Prostatitis

What is Prostatitis ?

The prostate gland is a time bomb ticking away deep in the plumbing of every male. The World Health Organisation estimates that 80% of men will eventually need treatment for prostate problems and as many as one in three men will need an operation. Despite this, few men know where their prostate gland is, what it does, or the symptoms that occur when it starts to go wrong.

There are three major diseases:

  • benign prostate hyperplasia
  • prostatitis
  • prostate cancer

A healthy prostate gland weighs around 20 grams and is the size and shape of a large chestnut. It is made up of millions of tiny glans that secret a thin, milky, acidic fluid. The prostate also contains muscle and fibre cells which help the gland to contract.

Prostatitis: When looked under a microscope, the prostate gland contains more canals and blind passageways than Venice. These can become infected, inflamed or clogged either with thickened secretions or tiny, gravel-like stones to produce prostatitis. It is estimated that one in three men will suffer from prostatitis at some stage between the ages of 20 and 50 years.

There are four main types of prostatitis:

  • Acute (recent onset) a bacterial infection
  • Chronic infection, one of two kinds:
    • long-term, grumbling bacterial infection
    • long-term non-bacterial inflammation.
  • Prostatodynia, symptoms of prostate pain without obvious signs of inflammation or infection.

Diagnosis of Prostatitis

Acute Bacterial Prostatitis

This is usually caused by bacteria from the intestines which find their way into the urinary system either through the urethra or by traveling in the bloodstream or lymphatic fluids. Sometimes, organisms causing sexually transmissible diseases ( e.g. gonorrhoea, chlamydia ) are involved or occasionally, the fungus that causes thrush (candida) can also be responsible.

Symptoms can occur suddenly and include:

  • feeling unwell, chills or fever
  • low back pain
  • aching round the thighs and genitals
  • deep pain between the scrotum and the anus
  • pain and difficulty on passing water
  • frequency of passing water
  • pain on ejaculation

The prostate gland will also usually feel hot, swollen and tender when the doctor examines it. Sometimes, infection persists inside the prostate gland, despite treatment. When this happens, chronic prostatitis is the diagnosis.

Chronic Bacterial Prostatitis

This is when micro-organisms enter the prostate gland causing infection with pus and occasionally micro-abscesses. Swelling occurs rapidly which traps the bacteria in the gland and the usual drainage channels become blocked off. In some cases, bacteria become coated in the prostate gland secretions this hardens to form tiny crystals or stones. This protects them from attack by the bodies immune system and prevents healing, it prevents the antibiotics getting to the infection also, this accounts for the repeated flare ups that are common in chronic bacterial prostatitis.

Symptoms of Chronic Bacterial Prostatitis
Symptoms may vary, but include:
  • pain and discomfort in the prostate, scrotum, testes, rectum, or tip of the penis
  • aching in the lower back, lower abdomen or inner-thighs
  • watery discharge from the penis
  • urinary problems such as urgency, getting up at night to pass water, pain on passing water
  • pain on ejaculation, premature ejaculation, blood in the semen, infection and swelling of the testes
This condition can be difficult to eradicate. Some men suffer recurrent symptoms throughout their life.
Chronic Non-bacterial Prostatitis
This can occur at any time after puberty but is most common between the ages of 30 and 50. It is an inflammatory condition in which prostate secretions contain white pus cells but no bacteria. One of the most common causes of non-bacterial prostatitis is claimed to be due to abnormal emptying of the bladder where urine is forced into the channels and ducts of the prostate causing inflammation. Sometimes suggested it can be triggered and made worse if a man jogs or plays active sports on a full bladder. The most common symptoms of non-bacterial prostatitis are:
  • pain/ache in the testicles, penis or rectum
  • Low backache, especially after intercourse
  • burning sensation on passing water
  • urinary frequency
  • discharge from the urethra, especially after sex

 

Treatment of Prostatitis

Investigations and Treatment

Prostatitis is best investigated by either a doctor specializing in urology or in genito-urinary medicine.

Porstatitis is difficult to diagnose accurately, specific equipment and expertise are needed to investigate and treat symptoms sympathetically and in confidence. The tests are likely to involve, having a full genital and rectal examination, swabs from the end of the penis, urine sample, prostate massage, routine screening for sexually transmitted diseases such as chlamydia, a blood test to check for signs of infection.

Treatment for Acute Prostatitis

Once a diagnosis is made, a course of antibiotics are usually prescribed, the length of the course depends on the doctor prescribing, but usually it is for a period of 4 weeks. Symptoms should start to improve within a few days. Occasionally, infection causes the prostate gland to swell enough to cause the opening of the urethra to shut. This causes urinary outflow obstruction, and admission to hospital is required, where a urinary catheter is inserted to ease urinary flow, though this is rare.

Chronic Prostititis

Chronic prostitis can be difficult to treat, as inflammation and swelling traps infection inside the gland. Once diagnosis is made, antibiotics are prescribed for at least six weeks. Sometimes, they are needed for three months or more. Anti-inflammatory painkillers also help to reduce swelling, inflammation and pain.

Chronic Non-bacterial Prostatitis

This is sometimes treated with natural food supplements, these can be discussed with the doctor, and can take three to six months before signs of improvement.

I May Have Prostatitis

 

Dr Prabhat Sood

Consultant Physician
Genitourinary and HIV Medicine

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