Prostatitis (male pelvic pain)

Prostatitis (male pelvic pain)

Overview. The prostate is a walnut-sized gland in males that sits in front of the rectum and below the bladder and is responsible for making part of the fluid for semen. Prostatitis, an infection or inflammation of the prostate, is the most common urologic problem in men younger than 50. It can cause painful urination and ejaculation and is often confused with other urinary tract infections. Although it can be associated with rising prostate-specific antigen (PSA) levels, it has no relationship to cancer.

Types. Prostatitis can be acute or chronic, and it may or may not be associated with bacterial infection of the prostate. Most commonly, prostatitis is not associated with detectable bacteria within the urine. Acute cases may produce severe complications and can even be fatal if not treated promptly. Chronic bacterial prostatitis is a recurrent infection, and it tends to produce less severe symptoms of inflammation.

Causes and Risk Factors. In rare cases, sexually transmitted infections (such as Chlamydia) can cause prostatitis. However, with the exception of sexually transmitted infections, prostatitis cannot be passed on to someone else. Although it is often not clear what caused the infection, certain risk factors for prostatitis and prostate pain have been identified, including being diabetic or having a suppressed immune system, having an enlarged prostate or a congenital urinary tract abnormality, engaging in rectal intercourse, and having recently had a urinary catheter inserted during a medical procedure. In addition, as many as half of men who have one episode of prostatitis will have another in their lifetime.

Symptoms. The symptoms of prostatitis include difficult, painful, or frequent urination; pain in the area of the bladder, groin, anus, and abdomen; inability to obtain an erection or pain during ejaculation; and fever and chills. Some men experience no symptoms. For those who do, the onset can be gradual (for chronic cases) or sudden (for acute cases). These symptoms do not necessarily indicate prostatitis.

Diagnosis: A detailed history and physical exam are key, and always should include a digital rectal exam, where the doctor inserts a gloved, lubricated finger into the rectum to feel the prostate and determine if it is tender or swollen. If prostatitis is suspected, urine samples are taken and analyzed.

Treatment. Treatment depends on the type of prostatitis. If caused by a bacterial infection, an extended course of oral antibiotics is often used. For acute infections, intravenous antibiotics and hospitalization may be required. When the prostatitis doesn’t appear to be caused by a bacterial infection, antibiotics are often still effective, as for some men, the bacterial infection can remain “hidden” within the gland tissue of the prostate and may not be detected within the urine. Additional treatment strategies include over-the-counter nonsteroidal anti-inflammatory medicines or prescription pain medications to reduce swelling. The use of stool softeners, drinking lots of fluids, and soaking in hot baths also commonly provide relief.  For the most part, treatment of prostatitis is aimed at providing symptomatic relief until the associated discomfort subsides.

  

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Associate Professor of Urology