Overview. Prostatitis, an infection or inflammation of the prostate, is the most common urologic problem in men younger than 50, responsible for more than 2 million patient visits per year in the United States . 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. 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 can be in the form of an acute or chronic bacterial infection; more often, the inflamed prostate can occur without a bacterial infection. Acute cases may produce severe complications and can even be fatal if not treated promptly. Chronic bacterial prostatitis is a recurrent infection and inflammation that tends to produce less severe symptoms. Prostatitis symptoms can also occur with neither inflammation nor an infection – a condition known as prostatodynia, or chronic pelvic pain syndrome.
Causes and Risk Factors. In rare cases, sexually transmitted infections (such as Chlamydia) can cause prostatitis, but prostatitis cannot be transmitted to someone else. Although it is often not clear what caused the infection, certain risk factors 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 lower back, groin, anus, abdomen, or upper thighs; 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 involves a history and physical exam, including a digital rectal exam in which 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, including one taken after a prostate massage is performed, in order to release prostatic fluids in the urine.
Treatment. Treatment depends on the type of prostatitis. If caused by a bacterial infection, antibiotics are used. For acute infections, intravenous antibiotics and hospitalization may be required. When the prostatitis doesn’t appear to be caused by an infection, antibiotics may still be applied in case there is a hidden infection, but for the most part treatment in such cases is aimed at providing symptomatic relief until the problem subsides. Strategies include over-the-counter nonsteroidal anti-inflammatory medicines or prescription pain medications to reduce swelling, stool softeners, drinking lots of fluids, and soaking in hot baths. Although rarely indicated, in the most severe cases of chronic bacterial prostatitis or prostatodynia, surgical removal of part of the prostate may be the best option.
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