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What is prostatitis?

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Prostatitis is inflammation of the prostate (a gland beneath the bladder that produces components of semen). This inflammation can be acute (acute prostatitis) when it is commonly due to infection, or persistent or relapsing (chronic prostatitis). Acute prostatitis is caused by bacterial infection usually associated with spread from the bladder or urethra. Acute prostatitis is usually associated with lower urinary infection speading from the bladder or associated with sexually transmitted diseases (STDs) such as gonorrhoea or chlamydia. Symptoms include burning on passing urine with severe pain felt deep between the legs. There may be a penile discharge if an STD is present.

The infection may be cultured from the urine, a swab from the urethra or occasionally the doctor may obtain a specimen of prostate secretions by massaging the prostate using a finger placed in the rectum. Treatment is with the appropriate antibiotic. .

What is chronic prostatitis

Family doctors are seeing increasing numbers of men, usually aged 35-45 years, who have genital or pelvic pain that persists for weeks or months. These symptoms have been blamed on chronic inflammation of the prostate gland that in the past was presumed to be due to infection. However, an infection will be found in few of such patients, so the term chronic pelvic pain syndrome (CPPS) is now often used instead of chronic prostatitis.

What causes chronic prostatitis?

Definite chronic infection of the prostate is rare and usually associated with infection elsewhere in the urinary tract or a surgical instrument. A recent study suggests that in the majority of patients the condition is a consequence of modern living. Psychological tests have demonstrated higher than average scores for anxiety, depression and hypochondriasis in men with CPPS. Other studies have found physical abnormalities that could be the cause of the inflammatory or infective process: excessive pressure on the external urethral sphincter (responsible for voluntary control of urination) and sometimes reflux of urine into the prostate gland from the urethra (urine tube in the penis).

Attacks may be provoked by several triggering events, such as:

  • Urinary or sexual infections.
  • Trauma, especially during sex or sport (particularly cycling).
  • A surgical instrument.
  • Emotional factors including stress and depression.

What are the symptoms of chronic prostatitis?

The common symptoms are:

  • Penile, pelvic or rectal pain, often felt deep between the legs, which is worse on sitting.
  • Frequency or discomfort on passing urine.
  • Pain on or after ejaculation.
  • Quick, delayed or unsatisfactory ejaculation.
  • Rarely, blood in semen (haemospermia), more likely if infection present.

What is the treatment?

Unfortunately no single intervention has been shown to work. As the patient may be excessively anxious about this and other aspects of his health this makes the problem more difficult to treat. If the patient expects a simple solution to the problem, he is often reluctant to accept its relapsing nature. A full explanation of the nature of the disorder often helps. Treatment may include any of the following:

  • Avoid activities that provoke attacks (especially cycling).
  • Take regular hot baths.
  • Regular ejaculation through sexual intercourse or masturbation. This encourages drainage of the prostate and assists clearance of infection.
  • Antibiotics are frequently useful and are usually tried first even if infection is not found, although they might be working by an anti-inflammatory rather than an antibacterial effect. Drugs that reach adequate levels in the prostate must be used and for sufficient periods, at least one month. Tetracycline antibiotics, especially doxycycline, erythromycin or ofloxacin are the drugs of choice.
  • Drugs, such as alpha-blockers, which act by relaxing the urethral sphincter and easing spasm can be helpful, as can finasteride, a drug known to “shrink” the prostate. The latter is more likely to work in patients with an enlarged or tender prostate.

The range of other treatments used is listed below and probably reflects the lack of a single effective therapy:

  • Pain-killers and anti-inflammatory drugs
  • Anti-depressants
  • Psychological support and counseling
  • Pollen extracts
  • Microwave therapy
  • Transcutaneous electrical nerve stimulation (TENS) – a form of pain relief using tiny electrical currents applied to the skin from a small electronic pulse generator

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