Mr Karyee Chow and Mr Aziz Gulamhusein share the facts – on prostatitis and what to do if you’re suffering with it.
What is prostatitis?
Prostatitis literally means inflammation of the prostate gland.
What is the prostate?
The prostate is a small gland located between the penis and the bladder. Its function is to produce fluid that is mixed with sperm to create semen.
What are the symptoms of prostatitis?
The typical symptoms involve pain in the pelvic area. This can be felt in the perineum (the area between the scrotum and anus), lower abdomen and genitals. There may be pain on ejaculation and/or on passing urine. There may be other urinary symptoms such as frequency, urgency or difficulty in urination. These symptoms can vary from being mild to severely debilitating.
What is the cause of prostatitis?
Prostatitis may be acute when the symptoms are severe and come on suddenly. Acute prostatitis is usually due to a bacterial infection. The chronic form of prostatitis is more common – this is when the symptoms are present for more than three months. Chronic prostatitis may or may not be associated with the presence of bacteria. In some instances, there may be symptoms of prostatitis but no inflammation which is called prostatodynia.
Symptoms of prostatitis may be made worse by stress, constipation and certain foods that irritate the urinary tract such as spicy foods, acidic fruits (citrus), caffeine and alcohol. There is no link between prostatitis and prostate cancer.
What assessments and investigations are needed?
The initial assessment would include an examination of the prostate which is done with a finger through the back passage. The urine is checked for an infection. Sometimes secretion from the prostate or a semen sample will be obtained to check for bacteria. Other investigations that may be carried out include blood tests, a scan of the urinary tract and prostate, urinary flow assessments and camera or endoscopic inspection of the urinary tract.
What are the treatment options?
Antibiotics are prescribed as an initial treatment. This is because one cannot be completely certain that there is no infection, and patients often experience some improvement with antibiotics. It is difficult for antibiotics to penetrate prostate tissue and so the treatment course is longer than usual (four to six weeks). Certain antibiotics classes also work better (quinolones such as ciprofloxacin). Other treatments include anti-inflammatories, alpha-blockers (such as tamsulosin which relaxes the muscles of the prostate), drugs that reduce the size of the prostate (such as finasteride or dutasteride), chronic pain medicines, anti-depressants and muscle relaxants.
Often the symptoms improve with treatment but they may take many months to fully resolve. The symptoms may also recur, sometimes many months or years later.
For some patients who have significant pain that do not respond to the above treatments, a referral to a chronic pelvic pain specialist may be required. Pelvic floor therapy and pelvic nerve blocks are treatment options that may also be of benefit.
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This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.
