Prostatitis: inflamed prostate can be a vexing health problem

When it comes to prostate trouble, the lion’s share of attention goes to prostate cancer and an enlarged prostate. A third condition, prostatitis, flies under the radar even though it affects up to one in six men at some point in their lifetimes. It triggers more than two million visits to doctors and untold agony each year.

Prostatitis, which means inflammation of the prostate gland, is an equal opportunity disorder. Unlike prostate cancer and benign prostatic hyperplasia (BPH), which predominantly affect older men, prostatitis affects men of all ages.

Prostatitis refers to a loose assemblage of syndromes characterized by urinary problems such as burning or painful urination, the urgent need to urinate, trouble voiding, difficult or painful ejaculation, and pain in the area between the scrotum and rectum (known as the perineum) or lower back. Although it causes some of the same symptoms as BPH and can occur at the same time, prostatitis is a separate condition.

Some types of prostatitis are caused by bacterial infection. These cases are often accompanied by the classic symptoms of infection, such as fever, chills, and muscle pain along with urinary problems. As a result, they are relatively easy to diagnose and treat, and they usually respond well to antibiotics. Unfortunately, such straightforward forms of prostatitis are the minority.

Physicians aren’t sure what causes the rest. Potential culprits include difficult-to-detect bacteria, inflammation, depression and stress, and mechanical or neuromuscular problems in the pelvic muscles that irritate the general area. This uncertainty is what can make the treatment of prostatitis so maddening.

Types of prostatitis

Prostatitis is classified into four categories, each with its own treatment approach

Acute infection of the prostate

This sudden-onset infection is caused by bacteria that travel from the urethra, and perhaps from the rectum, to the prostate. It’s the least common but most dramatic form of prostatitis, beginning abruptly with high fever, chills, joint and muscle aches, and profound fatigue. In addition, you may have pain around the base of the penis and behind the scrotum, pain in the lower back, and the feeling of a full rectum. As the prostate becomes more swollen, you may find it more difficult to urinate, and the urine stream may become weak. (If you can’t urinate at all, it’s a medical emergency; this usually means the prostate is so swollen that it’s completely blocking urine flow. Depending on the severity of symptoms, hospitalization may be necessary.)

Antibiotics are the standard treatment and are highly effective for this form of prostatitis Typical choices include fluoroquinolones—such as ciprofloxacin (Cipro), levofloxacin (Levaquin), and ofloxacin (Floxin)—and trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim). It’s important to continue your medication for the entire prescribed course, even if you are feeling better. This will help prevent your infection from returning.

To help ease any discomfort, try sitting in a hot bath, take stool softeners, and use over-the-counter pain relievers, such as aspirin or ibuprofen. Drinking plenty of fluids can help flush the bacteria from your system, too.

Chronic bacterial prostatitis

This type of prostatitis is also caused by bacteria. It’s more common in older men who have BPH. It sometimes follows a bout of acute bacterial prostatitis. Unlike the acute form, however, chronic bacterial prostatitis is a subtle, low-grade infection that can begin insidiously and persist for weeks or even months.

A man with chronic bacterial prostatitis usually doesn’t have a fever, but is troubled by intermittent symptoms such as a sudden urge to urinate, frequent urination, painful urination, or the need to get up at night to urinate. Some men have low back pain, pain in the rectum, or a feeling of heaviness behind the scrotum. Others have pain after ejaculation, and the semen may be tinged with blood. These symptoms wax and wane, and they are sometimes so understated that they aren’t noticeable.

Treatment requires the same antibiotics used for the acute form, usually for one to three months, but even with the prolonged treatment, the infection often recurs. If this happens, the recurrence can usually be controlled with another course of antibiotics.

Chronic nonbacterial prostatitis

Chronic nonbacterial prostatitis, also known as chronic pelvic pain syndrome is the most common form of prostatitis. Its symptoms resemble those of chronic bacterial prostatitis. Yet no bacteria are evident, and pinpointing a cause or causes has been difficult.

Research suggests that chronic nonbacterial prostatitis may result from a cascade of interconnected events. The initiating event may be stress, an undetectable infectious agent, or a physical trauma that causes inflammation or nerve damage in the genitourinary area. Over time, this may lead to heightened sensitivity of the nervous system. In other words, CP/CPPS may be an overactive pain syndrome. What’s more, some physicians and researchers are beginning to think that the condition may affect the entire pelvic floor—all of the muscles involved with bowel, bladder, and sexual function—not just the prostate gland.

Because men often suffer from multiple symptoms simultaneously—such as pain and difficulty urinating—they may require several types of medication or other therapy, depending on the pattern of symptoms. These include antibiotics, Pain relievers, a medication to reduce the urge to urinate, a medication to ease urine flow by relaxing the muscles at the neck of the bladder, and even some alternative therapies such as myofascial release. (HarvardProstateKnowledge.org will explore treatments for chronic nonbacterial prostatitis/chronic pelvic pain syndrome in a future article.)

Asymptomatic inflammatory prostatitis

This is usually discovered during tests for another medical condition, such as infertility or other prostate disorders. White blood cells are present in the urine or prostate secretions, but there are no symptoms. With no symptoms and no known cause, it isn’t treated.