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Prostatitis
Health Guide
What is prostatitis?

Prostatitis refers to the condition in which there is inflammation of the prostate gland.

What causes prostatitis?

Bacterial prostatitis

Is caused by a bacterial infection of the prostate gland. Bacteria get into the prostate either by ascending the urinary tract, or when infected urine refluxes into the ducts of the prostate. Bacterial prostatitis may be either acute (sudden) or chronic. Chronic prostatitis is sometimes caused by an infected stone blocking one of the ducts of the prostate gland.

Non-bacterial prostatitis

Is the other form of the illness. It is not known what causes inflammation of the prostate gland in this scenario. One theory is that a muscle spasm in the bladder neck causes higher pressure in the urinary tract – forcing urine into the ducts of the prostate and causing a chemical irritation of the gland.

What are the symptoms?

In an attack of acute bacterial prostatitis the patient may experience abrupt onset of :


  • High fever.

  • Chills, shaking, shivering.

  • Generally unwell with muscle aches sometimes accompanied by nausea and vomiting.

  • Pain in and around the base of the penis, lower back, or groin.

  • Difficulty and/or pain on urination with increased frequency and urgency of urination.


Chronic prostatitis is a much more subtle illness. It is characterised by repeated urinary tract infections. The patient may experience deep pelvic pain, and urinary symptoms of difficult, painful or frequent urination.

In non-bacterial prostatitis there is no evidence of bacteria in the urine, and no history of urinary tract infection. The patient may complain of:


  • Deep pain in the pelvic and lower back regions.

  • Urinary symptoms – diminished stream, hesitancy, pulsatile flow or dribbling of urine.

  • Painful erections or pain after ejaculation


Epidemiology


  • By the time men reach 80 years of age, up to 25% could have developed prostatitis

  • Prostatitis is most common in adult men. It rarely occurs before puberty.

  • 5-8% of men are thought to have prostatitis at any one time.

  • It is the most common disease of the urinary tract in men of less that 50 years of age.


How is it diagnosed?

Although the above symptoms are fairly dramatic and characteristic, it may be difficult to distinguish infection of the prostate from an infection of the urinary tract or bladder. It is usually necessary to do laboratory tests of the urine sample by different techniques to try to identify the site of infection. Collecting fluid after prostatic massage for analysis assists in establishing the diagnosis.

The prostate gland feels large, warm and very tender when felt by doing a rectal examination by a finger inserted in the anus.

In chronic prostatitis, or when the presentation of the illness is not typical, it may be necessary to employ other diagnostic techniques including:


  • Examining a piece of prostate tissue under the microscope (biopsy).

  • Measuring antibodies in the prostatic fluid

  • Semen analysis.

  • Video studies of the process of urination.

How is it treated?

Acute bacterial prostatitis

This usually responds dramatically to antibiotics. It is usually necessary to take a prolonged course of antibiotics (for up to 4 weeks) If the patient is very sick, they may need to be admitted to hospital for antibiotics to be administered through a vein, directly into the circulation. Pain relief, and stool softeners are used to relieve discomfort in the anal region. If urine is retained, a catheter will need to be inserted to drain the urine.

Chronic bacterial prostatitis

If the infection fails to resolve with t

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