Prostatitis

Prostatitis is a swelling of the prostate gland which, lies between the penis and the bladder. It affects men of all ages. Most men will get better reasonably quickly with the right treatment, although some can go on to develop chronic prostatitis after an acute bout. If it becomes a chronic, long term condition it can be harder to treat.

Symptoms can start gradually, but in acute prostatitis they will usually come on suddenly. They include:

• pain in your pelvis, genital area, lower back and buttocks
• pain or burning when urinating and needing to go more often
• difficulty urinating, problems getting ‘going’ or a flow that seems to stop and start
• pain when ejaculating

In some cases you might feel tired, with aching joints and muscles, chills, or a high temperature. If these symptoms come on quickly, seek medical advice straight away.

In chronic prostatitis where your symptoms come and go, it’s not unusual for doctors to find no infection, and the cause isn’t clear.

Where the symptoms develop suddenly they need immediate treatment. Acute prostatitis is often caused by bacteria in the urinary tract (kidneys, bladder, and connecting tubes). It’s possible that bacteria could get into the prostate through infected urine or stool bacteria that enters from the rectum.

Only a small number of cases are sexually transmitted, although you’re more at risk of developing the condition if you take part in anal intercourse.

Other things that can lead to a higher risk of getting prostatitis include:

• having a urinary catheter inserted as part of a medical procedure
• having a recent bladder infection
• having an enlarged prostate gland

Your doctor will ask you questions about:

• What symptoms you’re experiencing, how often, and when they started
• If you’ve had any urinary tract infections recently
• What medicines you take, prescribed or otherwise
• How much fluid you drink, including caffeine and alcohol
• Your medical history, major illnesses and surgeries

Your doctor will need to carry out a physical examination of your abdomen and usually what’s called a digital rectal examination where you lie on your side while a gloved, lubricated finger is slid into your rectum to feel your prostate. It’s nothing to worry about, it might be a little uncomfortable but it doesn’t take long.

Your urine will usually be tested for signs of infection, and if your doctor suspects other conditions you may be referred to a urologist for further tests such as a prostate fluid analysis, a transrectal ultrasound, a biopsy or voiding studies (monitoring the flow of urine to see if there are any obstructions).

There’s another test called a PSA test - a blood test that detects the signs of an enlarged prostate. The test measures the level of prostate-specific antigen (PSA) in your blood. There are issues with the test’s accuracy when used to detect prostate cancer, and a raised level of PSA can also indicate prostatitis.

For chronic prostatitis, doctors often recommend anti-inflammatory medicines. Sometimes sitting in two to three inches of warm water to relieve uncomfortable symptoms can help too.

If it’s caused by a bacterial infection, you’ll be given antibiotics. For chronic bacterial prostatitis, a 4 to 6 week course of antibiotics clears up about 75 per cent of cases. If that doesn’t work, a low dose of antibiotics long term might be an option.

Symptoms can often be eased with painkillers or muscle relaxant drugs, and sometimes you might be advised to try prostate massage or stool softeners.

For acute prostatitis, doctors often recommend painkillers and 2 to 4 weeks of antibiotics.

If you’re very ill or can’t pee (urinate), you may need to be treated at a hospital.

Acute prostatitis is often curable with the right treatment.

For chronic prostatitis that doesn’t respond to treatment, doctors may suggest surgical removal of the infected parts of the prostate. This is only used in severe cases, or if your swollen prostate is interfering with the flow of urine.

It depends on the type of prostatitis and what’s causing it. Antibiotic treatment for chronic prostatitis can take anything from 4 weeks to several months. If the antibiotics don’t help, you may have to have more tests. There’s no definitive treatment so it might be a case of trying different things until something works for you.

In acute prostatitis, treatment usually lasts for 2 to 4 weeks.

Not usually, but in certain types of prostatitis, called asymptomatic inflammatory prostatitis, where there’s swelling but no obvious infection, there can be a raised PSA level and higher amounts of white blood cells in semen leading to fertility problems. This type of prostatitis isn’t usually discovered until infertility is being looked into, and if you’re not trying to conceive, it probably won’t need treating.

No, although some people find that avoiding spicy foods and caffeinated or acidic drinks can help with their symptoms.