Prostatitis literally means inflammation of the prostate, which is often linked to infection but can occur without it too. Prostatitis is not an uncommon condition in men and can be due to a variety of reasons. The impact in men can be variable, ranging from mild to severe symptoms. In this article, we will talk about the causes, diagnosis and treatments that are available.
The prostate sits in the pelvis, beneath the bladder, and the waterpipe (urethra) passes through the middle of it. Its main role is to produce the fluid a man ejaculates, which keeps sperm viable outside of the body. Every man’s prostate grows throughout their life, from the day they go through puberty, and over time, some men will develop symptoms of an enlarged prostate due to pressure on the waterpipe, often in the form of hesitancy, reduced urinary flow and a sensation of incomplete emptying.
Whilst troublesome, there are several treatments that can address these problems, but incomplete bladder emptying or infections in the urethra (urethritis) can lead to urinary tract infections (UTI) and in men, UTIs can result in bacteria invading the prostate, producing acute bacterial prostatitis. Prostate biopsy can also cause an infection. In conjunction with more common symptoms of a UTI (such as urinary frequency, urgency and pain on passing urine), acute bacterial prostatitis can also cause a sudden reduction in urinary flow (or even the inability to pass urine at all), significant pain deep in the pelvis and blood in the semen or urine.
Initial treatment is with antibiotics and anti-inflammatories, though normally a much longer course is required than in women, as antibiotics need time to penetrate the prostate. Shorter courses of antibiotics can result in persistence or early recurrence of symptoms due to inability to eradicate infection completely.
It is important that a man is investigated for any underlying cause of prostatitis and to rule out other causes. As mentioned above, the most common cause is incomplete bladder emptying, though there are several other potential causes and specialist investigations by a urologist are very much recommended because, in some cases, the symptoms may not be due to an infection.
Prostate infections can go on to cause a different type of prostatitis called chronic (or long-term) prostatitis. Symptoms usually persist for greater than three months. This can be due to ongoing low levels of infection or can occur as the result of the inflammation caused by the initial infection. Symptoms can vary and may be intermittent. These include mild discomfort to significant/persistent pain in the perineum (the area between the scrotum and the back passage) and/or pelvis and urinary symptoms. Men can also experience more generalised symptoms, such as fatigue, malaise, loss of libido and muscle aches. Some men may notice pain during or after ejaculation.
Treating chronic prostatitis can be challenging and often requires specialist input. Meticulous cultures and identification of correctable causes are mandatory. Treatment revolves around alleviating and controlling symptoms through a combination of medication and non-medical strategies. Initial management with a prolonged course of antibiotics can be useful, though this often needs to be done in conjunction with anti-inflammatories and medications designed to relax the prostate. Some men get good results with medication designed to treat nerve pain (otherwise known as neuropathic pain), though results are not consistent and careful discussion with an expert is important to ensure the right regimen is used. There may also be a role for non-medical techniques, including pain education, acupuncture and pelvic floor physiotherapy, particularly in patients where there is no evidence of an in infection (chronic pelvic pain), which some men find very helpful.
At Urology Clinics Manchester, we recognise the importance of early investigation and management both acute and chronic prostatitis and have leading specialists in this field available to assess and manage these conditions. Many men may simply seek a reassurance regarding the cause of their symptoms. If you feel like you may be suffering from some of the symptoms described here or want to talk to an expert on men’s health issues, get in contact with the team. We have appointments available with our consultants at a number of sites round Manchester at times convenient to you and we are happy to help.
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