
- Physical Examination: Your health care provider may physically assess your lower abdominal area including genitalia, pelvic floor, and the prostate. This is to examine for enlarged lymph nodes, tenderness (pain on touch), or swelling. A digital rectal examination (DRE) is performed to inspect the prostate gland. In this examination, your doctor inserts a gloved finger through the rectum and presses against the rectal wall. The prostate is located right next to the rectum. This part of the examination may make you feel uncomfortable, so do communicate with your doctor regarding any concerns.
- Imaging: your doctor may order a CT or MRI to rule out other diagnoses.
- Transrectal Prostatic ultrasonography: A probe is inserted through the rectum to view the prostate gland. At times, a biopsy may be taken if your doctor advises.
- Culture: Urine or semen samples may be taken to assess the type of bacterial infection present. This would help your doctor provide a target medication to treat prostatitis.
- Blood tests: Prostate-specific antigen (PSA) may be elevated in certain categories.
- Urodynamics: It is the study of urinary flow. In case of interruption in the urine stream, your doctor may advise you to get this test done. The results of these series of tests will help your doctor categorize your infection and provide an effective treatment plan.
Prostatitis : Causes , Symptoms, Diagnosis & Treatment
Depending on the type, the treatment plan is chosen. The overall outline is similar but may vary depending on the condition and symptom severity.
- Antimicrobial medication: In the case of ABP and CBP, oral fluoroquinolone is given as the first line of antibiotics. In case the patient is severely ill, fluoroquinolone is given intravenously along with ampicillin. Duration of this treatment is about 2-4 weeks in ABP but in the chronic condition, medication may continue up to 6 months till the bacterial growth is cleared. In the case of CPPS, studies have shown that antimicrobial therapy is ineffective.
- Catheterization: In cases where patients experience problems in voiding urine or urine retention are advised for urinary catheterization. Here a catheter is inserted up the urethra into the bladder. The catheter is connected to a pouch that collects the urine.
- Abscess drainage: With the help of TRUS, an incision can be made at the site of the pus and drained effectively. This helps in reducing the bacterial load or the risk of abscess bursting and infecting the blood circulation.
- Alpha-blockers: Alpha-blockers help in reducing inflammation. Helps to combat fever, body aches, chills, and obstructed urination. A combination of antimicrobials and alpha-blockers is suggested to prevent the recurrence of prostatitis.
- Physiotherapy: In the case of CPPS, physiotherapy has been effective in significantly reducing pain symptoms. Kegel exercises along with deep tissue release have helped relieve the pain symptoms. For temporary relief, Heat therapy for swelling and pain is also advised. The light intensity of physical activity has also been suggested and has been seen to hasten the recovery process.
- Muscle relaxants: In severe cases of CPPS, muscle relaxants like clonazepam may be advised. Due to the pain experienced in chronic prostatitis and CPPS may require extreme measures to reduce stress and anxiety.
How can I avoid prostatitis?
This infection is highly prevalent in older males and can be painful and debilitating. Prevention is better than cure. Although it may be difficult to prevent it, an attempt can always be made. Here are some tips to avoid the prostatitis experience:
- Hydration: intake of water should be about 2-3L per day
- Diet: acidic or spicy food tends to irritate the bladder and cause inflammation. Increase the number of fruits and vegetables in your diet.
- No alcohol
- Hygiene: the pelvic area should be cleaned regularly.
- Exercise: light to moderate exercise for 30 minutes, 5 days a week.
- Safe sex: Wearing a condom during intercourse can prevent the risk of infections.
- Meditation/Relaxation: increased stress levels can increase the risk of infection.
- Weight loss: Increasing weight around the abdominal area can put pressure on the prostate gland.
- Regular checkups: Asymptomatic prostatitis is difficult to detect, so regular visits to your urologist will help prevent it in the long run. Early detection of infections will help resolve the condition quickly.