Prostatitis

Prostatitis is inflammation of the prostate gland. It typically causes pain and swelling.

Prostatitis is common among men of all ages. Usually, prostatitis develops slowly and recurs. This type is called chronic prostatitis. Prostatitis can also develop rapidly. This type is called acute prostatitis. Occasionally, prostatitis causes a collection of pus (abscess) to form in the prostate gland.

Treatment often relieves the symptoms of prostatitis effectively. But prostatitis is sometimes difficult to cure.

Causes

Why chronic prostatitis develops is usually unknown. Sometimes it results from an infection. Acute prostatitis almost always results from an infection. Infections that cause prostatitis are often bacterial. They are rarely fungal, viral, or protozoal.

Symptoms and Diagnosis

Prostatitis causes pain in the area between the scrotum and anus (perineum), in the lower back, and often in the penis and testes. A man may need to urinate frequently and urgently. Urinating may cause pain or burning. Prostatitis may make achieving an erection or ejaculating difficult or even painful. Constipation can develop, making bowel movements painful. Acute bacterial prostatitis commonly causes fever, difficulty urinating, and blood in the urine. These symptoms occasionally occur in other types of prostatitis.

The diagnosis is usually based on the man's symptoms and results of a physical examination. A doctor feels (palpates) the prostate gland by inserting a gloved, lubricated finger into the rectum. The prostate gland may feel swollen and tender when palpated. With the finger still inserted, the doctor may exert gentle pressure (massage) on all parts of the prostate gland. Massaging the prostate gland causes a feeling of pressure but is usually not painful. To confirm the diagnosis, the doctor may ask for urine samples, which may contain any fluids released when the prostate gland is massaged. The urine sample and fluids are then checked for signs of infection, such as a high white blood cell count or bacteria.

Treatment

Relieving symptoms is an important part of treatment. Frequent ejaculation and sitting in a warm bath can help. Relaxation techniques may relieve pain.

Stool softeners can relieve constipation so that bowel movements are not painful. Pain relievers (analgesics) may be effective. Alpha-blockers, such as doxazosin, terazosin, and tamsulosin, may help relieve symptoms by relaxing the urinary sphincter (the band of muscle around the opening between the bladder and the urethra) and the urethra.

For chronic bacterial prostatitis, antibiotics are the traditional treatment. But their benefit is unclear. An antibiotic that can penetrate prostate tissue, such as ofloxacin, levofloxacin, ciprofloxacin, or trimethoprim-sulfamethoxazole, is taken by mouth for 4 to 6 weeks.

Acute bacterial prostatitis can usually be cured with antibiotics. The same antibiotics used to treat chronic bacterial prostatitis are taken for 2 to 3 weeks.

If an abscess develops in the prostate gland or in the urinary system, it must be drained by making a surgical incision.