Prostatitis is one the most frustrating and challenging diagnoses in urology. Much confusion exists about the cause of symptoms often attributed to prostatitis. Cleveland Clinic urologists specialize in treating chronic prostatitis through a variety of methods depending on the individual patient. Cleveland Clinic is one of the only centers in the nation that specializes in the diagnosis and treatment of chronic prostatitis.
What is prostatitis?
Prostatitis is a usually painful condition of the prostate gland, the small walnut-shaped organ that lies just below a man's bladder and surrounds the urethra. The prostate gland produces most of the fluid in semen.
Prostatitis symptoms depend on the category of the disease.
Prostatitis includes patients with acute bacterial prostatitis. Patients present with fever, and symptoms of the lower urinary tract such as burning, frequency and/ or difficulty urinating. Some may even notice blood in their urine.
This rare type of infection can occur suddenly, without risk factors, or in men who have had recent instrumentation of the urinary tract, such as catheterization. The urinalysis is usually abnormal and subsequent culture typically grows the culpable bacteria. Antibiotic therapy is highly effective in this setting.
Prostatitis or chronic bacterial prostatitis, is a diagnosis usually given to men with recurrent urinary tract infections, who grow the same organism in the urine, over and over again when they are symptomatic. After excluding sources of reinfection, like abnormal urinary tract anatomy or a stone within the ureters or bladder, the organism can usually be localized to the prostate gland, by means of a special culture technique which involves urine specimens taken before and after a prostate massage.
These men are usually symptom-free when microscopic analysis of their urine is normal. Sometimes it is impossible to eradicate the organism from the prostate gland despite prolonged antibiotic therapy. Depending upon the frequency or severity of re-infection, your doctor may suggest daily low dose antibiotic therapy to prevent recurrent bouts.
Prostatitis refers to a form of chronic abacterial prostatitis and represents the most common form of the diagnosis- most men who present to their doctor with burning or pain in the pelvis or urinary tract, and lower urinary tract symptoms do not have bacteria in their urine nor prostate massage specimen. Fortunately, this observation was taken into account during the classification process, and includes a broader and more accurate diagnosis: Chronic Pelvic Pain Syndrome. Some men only experience pain, while some may experience urinary problems as well as changes in their sexual function.
Many patients receive antibiotics or other medications which afford them no relief of their symptoms. Often, an abnormality of the pelvic floor musculature is identified, which can also explain certain urinary symptoms such as inability to start a urinary stream or weaker flow, and certain components of sexual dysfunction, such as pain or spasm after ejaculation. Certainly, there are other causes for one or all of these symptoms, therefore, a physician must exclude the other possibilities prior to making a diagnosis of chronic pelvic pain syndrome. Besides muscular tension and myofascial trigger points, some men also have symptoms consistent with irritable bowel syndrome, Fibromyalgia or disorders of defecation. For this reason, a multidisciplinary treatment plan is often necessary, incorporating the expertise of urologists, physical therapists, psychologists and colorectal specialists.
Prostatitis refers to a form of asymptomatic prostatitis which is identified, incidentally, in semen specimens or prostate biopsies. This type of prostatitis may not require treatment since it is not a clinical diagnosis, which means it was not identified by the patient’s symptoms nor the findings on clinical exam.
On the other hand, treatment may be warranted if an asymptomatic man is being evaluated for infertility, since the inflammation noted in his semen may be a sign of reproductive tract infection, and in some instances, when a man has an elevated PSA without evidence of prostate cancer.
Prostatitis can affect men of all ages. An estimated 50 percent of all men experience prostatitis-like symptoms at some point during their lifetime. In fact, chronic prostatitis is the number one reason men under the age of 50 visit a urologist.
Patients typically undergo a comprehensive examination, including a digital rectal exam. Then, if the doctor is still not sure what you have, more tests, such as a biopsy, voiding studies, or MRI might be conducted. Voiding studies involve the collection and analysis of urine to determine which part of the urinary system is infected.
Treatments vary among urologists and are tailored to the type of prostatitis you have. Correct diagnosis is crucial because each type of prostatitis is treated differently, and it’s important to make sure your symptoms are not caused by urethritis (inflammation of the urethra) or another condition that might lead to permanent bladder or kidney damage.
Treatments generally include the following:
- Taking anti-inflammatory medicines along with warm sitz baths (sitting in 2-3 inches of warm water) is the most conservative treatment for chronic prostatitis
- Antibiotic medicine for infectious prostatitis are not effective treatments for non-infectious prostatitis. For acute infectious prostatitis, patients usually need to take antibiotic medicine for 2-4 weeks. Almost all acute infections can be cured with this treatment
- For chronic infectious prostatitis, antibiotic medicine is taken for a longer period of time, usually 4 to 12 weeks. About 60 percent of all cases of chronic infectious prostatitis clear up with this treatment. For cases that don't respond to this treatment, taking antibiotics at a low dose for a long time might be recommended to relieve the symptoms
- Pain medicines might be use to relieve pain
- Surgical removal of infected portions of the prostate might be advised for severe cases of chronic prostatitis or for men whose swollen prostate is blocking the flow of urine
- Supportive therapies for chronic prostatitis include stool softeners and prostate massage
Other treatments for chronic non-infectious prostatitis include the use of the drugs Proscar, Hytrin, and Cardura. These drugs relax the muscles of the prostate and bladder to improve urine flow and decrease symptoms.
Many cases of abacterial (non-bacterial) prostatitis (also considered chronic pelvic pain syndrome) respond to multidisciplinary approaches incorporating exercise, myofascial trigger point release, progressive relaxation, and counseling.
Prostatitis is a treatable disease. Even if the problem cannot be cured, you can usually get relief from your symptoms by following the recommended treatment. It is important to follow the full course of the prescription, even if you no longer have any symptoms. With infectious prostatitis, for example, the symptoms might disappear before the infection has completely cleared.