Prostatitis

The term 'prostatitis' describes four different conditions that affect the prostate gland. Only two of these are related to urinary tract infections (UTIs). The signs and symptoms of prostatitis vary depending on the cause, and many symptoms are common to other conditions. Based on the type of prostatitis, the symptoms a person may experience are:

Type 1: Acute bacterial infection or acute bacterial prostatitis (ABP)

Type 1 prostatitis is an acute bacterial infection with signs and symptoms that have an abrupt onset. It is caused by an ascending urinary tract infection, meaning the bacteria travel up the urethra and infect surrounding areas, including the prostate gland. The symptoms of type 1 prostatitis include:

• Fever
• Myalgia (muscle pain)
• Malaise (generalized feeling of being unwell)
• Lower urinary tract symptoms (LUTS) like urgency, frequency, and dysuria (burning sensation)
• Nocturia (frequent urination during periods of sleep)
• Nausea and vomiting
• Pain in or around the penis, testicles, anus, lower abdomen, or lower back
• Pain when urinating, needing to urinate frequently (particularly at night), problems starting or "stop-start" urination, an urgent need to urinate, and sometimes blood in urine
• Lower back pain and pain on ejaculation

Type 2: Chronic bacterial infection or chronic bacterial prostatitis (CBP)

The symptoms of type 2 prostatitis (CBP) are similar to those of ABP (type 1), except they are chronic, recurrent, and less severe. It is caused by a bacterial infection, specifically recurrent urinary tract infections and previous ABP. Often, if type 1 prostatitis is not appropriately treated, it develops into type 2 prostatitis. In this condition, the bacteria may form a biofilm that helps them adhere to the prostate gland tissues, protecting them from antibiotics and immune system attacks. The symptoms of type 2 prostatitis include:

• Pain during and after ejaculation
• Sexual dysfunction
• Infertility
• A weak or interrupted urine stream
• Urinary blockage
• An enlarged or tender prostate on rectal examination
• Sexual problems such as erectile dysfunction or pelvic pain after sex

Type 3: Chronic sterile inflammation/chronic pelvic pain syndrome

Type 3 prostatitis is the most common form. It is called sterile prostatitis because it is not caused by bacterial infection and does not have symptoms like increased urgency and frequency of urination. Chronic sterile inflammation is caused by the obstruction of the urinary bladder outlet or by urine reflux within the prostate gland due to an enlarged prostate or stones. Symptoms are similar to type 2 prostatitis but also include:

• Chronic pelvic pain affecting the penis, scrotum, and perineum
• Urinary retention
• Difficulty in passing urine
• A weak or interrupted urine stream

Type 4: Asymptomatic inflammatory prostatitis

Type 4 prostatitis is asymptomatic, meaning it has no indicative symptoms. There may be some mild inflammation within the prostate gland. Here are a few common causes of frequent urination and why you should not ignore this symptom.

Prostatitis is more often caused by a bacterial infection resulting from a UTI or procedures like catheter insertion, prostate biopsy, or other urological interventions. Bacterial prostatitis is generally more difficult to treat than a simple urinary tract infection and often requires a prolonged course of antibiotics. In certain cases, the underlying cause of prostatitis may not be found, and it may be a reflection of inflammatory changes around the nerves causing pain arising from the pelvis. In such situations, treatment often requires a multidisciplinary approach involving physicians, urologists, and microbiologists, who try to understand the individual’s condition in-depth and ensure that it is adequately treated. The common causes of bacterial or nonbacterial prostatitis are:

• Inflammation of the genitourinary system
• Chronic pelvic floor tension
• Muscle dysfunction
• Autoimmune diseases
• Pelvic floor muscle spasms
• Stress
• Bladder infections or bladder stones
• Surgery or biopsy requiring the use of a urinary catheter
• Prostate stones
• Urinary retention (not emptying the bladder)
• Urinary tract infections (UTIs)
• Sexually transmitted infections (STIs)

Another problem that could occur in the prostate is prostate enlargement, which is:

• Most often non-cancerous (also referred to as benign prostatic hyperplasia or BPH)
• In some patients, enlargement of the prostate is cancerous (prostate cancer)
• Likely related to hormonal changes in testosterone and estrogen levels.

Benign prostatic hyperplasia or BPH is the most common form of an enlarged prostate. The prevalence of BPH increases with:

• Increasing age; an estimated 50 to 60% of male patients in their 60s are affected by BPH, and these rates increase as the patient gets older.
• Increased risk in individuals with metabolic syndrome and obesity.

BPH is a medical condition that commonly occurs in older men. Read more about its causes, symptoms, and treatment.

The prostate is around the size of a walnut and is located near the base of the penis. It encircles the urethra (the tube that urine comes from). For unknown reasons, the prostate continues to enlarge as a man ages, leading to urinary problems that affect half of men by the age of 60 and nearly all men by the age of 80. The exact cause of prostatitis isn’t limited to one factor, but the following are some risk factors for the development of prostatitis:

• Having experienced prostatitis in the past
• Having had a recent bladder infection
• Infections of the bladder or the urethra (the tube that carries sperm and urine to the penis)
• Having pelvic trauma, such as from a bike or horseback riding accident
• Using a urinary catheter to empty the bladder
• Infection with HIV/AIDS
• Enlarged prostate gland
• Having undergone a prostate biopsy
• Consuming a lot of spicy or marinated food
• Injury to the lower pelvis, often as a result of cycling or lifting weights

The symptoms will be examined, and a physical exam will be performed by your healthcare professional to rule out the presence of prostatitis. Less invasive prostatitis testing may include:

• Urinalysis: A urinalysis and urine culture are performed to look for bacteria and UTIs.
• Urine culture and sensitivity: Identifies which bacteria are causing the infection and the best medicine to treat it.
• Sexually transmitted infections testing: Some STIs can be confirmed with a urine sample.
• Complete blood count (CBC): A blood test detects PSA, a protein produced by the prostate gland. High levels may suggest prostatitis, BPH, or prostate cancer.
• Digital rectal exam: Your doctor inserts a gloved, lubricated finger into the rectum to assess discomfort and inflammation in the prostate gland. This examination may include a prostate massage to obtain a sample of seminal fluid.
• Prostate-specific antigen (PSA): The PSA test determines the level of prostate-specific antigen (PSA) in your blood. High PSA levels indicate prostatitis.
• CT imaging to assess prostatic abscesses: If the patient is immunocompromised, the doctor may request a CT scan of the urinary system and prostate, as well as prostate ultrasonography. CT scan images provide more detail than standard X-rays. The visual image created by ultrasound is known as a sonogram.
• 2-glass and 4-glass tests: The 2-glass pre-massage and post-massage test and the Meares-Stamey 4-glass test are conducted to detect and identify pathogens causing chronic prostatitis/chronic pelvic pain syndrome.
• Urine flow studies (urodynamics): Your urologist may also order urine flow studies or urodynamics to measure the strength of your urine flow and identify any blockage caused by the prostate, urethra, or pelvic muscles.
• Transrectal ultrasound: This test examines for abnormalities in the rectum and surrounding tissues, particularly the prostate. It is also known as endorectal ultrasound (ERUS) and transrectal ultrasound (TRUS), where an ultrasound probe is inserted into the rectum to examine the prostate.
• Cystoscopy: A cystoscopy can detect various urinary tract issues but cannot confirm prostatitis. To examine within the bladder and urethra, your physician will use a cystoscope, a pencil-sized lighted tube with a camera at its end.

Prostatitis is a harmless condition (not cancerous). It does not raise your chances of developing prostate cancer. However, prostatitis-induced inflammation raises the level of prostate-specific antigens (PSA) in the blood, similarly to prostate cancer. Additional testing can be used to discover what is causing the increased PSA levels. Prostatitis is a condition that doctors aren't always clear about. The most common causes vary based on whether the condition is acute or chronic, infectious or inflammatory. An infection in your urinary tract is sometimes to blame. Sometimes, it's due to an injury or nerve damage. In many cases, doctors are unable to identify the root problem. As a result, treating prostatitis might be difficult. It might take months, if not years, for some patients to recover.

• Maintain good hygiene: To avoid infection, keep your pelvic area and the surrounding area clean.
• Stand up when possible: Extended durations of sitting put pressure on your prostate gland, which can cause inflammation over time.
• Move a lot: Make it a habit to exercise at least three times a week. Take regular walks, stretch, or go to the gym for a cardio class to get your blood flowing. Physical exercise can help lower anxiety, which has been related to some types of prostatitis.
• Stay hydrated: Some types of prostatitis are caused by bacteria in the urinary tract that invade and infect the prostate gland. Drink plenty of fluids to keep urine diluted and the bladder flushed. If you have a medical condition such as chronic renal disease or congestive heart failure, consult your doctor about additional precautions you should follow.
• Eat more fruits and green vegetables: Fruits and vegetables are high in nutrients that maintain health and fight infections and inflammation.
• Limit or avoid caffeine and alcohol: Tea, coffee, carbonated drinks, and alcoholic beverages can irritate the urinary system and bladder.
• Manage stress: Men who experience high stress levels at work or home are more prone to develop prostatitis. Consult with a doctor to manage your emotions. Meditation and relaxation techniques may also help release tension in the body and mind.
• Practice safe sex: Prostatitis can be caused by sexually transmitted infections (STIs). Bacterial infections can occur through oral, vaginal, or anal intercourse with an infected partner without using a condom.
• Maintain a healthy body weight: Being obese puts pressure on the prostate gland. Aim to lose weight by eating a balanced diet, staying active, and getting adequate rest.
• See your doctor: Consult with your doctor if you notice signs such as increased urinary frequency, painful urination, constipation, or painful bowel movements. These may indicate poor prostate health.

Urinary tract infections (UTIs) should be treated as soon as possible to prevent the infection from spreading to the prostate gland and causing prostatitis. Consult your doctor if you experience discomfort in your perineum (the area extending from behind the scrotum to the anus) when sitting. You can address this issue before it progresses to chronic pelvic pain syndrome. Here’s more on who the right expert is to consult for male sexual and reproductive health problems.

Treatment for prostatitis varies based on the cause and type. Treatment is not required for asymptomatic inflammatory prostatitis. Your healthcare practitioner may use a method called UPOINT to categorize symptoms of chronic pelvic pain syndrome (CPPS) and may utilize multiple treatments simultaneously to address the specific symptoms you are experiencing. The UPOINT method has improved the condition of over 80% of males with CPPS. The method focuses on the following symptoms and treatments:

• Urinary: Tamsulosin and alfuzosin are alpha blockers that relax the muscles around the prostate and bladder to increase urine flow.
• Psychosocial: Stress and anxiety management can be beneficial. Counseling or medication for anxiety, depression, and negative thinking can help some men.
• Organ-specific: Quercetin may reduce prostate inflammation and help ease an inflamed prostate gland or prostatitis.
• Infection-related: Antibiotics help eliminate infection-causing bacteria.
• Neurological: Prescription pain relievers such as amitriptyline, pregabalin, and gabapentin help treat neurogenic pain, which may involve fibromyalgia or pain that radiates into the legs, arms, or back.
• Tenderness: Gentle massage can ease tension on tight pelvic floor muscles, helping to lessen or eliminate muscular spasms.

To treat acute and chronic bacterial prostatitis:

• Antibiotics such as fluoroquinolones, macrolides, and tetracyclines are recommended. The dose and duration of treatment depend on the type of prostatitis.
• Surgical drainage of abscesses can help alleviate inflammation and ease symptoms.
• Alpha-blockers are recommended to relax the muscles around the prostate and the base of the bladder.
• Anti-inflammatory agents, including non-steroidal drugs, help reduce pain from inflammation in the prostate or muscles. These include pain medications like aspirin and ibuprofen, as well as muscle relaxers.

Other treatments may be required at some point:

• Urinary catheter: If you cannot urinate, a nurse may help empty your bladder by inserting a flexible tube into your urethra.
• Prostate massage: This technique helps remove fluid from your prostate ducts. Receiving this treatment two to three times a week may be beneficial. Frequent ejaculation during orgasm may also provide similar benefits.
• Pelvic floor physical therapy: Prostatitis can be linked to issues with pelvic floor muscles. This therapy helps you learn to relax specific muscles in your pelvis, aiding with sexual function and supporting your bladder and intestines.
• Mental health therapy: Stress, depression, and a sense of helplessness may contribute to certain types of prostatitis. Consulting a mental health professional can help you manage negative thoughts and improve your mood. If prostatitis affects your emotional well-being, your doctor may recommend antidepressant medication or refer you to a counselor. Joining a support group and conversing with others who have prostatitis may also enhance your mood.
• Treatments for sexual dysfunction: If prostatitis affects your sex life, such as causing difficulties in achieving or maintaining an erection, discuss this with your doctor. There are various options available, including medications like sildenafil or tadalafil.

Natural home remedies for prostatitis, in addition to medical therapy, can help relieve some symptoms at home:

• Soak in a warm bath (sitz bath) or apply a heating pad to your body.
• Avoid or limit alcohol, caffeine, spicy or acidic meals, and other items that might irritate your bladder.
• Prolonged sitting or biking may aggravate your prostate.
• Consuming a lot of caffeine-free drinks can increase urination, aiding in the removal of germs from your bladder.
• Prostate massage has been shown in some trials to alleviate symptoms in certain individuals with chronic nonbacterial prostatitis.

Here are 7 superfoods that are beneficial for maintaining prostate health.

• Bacterial infection of the blood (bacteremia)
• Inflammation of the coiled tube connecting to the back of the testicle (epididymitis)
• Prostate cavity filled with pus (prostatic abscess)
• Infertility and sperm abnormalities can arise as a result of chronic prostatitis
• Pyelonephritis (UTI where one or both kidneys get infected)
• Renal damage
• Sepsis (spread of bacteria through the bloodstream)
• Bladder outlet obstruction/urinary retention

There is no concrete evidence that prostatitis can lead to prostate cancer. Whether chronic inflammation of the prostate can lead to cancer is still under research.

Many men find that complementary treatments help them manage their symptoms and the day-to-day effects of prostatitis, giving them a sense of control. Some men report feeling more comfortable and confident in themselves and their treatment. Complementary therapies are typically utilized in addition to, rather than in place of, medical treatments. Some complementary remedies have adverse effects, while others may interfere with your therapy for prostatitis. Inform your doctor or urologist about any complementary therapies you are receiving or considering using.

Here are some alternative treatments that have shown potential in decreasing prostatitis symptoms:

• Biofeedback: A biofeedback professional utilizes signals from monitoring equipment to teach you how to manage specific body functions and responses such as muscular relaxation.
• Acupuncture: This procedure entails inserting very small needles into your skin at varying depths at various places on your body.
• Herbal remedies and supplements: Some herbal therapies for prostatitis include ryegrass (cernilton), a substance found in green tea, onions, and other plants (quercetin), and saw palmetto plant extract. However, these lack scientific backing regarding their effectiveness in improving prostatitis symptoms.

Prostatitis is accompanied by pain that can cause discomfort and a desire to avoid activity. The following suggestions may help you feel more at ease and in control of your pain. Follow these tips to live comfortably with prostatitis:

• Find methods to relax: Stress or anxiety can trigger flare-ups or worsen symptoms. If this is an issue for you, try relaxation techniques such as deep breathing, meditation, taking a warm bath, or listening to music.
• Divert your attention: Take a break from the pain by engaging in activities such as listening to music, reading, watching television, or talking with someone. This may seem simple, but it can be quite beneficial.
• Watch what you consume: Drink plenty of fluids—aim for 6 to 8 glasses of water each day. Reduce your intake of carbonated drinks, artificial sweeteners, alcohol, and caffeine-containing beverages (tea, coffee, and cola), as these can irritate the bladder and aggravate urinary disorders. There is some evidence that spicy foods may worsen symptoms of chronic pelvic pain syndrome (CPPS).
• Avoid cycling: Cycling can put pressure on the area between your back passage and testicles (perineum), potentially exacerbating symptoms. If you wish to continue cycling, consider using a different type of saddle, such as a gel saddle.
• Keep a journal: This can help you identify triggers that worsen your symptoms and can be an effective way to communicate with your doctor about your experiences. Track everything you eat and drink, your level of exercise, stress levels, and your symptoms.