PROSTATITIS - REVIEW

Prostatitis is an inflammation of the prostate. The following information will answer your questions on prostatitis, as well as those about the prostate itself - where it is, what is does.

What is the prostate and what does it do?

The prostate is a gland of the male reproductive system. It is located in front of the rectum and just below the bladder, the organ that stores urine. The prostate is quite small - it weighs only about an ounce - and is nearly the same size and shape as a walnut. As shown below, the prostate wraps around a tube called the urethra, which carries urine from the bladder out through the tip of the penis.

The prostate is made up largely of muscular and glandular tissues. Its main function is to produce fluid for semen, which transports sperm. During the male orgasm (climax), muscular contractions squeeze the prostate's fluid into the urethra. Sperm, which are produced in the testicles, are also propelled into the urethra during orgasm. The sperm-containing semen leaves the penis during ejaculation.

Types of prostatitis

There are three types of prostatitis:

• acute infectious prostatitis
• chronic infectious prostatitis
• non-infectious prostatitis

Acute infectious prostatitis is caused by bacteria and is treated with antimicrobial medication. Acute infectious prostatitis comes on suddenly, and its symptoms - including chills and fever - are severe. Therefore, a visit to your doctor's office or the emergency room is essential, and hospitalization is frequently required.

Chronic infectious prostatitis is also caused by bacteria and requires antimicrobial medication. Unlike an acute prostate infection, the only symptoms of chronic infectious prostatitis may be recurring infectious cystitis (bladder infection).

Non-infectious prostatitis is not caused by bacteria - its cause is not known. Antimicrobial medications are not effective for this type of prostatitis. Treatments, described later, may be helpful in some cases.

How does prostatitis develop?

Despite their names, acute and chronic infectious prostatitis are not contagious and are not considered to be sexually transmitted diseases. Your sexual partner cannot catch this infection from you.

How then did you get it? The way in which the prostate becomes infected is not clearly understood. The bacteria that cause prostatitis may get into the prostate from the urethra by backward flow of infected urine into the prostate ducts or from rectal bacteria.

Certain conditions or medical procedures increase the risk of contracting prostatitis. You are at higher risk for getting prostatitis if you:

• recently have had a medical instrument, such as a urinary catheter (a soft, lubricated tube used to drain urine from the bladder), inserted during a medical procedure
• engage in rectal intercourse
• have an abnormal urinary tract
• have had a recent bladder infection
• have an enlarged prostate

What are the symptoms of prostatitis?

The symptoms of prostatitis depend on the type of disease you have. You may experience no symptoms or symptoms so sudden and severe that they cause you to seek emergency medical care. Symptoms, when present, can include any of the following: fever, chills, urinary frequency, frequent urination at night, difficulty urinating, burning or painful urination, perineal (referring to the perineum, the area between the scrotum and the anus) and low-back pain, joint or muscle pain, tender or swollen prostate, blood in the urine, or painful ejaculation.

Are the symptoms of prostatitis unique?

The symptoms of prostatitis resemble those of other infections or prostate diseases. Thus, even if the symptoms disappear, you should have your prostate checked. For example, benign prostatic hyperplasia (BPH), a noncancerous enlargement of the prostate that is common in men over age 40, may produce urinary tract symptoms similar to those experienced with prostatitis.

Similarly, urethritis, an inflammation of the urethra (often caused by an infection), may also give rise to many of the symptoms associated with prostatitis.

Still another condition that mimics the symptoms of prostatitis - when prostatitis is not present - is prostatodynia (painful prostate). Patients with prostatodynia have pain in the pelvis or in the perineum. Such pain may result from a prostate problem, but the pain can have a variety of different causes including muscle spasms or other musculoskeletal conditions.

Yet another term your doctor may mention in discussing your prostate problem is prostatosis, a more vague word, which simply means "a condition of the prostate."

Because of the connections between the urethra, the bladder, and the prostate, conditions affecting one or the other often have similar or overlapping symptoms.

How is prostatitis diagnosed?

To help make an accurate diagnosis, several types of examinations are useful.

The prostate is an internal organ, so the physician cannot look at it directly. Because the prostate lies in front of the rectum, however, the doctor can feel it by inserting a gloved, lubricated finger into the rectum.

This simple procedure, called a digital rectal examination, allows the physician to estimate whether the prostate is enlarged or has lumps or other areas of abnormal texture. While this examination may produce momentary discomfort, it causes neither damage nor significant pain.

Because this examination is essential in detecting early prostate cancer, which is often without symptoms, the American Urological Association recommends a yearly prostate examination for every man over age 40 and an immediate examination for any man who develops persistent urinary symptoms.

If your physician suspects that you have prostatitis or another prostate problem, he or she may refer you to a urologist (a doctor who specializes in diseases of the urinary tract and the male reproductive system) to confirm the diagnosis.

The test that must be performed when prostatitis is suspected is prostate stripping (massaging), during which prostatic fluid is collected. While performing the digital rectal examination, your doctor may vigorously massage, or "strip," the prostate to force prostatic fluid out of the gland and into the urethra. Although prostate stripping is not particularly painful, you may feel some discomfort depending on the sensitivity of your prostate.

The prostatic fluid is then analyzed under a microscope for signs of inflammation and infection. The three-glass urine collection method is used to measure the presence of white blood cells and bacteria in the urine and prostatic fluid. You will be asked to collect two urine samples separately: the first ounce of the urine you void (urine from your urethra) and then another sample of flowing, midstream urine (urine from your bladder). You will then almost empty your bladder by urinating into the toilet. At this point, your doctor will massage your prostate and collect on a slide any secretions that appear. You will then collect in a third container the first ounce of urine that remains in your bladder.

Examination of these samples will help your physician determine whether your problem is an inflammation or an infection and whether the problem is in your urethra, bladder, or prostate. If an infection is present, your doctor will also be able to identify the type of bacteria involved so that the most effective antimicrobial medication can be prescribed.

How do I know what type of prostatitis I have?

Acute infectious prostatitis is the easiest of the three conditions to diagnose because it comes on suddenly and the symptoms require quick medical attention. Not only will you have urinary problems, but you may also have a fever and pain and, frequently, blood in your urine.

Chronic infectious prostatitis is associated with repeated urinary tract infections, while noninfectious prostatitis is not. In fact, if you do not have a urinary tract infection or a history of one, you probably do not have chronic infectious prostatitis. Other symptoms, if any, may include urinary problems such as the need to urinate frequently, a sense of urgency, burning or painful urination, and possibly perineal and low-back pain.

Noninfectious prostatitis is more common than infectious prostatitis. It may cause no symptoms, or its symptoms may mimic those of chronic infectious prostatitis. If you have noninfectious prostatitis, however, it is unlikely that you will have urinary tract infections.

Why is correct diagnosis so important?

Because the treatment is different for the three types of prostatitis, the correct diagnosis is very important. Noninfectious prostatitis will not clear up with antimicrobial treatment, and infectious prostatitis will not go away without such treatment.

In addition, it is important to make sure that your symptoms are not caused by urethritis or some other condition that may lead to permanent bladder or kidney damage.

How is prostatitis treated?

Your treatment depends on the type of prostatitis you have.

If you have acute infectious prostatitis, you will usually need to take antimicrobial medication for 7 to 14 days. Almost all acute infections can be cured with this treatment. Analgesic drugs to relieve pain or discomfort and, at times, hospitalization may also be required.

If you have chronic infectious prostatitis, you will require antimicrobial medication 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, long-term, low-dose anti-microbial therapy may be recommended to relieve the symptoms. In some cases, surgical removal of the infected portions of the prostate may be advised.

If you have noninfectious prostatitis, you do not need antimicrobial medication. Depending on your symptoms, you may receive one of a variety of treatments. If your condition responds to muscle relaxation, you may be given an alpha blocker, a drug that can relax the muscle tissue in the prostate and reduce the difficulty in urination.

You may find that tub baths or changes in your diet may help to alleviate your symptoms. While there is no scientific evidence proving that these "home remedies" are effective, they are not harmful and some people experience relief from symptoms while using them.

Will prostatitis affect me or my lifestyle?

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.

Prostatitis is not a contagious disease. You can live your life normally and continue sexual relations without passing it on.

You should keep in mind the following ideas:

• Correct diagnosis is key to management of prostatitis.
• Treatment should be followed even if you have no symptoms.

Having prostatitis does not increase your risk of getting any other prostate disease. But remember, even if your prostatitis is cured, there are other prostate conditions, such as prostate cancer, that require prostate checkups at least once a year after age 40.