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Prostatitis is swelling and inflammation of the prostate gland, a gland the size of a walnut that is located directly below the bladder in men. The prostate gland produces semen that nourishes and transports sperm.

This condition often causes painful or difficult urination, but other symptoms may include pain in the groin, pelvic area, or genitals and sometimes flu-like symptoms.

Prostatitis can affect men of all ages, but tends to be more prevalent in men age 50 and younger. Nearly half of all men have prostatitis-like symptoms at some point during their lifetime. The condition can be caused by a variety of things, but sometimes, the cause is unable to be identified. If prostatitis is caused by a bacterial infection, antibiotics can usually be the main source of treatment.

Types of Prostatitis

Prostatitis can be present in different forms which can range in severity. Types of chronic prostatitis include the following:

  • Chronic bacterial prostatitis – This refers to a bacterial infection that causes swelling and inflammation of the prostate. Doctors can make a definitive diagnosis of this type of prostatitis if bacteria and white blood cells are found in the urine and semen. When white blood cells are present, there is inflammation that may or may not be related to an actual infection. True chronic bacterial infection accounts for a small percentage of cases of chronic prostatitis. Doctors may sometimes suspect a lingering bacterial infection even though no bacteria may be identified when tested.
  • Chronic nonbacterial prostatitis – Your doctor may make this diagnosis when you have typical symptoms of chronic prostatitis, but no bacteria is found in a provided urine or semen sample. The cause of most cases of nonbacterial prostatitis is still unknown. The urine often contains white blood cells. Some patients may experience a persistent low-grade infection that goes undetected in a routine urine sample. Although, a majority of patients with nonbacterial prostatitis have no evidence of an infection, even when other, more sophisticated tests are performed.
  • Prostadynia – Doctors use this term when symptoms of prostatitis are present, but there is no evidence of prostate infection or inflammation. Little is known about why some patients – often young, otherwise healthy men – develop this problem. There are theories as to why that include abnormal buildup of pressure in the urinary tract, irritation resulting from an autoimmune or chemical process, or pain generated from nerves and muscles within the pelvis.

Chronic prostatitis is fairly common and can affect men of all walks of life. Roughly five percent of men will experience symptoms of chronic prostatitis at some point in their life. Chronic prostatitis makes up the reason for up to 25% of male visits to a urologist.

In some cases, men can develop a chronic infection in the prostate that does not cause any noticeable symptoms. Men who experience this issue may be diagnosed during an evaluation for other urological conditions, such as an enlarged prostate or infertility. Many doctors often treat the infection with the same antibiotics used for chronic bacterial prostatitis.

Symptoms of Prostatitis

Prostatitis commonly causes swelling of the prostate gland. The prostate surrounds the urethra – the tube that carries urine out of the body from the bladder. The swollen prostate presses on the urethra causing pain or other issues during urination. A swollen prostate gland can also be a sign of another condition known as benign prostatic hyperplasia (BPH) – and can be a common condition as men get older. For more information on BPH, click here.

Common symptoms of chronic prostatitis include:

  • Difficulty starting the urine stream
  • Burning during or after urination
  • Dribbling after urination is complete
  • The need to urinate urgently or frequently
  • Blood in the urine
  • A feeling that the bladder cannot be emptied completely
  • Pain felt above the penis, in or under the scrotum, or in the back or rectum
  • Pain felt during or after orgasm

In some cases, men may not notice the symptoms or may only be slightly annoyed by them. Other men can be quite bothered by chronic prostatitis and find that the symptoms interfere with everyday life.

Diagnosing Prostatitis

If your doctor feels that you are experiencing prostatitis, they will ask you to describe your symptoms in detail. Your doctor will also need to know your general medical history, if you are currently taking any medications, your normal caffeine and alcohol intake, and whether you have had sexual contacts that may increase your risk of any sexually transmitted infections. The symptoms of some sexually transmitted infections can mimic those of prostatitis.

The doctor will examine your prostate gland by inserting a gloved and lubricated finger into your rectum. In chronic prostatitis, the gland may be swollen, firm, and tender, or it may even feel normal. You could experience pain or an urgent need to urinate when pressure is applied to the prostate. Your doctor will examine you to look for other problems that could be leading to your symptoms.

Next, the doctor will inspect a urine or semen sample to look for white blood cells and bacteria. Often your doctor will ask you to produce separate urine samples before and after your prostate gland has been examined.

In some cases of chronic prostatitis, this simple evaluation is the only test needed to make a concise diagnosis and begin treatment. Sometimes, a person may have vague or unusual symptoms. In these cases, the doctor will consider other diagnoses, such as interstitial cystitis, urethritis, benign enlargement of the prostate or even prostate cancer. In these situations, your doctor could recommend additional blood or urine tests, an ultrasound of the prostate, an examination of the bladder with a lighted telescope, or a needle biopsy of the prostate.

Treatment for Prostatitis

Treating prostatitis may depend on the underlying cause. Treatment options may include:

  • Antibiotics – this is the most commonly prescribed treatment for prostatitis. Your doctor will choose your medication based on your situation and the type of bacteria that is likely causing your infection.
  • If your symptoms are severe, intravenous (IV) antibiotics may be required. It is likely that you’ll need to take oral antibiotics for four to six weeks but might need longer treatment for chronic or recurring prostatitis.
  • Anti-inflammatory agents – Nonsteroidal anti-inflammatory drugs (NSAIDs) might make you more comfortable during the treatment period.
  • Alpha blockers – These medications help relax the bladder neck and the muscle fibers where the prostate joins the bladder. This treatment might ease symptoms, like pain during urination.
  • Prostate massage – Not as common as it once was, this treatment option may be recommended by your doctor for prolonged infections that are not responding to antibiotics.
  • Dietary modifications such as reducing the intake of caffeine, spicy foods, carbonated drinks, citrus drinks, and alcohol may be recommended.

Surgery for prostatitis is not common and is rarely needed as a treatment option.

Having prostatitis does not increase the risk for developing prostate cancer. Although, patients with a history of prostatitis should continue to have regular exams and blood work to check for prostate cancer.

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