Prostatitis

Prostatitis refers to inflammation of the prostate gland. The prostate is a small walnut-shaped organ that sits under the bladder and in front of the rectum, and is surrounded by muscles and nerves. The urethra (the tube that carries urine and semen out of the body) passes through the prostate. The most important function of the prostate is the production of a fluid that, together with sperm from the testes and fluids from other glands, makes up semen. Prostatitis is a common, often painful condition that can occur at any age, but usually 50 or younger. It is estimated that up to 15% of men may experience Prostatitis during their lifetime.

There are 4 types of Prostatitis:

  • This is the most common type of Prostatitis, resulting from inflammation of the prostate and irritation of the nerves which supply this area. It is not due to an infection. There is no cure, but the condition can be managed.

  • This is the least common type of Prostatitis. It often starts suddenly and causes severe symptoms. Patients tend to experience fever, chills and severe pain and difficulty passing urine. It requires immediate treatment.

  • This is fairly uncommon. It is due to a bacterial infection that comes and goes over a long period of time, and is difficult to treat. Symptoms are like a mild form of Acute Bacterial Prostatitis, but usually there is no fever.

  • The prostate gland is inflamed but there are no symptoms. It is often picked up incidentally during an exam for other health issues. It is usually left untreated.

What are the symptoms of Prostatitis?

  • Pain, burning or stinging while urinating

  • Difficulty urinating, such as dribbling or hesitancy

  • Frequent urination, particularly at night 

  • Urgent need to urinate

  • Cloudy urine

  • Blood in the urine or semen (Read about: Haematospermia)

  • Pain or discomfort around the penis, testicles, or perineum (area between the scrotum and anus)

  • Pain in the pelvis, lower abdomen, groin or lower back

  • Urethral discharge during bowel movements

  • Erectile Dysfunction or Premature Ejaculation

  • Painful ejaculation

  • Fever and chills (with acute infection)

How does Prostatitis occur?

It is not clear what causes most cases of Prostatitis. Most often, the nerves and muscles in the pelvis cause pain because of a local inflammation that affects the nerves in the area, or less commonly, bacterial infection. Several tests may need to be performed to figure out exactly why you feel pain. 

Bacterial Prostatitis occurs when infected urine flows backwards from the urethra, resulting in bacteria entering the prostate. These can include Sexually Transmitted Infections (STI) such as Chlamydia, Gonorrhoea, or other organisms like Mycoplasma and Ureaplasma. Non-STI related bacterial infections can also occur due to spread of rectal bacteria via lymph vessels, spread of bacteria from a remote source via blood vessels, or recurrent Urinary Tract Infection with prostatic reflux.

CPPS is poorly understood, but is thought to be linked to psychological stress, traumatic injuries, nerve inflammation or irritation, a history of urinary tract infections, or it may occur if your body reacts to an infection or injury that happened in the past. 

Other possible causes for pelvic pain may also be from:

  • Pelvic floor muscle tension

  • Prostate stones 

  • A urethral stricture (narrowing of the urethra) or scar tissue

  • Prostate cancer

  • Benign Prostatic Hyperplasia (BPH)

It is useful to note that Prostatitis is not contagious and is not considered as an STI, even though it can be caused by STIs. You do not have to avoid sex if you have Prostatitis, and having sex usually does not worsen the condition. Also, Prostatitis does not increase the risk of developing Prostate cancer later in life.

What can I expect at my visit?

In order to diagnose Prostatitis, your doctor will start off by conducting a detailed consultation to understand the severity of the symptoms and assess for any potential underlying causes. Next, a physical examination is performed, most important of which would include a digital rectal exam, whereby a gloved finger is inserted into the rectum to check for any prostate enlargement, tenderness or abnormal lumps. Investigations required usually include blood, urine and semen tests to look for signs of inflammation, infection and cancer markers, and an ultrasound scan of the prostate. If necessary, an MRI scan of the prostate may be ordered.

How is Prostatitis treated?

Treatment depends on the type of Prostatitis present, and the severity of the condition. 

  • Bacterial Prostatitis is treated with an appropriate course of antibiotics. The duration of treatment usually lasts 4 to 6 weeks. 

  • For CPPS, because the exact cause is unknown, usually a combination of therapies is employed. Antibiotics may be prescribed even if tests are negative for bacteria. Anti-inflammatory painkillers or medicines to reduce nerve pain are usually helpful. Your doctor may recommend a course of Extracorporeal Shock Wave Therapy (ESWT), as this has been found to be effective. Patients can also receive specialised physiotherapy to learn how to relax pelvic floor muscle tension.

Visit us.

If you think you have Prostatitis or have chronic or sharp pelvic pain, speak to our doctor today so you can get help.