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Prostatitis - A Patient's Guide

This guide is to help men better understand what prostatitis is all about and how to deal with it in the most effective way.

Please do not use this guide for self diagnosis. You should always consult your doctor before attempting any kind of treatment.

  1. What is the prostate gland?

  2. What is Acute Prostatitis?

  3. What is Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)?

  4. What causes Chronic Prostatitis?

  5. How do we diagnose Prostatitis?

  6. If I am diagnosed with Chronic Prostatitis, what treatment options are available?

What is the Prostate Gland?

The prostate is a gland about the size and shape of a walnut. It is situated just underneath the urinary bladder (just under bladder neck) and surrounds a portion of urethra (prostatic urethra). The urethra is a tube that allows the passage of urine from the bladder through the penis when you pee.

The prostate gland consists of hundreds of tiny glands (acini) that secrete a fluid called prostatic fluid. Numerous tiny channels (prostatic ducts) merge into larger ducts (like creeks into a river) and drain prostatic fluid into the urethra. The entire prostate is surrounded by smooth muscles that cannot be controlled by will.

Prostatic fluid gets squeezed out during ejaculation with the help of muscular contractions, and mixes with other fluids to make the semen. This prostatic fluid consists of many elements that help to make the sperm fertile.

The prostate gland is a hormone-dependent organ. Prostate development and function are influenced by the male hormone testosterone. This hormone is mainly produced by the testicles and released into the bloodstream. Once the testosterone enters the prostate it promotes prostate growth. Without testosterone, the prostate gland shrinks to a fraction of its normal size.

We often see low levels of testosterone in men aged 40 or older. Low testosterone levels may, in turn, affect the function of the prostate, lead to sexual dysfunction or be responsible for a number of other health problems. In general terms, this is referred to as Andropause.

Most common prostate problems:

  • Prostatitis (inflammation of the prostate)
  • Benign Prostatic Hyperplasia (BPH)
  • Prostate cancer

Prostatitis is divided in two major categories: Acute Prostatitis and Chronic Prostatitis (CP).

What is Acute Prostatitis?

Acute Prostatitis is not very common in modern western society. Usually it affects younger men who have never had any prostate problems. Symptoms of acute prostatitis include pain in the lower pelvic area, testicles and perineum (area between scrotum and anus), high fever and the frequent urge to pee, accompanied by a burning sensation. Occasionally, a swollen prostate blocks the urinary passage, making it difficult for you to pee even though you have a full bladder. This condition is referred to as Acute Urinary Retention (AUR).

Acute prostatitis occurs when bacteria are introduced into the prostate. Bacteria may reach the prostate from the urinary tract or travel via the bloodstream from other areas such as the lower portion of large bowel (rectum), gallbladder, infected teeth or gums.

If you develop any of these symptoms, you should see a doctor as soon as possible. This condition can be cured with prompt treatment using antibiotics.

If you develop Acute Urinary Retention (AUR), you need to be treated immediately in a hospital. A catheter will be inserted into your bladder through the penis to relieve the obstruction. This may be followed up by several weeks of antibiotics. With proper treatment, you can be completely cured after a few weeks of therapy. Chronic Prostatitis patients require a longer, more comprehensive treatment.

What is Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)?

This is a very common condition worldwide. It has been suggested that up to 25 per cent of all men have experienced symptoms of prostatitis at some point in their lives. At any one time, about 10 to 14 per cent of men in the community experience some prostatitis-like symptoms.

Prostatitis symptoms include:

  • Pain
    If you have CP, you may experience a dull, throbbing pain, a sensation of irritation or heaviness. It may be located anywhere in the lower pelvic region (groin, pubic area, perineum, and lower back), genitals (penis, scrotum). Sometimes it travels to hips, thighs or upper abdomen. Usually the pain comes and goes, and varies in intensity. You may have "good" days alternating with "bad" days. You often don't know what has triggered a "bad" day.
  • Voiding
    The most common symptoms are: frequent and urgent need to pee, burning when you pee, weak flow, feeling of an inability to empty your bladder completely, and the need to get up more frequently than normal at night to pee. These symptoms often interfere with daily activities.
  • Sexual dysfunction
    You may also have difficulty getting and/or keeping an erection during sexual activity, and have low sexual desire.
    You may also experience rapid (premature) ejaculation, and pain or discomfort upon or soon after ejaculation. Up to 50 per cent of men with prostatitis symptoms complain about ejaculatory or post-ejaculatory pain.
  • General symptoms
    You may experience fatigue, lethargy, headaches, low energy level, aches and pains all over the body, particularly during "bad" days. You may also feel unhappy or depressed.
    Several surveys have confirmed that the quality of life among men suffering from prostatitis symptoms is very poor and can be compared to the quality of life of patients who suffer from severe health problems such as heart attack, unstable angina, Inflammatory Bowel Disease, congestive heart failure or severe form of diabetes.
  • Asymptomatic prostatitis
    Some men with inflamed prostates do not have any symptoms. They are usually diagnosed with prostatitis while being checked for something else such as an elevated Prostate-specific Antigen (PSA), which is a blood test to screen for prostate cancer, BPH (Benign Prostatic Hyperplasia), or male infertility.

What Causes Chronic Prostatitis?
Unfortunately, it is not known exactly what causes chronic prostatitis. The oldest and most widely accepted theory suggests that chronic prostatitis is caused by a bacterial infection. Others have suggested that prostatitis may be due to autoimmune conditions or chemical irritation of the prostate. Most likely, there is no single cause of prostatitis but rather multiple conditions that lead to an inflammation of the prostate resulting in chronic prostatitis.This theory is supported by patients responding well to antibiotics.

Nevertheless, there are many men who do not respond well to antibiotics. In these cases, we need to look for other potential causes to the problem or factors that may predispose men to this painful condition.

Here is a list of other possible causes and contributing factors:

  • Possible anatomical abnormalities within urogenital tract (e.g. tight bladder neck, urethral narrowing, tight/inflamed foreskin, BPH)
  • History of sexually transmitted diseases (Gonorrhea, Chlamydia, Trichomoniasis, etc.)
  • Sexual behaviours (engagement in unprotected sex with multiple sexual partners, excessive sexual activities)
  • Gastro-intestinal disturbances (Irritable Bowel Syndrome, colitis, constipation, etc.)
  • High stress level (marital discord, unemployment, demanding job, etc.)
  • History of mechanical trauma to the lower pelvis area (excessive cycling, boating, operating heavy machinery, and/or horseback riding)
  • Overall compromised immune system due to other chronic illnesses and/or medications

In addition, there are a number of factors that may make prostatitis symptoms more severe. These include:
  • Dietary habits (spicy, marinated or pickled foods)
  • Consumption of alcohol, caffeinated beverages
  • Stress
  • Some sport activities (cycling, running, heavy weightlifting)
  • Excessive sexual activities

We have listed just a few important factors that can play a role in prostatitis and prostatitis-like symptoms. A thorough assessment by your doctor is necessary to determine what particular factors are relevant in your case.

How do we diagnose prostatitis?
One of the most important tools for diagnosing prostatitis is a detailed history of your symptoms, medical history, sex life, lifestyle, and dietary habits. These are very important and help the clinician choose the potential therapies.

A focused physical examination of external genitalia and pelvic area may provide your physician with many clues.

The next step is to have your prostate gland examined by performing a Direct Rectal Examination (DRE). A physician inserts a lubricated, gloved finger into your rectum and examines the prostate, which lies very close to the surface of the rectal wall. This exam is important because your doctor can often establish a diagnosis by assessing the shape, texture and the size of the prostate. Urine samples are usually collected before and after the prostate examination. The results of these tests may help to determine whether you have a problem in your urethra, your prostate or your bladder.

In order to make the diagnosis even more accurate, the prostate is gently pressed using a special technique. This can yield some prostatic fluid from the opening in the urethra at the tip of the penis. This fluid is examined under the microscope in order to identify cells of inflammation or other clues, and/or is sent to the lab for further testing.

Please be aware that the latter tests usually are performed in specialized urology clinics as are other, more invasive procedures such as a Cystoscopy, where the doctor looks inside your urethra and bladder in order to rule out possible abnormalities within the lower urinary tract (e.g. urethral narrowing, Urethritis, bladder tumor, etc.).

If your physician has trouble diagnosing prostatitis or the symptoms do not exactly fit the prostatitis profile, you may be asked to undergo other specialized tests or referred to another specialist.

If I am diagnosed with Chronic Prostatitis, what treatment options are available?
The good news is that there are a variety of treatments available, both traditional and non-traditional. The challenge is to identify the best treatment for you.

If bacteria are the cause of your symptoms, antibiotics would be the first line of therapy. They could be combined with an anti-inflammatory medication, and prostatic massages/drainages (as described earlier).

If you are having problems peeing, alpha-blockers are often prescribed. They help to relax the smooth muscles within the prostate and the bladder neck, and therefore, improve your ability to pee.

If you have constant pain in the perineum as well as trouble peeing, you may have pelvic floor muscular tension. In this case, you may benefit from physiotherapy, stretching exercises, yoga, biofeedback and acupuncture. Please remember that it is very important to be thoroughly assessed before embarking on alternative therapies.

Phytotherapy (herbal therapy) is growing in popularity. There is a long list of herbal remedies suggested for CP. The best known are: Saw Palmetto, Pygeum Africanum, Quercetin, Flower Pollen Extract, Stinging Nettle, Pumpkin Seed Extract and Uva-Urzi.

We have found that this kind of therapy is most helpful in cases where your symptoms are mild and you only need therapy to make the prostate healthier. Phytotherapy usually requires a few months of continuously taking supplements.

Lifestyle adjustments and diet are two of the most important factors in ensuring a healthier environment for the prostate. As examples, we often suggest that men reduce coffee intake, reduce stress, and avoid citrus fruits. In order to determine what type of adjustments you might require, please consult your doctor.

You may wonder how it is possible that one small gland can inflict so much misery on so many men. We know that prostatitis does not kill, but it can make life quite unpleasant. Since the beginning of the 20th Century, many physicians have regarded the prostate as a second heart in men. That statement is still valid. We need to maintain good prostate health just as we try to maintain good heart health.

For more information, please contact:

Ilia Kaploun
Clinical Trials Nurse
Prostatitis Clinic
Murray Koffler Urologic Wellness Centre
416-586-4800 ext. 3982