Prostatitis

What is Prostatitis?

Prostatitis is a prostate gland disorder which is usually associated with inflammation and/or pain. Prostatitis could be due to bacteria or not related to bacteria infection. Half of men have symptoms of prostatitis at some point in their life. It usually happens for men aged between 30 to 50. However, for men who are younger than 30 years old and older than 50 years old also can get prostatitis. Prostatitis is a benign condition, it will not increase the patient’s risk of getting prostate cancer.

Type of Prostatitis

There are 4 types of prostatitis:

1. Acute bacterial prostatitis

• Usually caused by urinary tract infection (UTI). Patients may experience urinary symptoms like painful urination, frequent urination and /or have trouble urinating.
• Immediate medical treatment is needed to prevent further complications.

2. Chronic bacterial prostatitis:

• Bacteria is being trapped in the prostate gland and causing recurrent UTIs that are difficult to treat.

3. Chronic pelvic pain syndrome (CPPS) 

• Most common type of prostatitis
• Usually, patients will feel chronic pain in the pelvis, perineum and genitals region.

4. Asymptomatic inflammatory prostatitis

• Patients with this type of prostatitis usually do not experience any symptoms. 
• Usually, a patient will accidentally find out he has this type of prostatitis when trying to find causes for other problems.
• This type of prostatitis does not need any treatment as patients do not experience any symptoms.

Symptoms of Prostatitis

Prostatitis symptoms vary depending on the type and cause. 

The common symptoms are:

• Pain in the pelvis, perineum, penis and/or testicles
• Painful urination
• Frequent urge to urinate
• Weak urine stream/ difficult to start urination
• Painful ejaculation
• Blood in semen
• Erectile dysfunction
• Fever and chills (for bacteria causes)

Causes for Prostatitis

Causes for prostatitis vary depending on the type of prostatitis:

1. Acute bacterial prostatitis is usually cause by bacteria that may spread from other parts of urinary or reproductive system for example urinary tract infection or sexually transmitted disease.
2. Chronic bacterial prostatitis has the same cause as acute bacterial prostatitis. However, it usually happens due to incomplete or failed treatment for acute bacterial prostatitis.
3. Chronic pelvic pain syndrome: the exact causes for this type of prostatitis is not well understood. Study found out that it might be due to previous infection, nervous system dysfunction, immune system dysfunction, psychological stress or irregular hormone. 
4. Asymptomatic inflammatory prostatitis: Usually no known cause found.

How to diagnose Prostatitis?

A few diagnostic tests will be run by your doctor to look for infection after examination.

For examination, your doctor will perform a digital rectal examination where your doctor will insert a finger into your rectum to check on the prostate.

Test that might be ordered:

• Urine test will be ordered to look for bacterial infection 
• Blood test:  Blood samples may be tested to look for signs of infection and prostate problem 
• Semen analysis: To look for sign of prostate infection 
• Imaging: Ultrasound will be done to look for any abnormality on prostate

Treatment for Prostatitis

1. Antibiotics

Antibiotics is the most commonly prescribed treatment for prostatitis. The doctor will choose the medication based on the type of bacteria that might be causing your infection.

If you have severe symptoms, intravenous antibiotics might be needed. You’ll likely need to take oral antibiotics for four to six weeks but might need longer treatment for chronic or recurring prostatitis.

2. Alpha blockers

These medications help to relax the bladder neck and the muscle fibres where your prostate joins your bladder. This treatment might ease symptoms, such as painful urination or ejaculation

3. Anti-inflammatory agents

Nonsteroidal anti-inflammatory drugs (NSAIDs) might give you pain relief and help to reduce inflammation.

4. ESWT (Electroshockwave therapy)

Electroshockwave therapy can sometimes be useful in controlling or treating symptoms due to CPPS or chronic prostatitis.

5. Neuropathic pain relief medication 

In some cases, the pain/ discomfort due to prostatitis may be due to nerves, thus in such cases medications such as gabapentin may be helpful in reducing the pain/ discomfort.