HisandHerHealth: Information About Sexuality, Prostate, Incontinence

The prostate is built like a sponge, with many pockets, called ascini. With all forms of prostatitis, these ascini become blocked and distended causing symptoms. Obviously, when bacteria are present, these blocked ascini become mini abscesses, like acne. It may be difficult to determine when bacteria are present, because they may be trapped in the ascini, and not easily obtained for identification, or may be very difficult to culture in the laboratory, especially if antibiotics have been recently taken. Similarly, some of these pockets may remain infected despite adequate antibiotic treatment causing the condition to recur.

Symptoms of prostatitis are very varied and many times non-specific: frequency of urination; increased voiding day or night; burning on urination; pain or ache in the penis, testicles, groins, lower abdomen or perineum, (behind the scrotum); low back pain; decreased sexual desire or function; pain on ejaculation; decreased volume or change in color of the semen; and sometime just chronic tiredness. Some patients complain of pain in the prostate or head of the penis on or after defecation or a urethral discharge following defecation. In some cases blood spotting on underwear or blood only at the beginning of urination may occur. Sometimes there is blood in the semen, which is from inflammation or infection of the seminal vesicles, the organs attached to the prostate that produce most of the semen fluid. Any combination of these symptoms can be found in different patients. A small number of patients will develop acute bacterial prostatitis with severe urinary symptoms, pain and high fever or possibly urinary retention. Some of these acute patients may require hospitalization.

Causes of prostatitis are varied. Bacteria are frequently showered into the body from many sources such as infections elsewhere, (like sinusitis), cuts and even simple daily activities like chewing, or moving your bowels. While the body's defenses usually clear these bacteria rapidly, occasionally they settle into areas like the prostate and cause a local infection. This can happen especially if some other problem such as inflammation or scarring exits.

The single most common cause leading to an attack of prostatitis is holding onto urine for a long time, as on a car or plane trip, or lifting or straining with a full bladder. This, high pressure situation forces urine into the tubes and ducts of the prostate, causing severe irritation, and making the prostate more susceptible to infection. Seasonal or dietary allergies may inflame the prostate causing symptoms and enabling it to be more easily infected. Sexually transmitted diseases such as gonorrhea or chlymidia may infect the prostate, and unprotected anal sex can cause bacterial contamination and infection. Prolonged sexual excitement without ejaculation may lead to painful, acute congestive prostatitis, easily relieved by ejaculation, but also resulting in inflammation and potential infection. Stress may lead to non-bacterial prostatitis or prostatosis, or worsen the symptoms of bacterial prostatitis.

Diagnosis of prostatitis is usually made by the history and symptoms, and by examination of the prostate by a digital rectal examination, (DRE). The prostate may be soft or boggy, or firm and lumpy. When the prostate is firm or lumpy reexamination after treatment is extremely important, as lumps or nodules may represent prostate cancer. The normal prostate is slightly tender to the examining finger, but is usually significantly tender or painful when prostatitis is present. There may or may not be pus or white blood cells present in the urine or semen.

Some urologists rely on the three glass test, a test involving intermittent urine specimens separated by a prostatic massage, to try to separate bacterial from non-bacterial prostatitis, and prostatitis from lower urinary tract infections. However, although a positive test will diagnose a bacterial condition, a negative test may miss an infection due to bacteria being trapped in ascini, and not found in the prostatic fluid; "fastidious" or difficult to culture, bacteria being present in the samples; or recent antibiotic treatment blocking the laboratory's ability to culture the bacteria. Separating prostatitis from lower urinary tract infection, which may have similar symptoms, is not vital, as both require antibiotic treatment.

Patients with recurrent prostatitis may require a urinary tract evaluation with a cystoscopy, an internal visual examination, of the urethra, bladder and prostate to rule out urinary tract blockage or other conditions that may be causing the recurrences. Urinary tract x-ray examinations may also be needed in difficult cases.

Treatment of prostatitis is usually effective, though sometimes may require several or prolonged treatments. Not all antibiotics can get into the prostatic fluid, so choice of treatment is important. Treatment should start with a simple effective, inexpensive drug such as a tetracycline, sulfa or nitrofurantoin,for two to four weeks, and only after failure of the primary treatment, should progress to the more expensive quinolones. Frequently several different drugs must be tried before success is obtained.

Prostatic irritants, such as caffeine, alcohol and highly spiced, especially peppery, foods should be completely avoided during treatment, and only slowly reintroduced after resolution of the condition. If the patient is aware of other foods that induce symptoms, those too should be eliminated completely.

Prostatic drainage, usually by ejaculation, should be achieved two to three times a week. Two to three times a night is overuse, and harmful. Infrequently, a patient may require a prostatic massage by a urologist, to help drain the prostate, though this is an uncomfortable procedure not needed by the vast majority of patients.

Sitting in a hot bathtub or hot tub once or twice a day may relieve symptoms and help treat the problem. Other stress reduction techniques may help relieve symptoms, especially in those patients with non-bacterial prostatitis or prostatosis or a psychosomatic component to the condition.

Never, never hold urine for extended periods of time, and do not do lifting or straining with a full bladder, even if this requires breaking a workout to urinate. Withholding of ejaculation for prolongation of sex is also inadvisable.

Some patients, including those not responsive to antibiotics, or with non-bacterial prostatitis may require anti-inflammatory drugs. Others, especially those with chronic unremitting pain syndromes may require the antidepressant drugs that have proven to be effective in chronic pain syndromes.

Prognosis is usually excellent for treating bacterial and non-bacterial prostatitis. Unfortunately, like sinusitis, the condition is likely to recur. The recurrence may be only days or may be years later, but will probably happen. Most men may get a day or twos symptoms on occasion especially after violating the no-hold rule, or a dietary indiscretion. It is important to remember that virtually everyone gets occasional, short lived urinary symptoms, that are not of consequence. If the symptoms disappear in hours or a day or three, treatment is not necessary. However when the symptoms continue for longer they should be treated.The longer untreated symptoms continue, in terms of weeks or months, the more difficult it may be to treat the condition.