Prostatitis

The prostate is located between the bladder and the urethral sphincter, in front of the rectum and behind the pubic bone. It surrounds the urethra and is responsible for production of most of the fluid found in semen. Prostatitis, an inflammation or infection of the prostate gland, is a common and usually painful condition that can affect men of all ages. Up to 50 percent of all men experience prostatitis-like symptoms at some point during their lifetimes.

Prostatitis is the most common condition urologists deal with in men under 50 years of age, but it is one of the most challenging conditions to diagnose and manage. Columbia Urology offers an array of treatment options for men with prostatitis. Since no two patients are the same, we tailor an individual treatment plan for each patient that takes into account their pain, disability, work schedule, and lifestyle.

Symptoms of Prostatitis

The symptoms of prostatitis vary tremendously and are similar to those of painful bladder syndrome. Symptoms can include:

• Burning at the tip of the penis
• Groin heaviness
• Pubic pain
• Urethral irritation
• Low back pain
• Radiating leg pain

Diagnosis of Prostatitis

As part of the evaluation, patients undergo a history and physical exam, including a digital rectal exam, and blood and urine tests. Doctors may examine the bladder and prostate with a cystoscope (a long flexible telescope that is inserted through the urethra), and use radiographic tests such as ultrasound, CT, and MRI to rule out other causes of pain. In patients with lower urinary tract symptoms they may perform urodynamic studies, which assess how well the bladder and urethra store and release urine.

There are four categories of prostatitis:

• Category I: acute bacterial prostatitis: Patients with this form of prostatitis typically have fever, chills, and lower urinary tract symptoms including blood in the urine, burning, frequency, and/ or difficulty urinating or inability to urinate at all. A urinalysis shows inflammatory cells and a urine culture will eventually grow a specific bacteria. Antibiotic therapy is highly effective. Sicker patients require hospitalization and intravenous antibiotics.
• Category II: chronic bacterial prostatitis: Doctors diagnose chronic bacterial prostatitis in men with recurrent urinary tract infections that are isolated to the prostate gland. Treatment involves a four- to six-week course of an antibiotic that is well concentrated in the prostate. Men with chronic bacterial prostatitis are usually symptom-free unless they have a urinary tract infection.
• Category III: chronic abacterial prostatitis: This is the most common form of prostatitis, and it is usually referred to as Chronic Pelvic Pain Syndrome (CPPS). Men with CPPS have varied symptoms including pain in the penis, testicles, scrotum, prostate, and rectum as well as frequency, urgency, and pain with ejaculation. Men with burning or pain in the pelvis or urinary tract, and lower urinary tract symptoms, usually do not have bacteria in their urine or prostate.
  Doctors have traditionally treated these patients with a four-week course of antibiotics, but this is often ineffective. Many men with CPPS have an abnormality of the pelvic floor musculature (including excess tension), and pelvic floor therapy often provides excellent symptom relief. A complete evaluation can rule out other problems with similar symptoms.
• Category IV: asymptomatic prostatitis: This type of prostatitis is often detected on prostate biopsy or semen analysis. Patients are typically without symptoms and no treatment is necessary.

Treatment for Prostatitis

Despite the challenge inherent in managing chronic pelvic pain, many patients can be treated successfully using a multidisciplinary approach including:

• Behavioral changes such as avoiding food and beverages that exacerbate symptoms.
• Anti-inflammatories can help alleviate significant discomfort in men with active and chronic prostatic inflammation.
• Antibiotics are often used by doctors to treat acute and chronic bacterial prostatitis.
• Alpha blockers (Flomax, Uroxatral, Cardura, Hytrin) are medications that help relax the muscle in the bladder neck and the prostate.
• Pelvic floor muscle therapy/biofeedback to relieve pain in men with CPPS.
• Acupuncture is used at The Center for Prostate Health and Male Voiding Dysfunction to help relieve pain in men with CPPS.