Prostatitis

(Acute or Chronic Bacterial Prostatitis; Chronic Non-Bacterial Prostatitis)

Prostatitis is an infection or inflammation of the prostate. This is the plum-shaped gland that surrounds the neck of the male bladder and urethra, the tube that transports urine during voiding.

Symptoms of prostatitis include low back pain and an urgent and frequent need to urinate, even during the night, with difficulty in starting the urine flow and in emptying the bladder completely. Urination and ejaculation often produce pain or burning; there also may be blood and bacteria in the urine. Acute bacterial prostatitis is often accompanied by chills, fever, and achy joints and muscles.

Of the two basic types, chronic nonbacterial prostatitis is the more common; its cause is unknown. Bacterial prostatitis, which can be chronic or acute, is often due to organisms found in feces. These may reach the prostate through the bloodstream, the lymph system, or the urethra. Young men and those with urinary catheters are most often affected. There has been speculation that a vasectomy increases vulnerability to prostatitis, but this has not been established.

Diagnostic Studies and Procedures

Generally, several urine samples will be obtained -- one from the beginning of the first voiding of the day, a second from urination at midstream, and a third following examination and massaging of the prostate. These will be studied for the presence of white blood cells and also cultured for bacteria.

A doctor will perform a digital rectal exam by inserting a gloved finger into the rectum to palpate the prostate. Pain experienced during this examination indicates that the prostate is inflamed. The gland itself may feel swollen and warm, and gently massaging it may force prostate secretions into the penis. A culture of these secretions can also determine whether or not the cause is bacterial and, if so, identify the infecting organism. An ultrasound examination and other diagnostic tests may be performed to rule out cancer.

Medical Treatments

Acute bacterial prostatitis is most often treated with antibiotics, usually trimethoprim and sulfamethoxazole (Bactrim, Septra, and others) or a cephalosporin. Treatment, which may include both the oral and intravenous forms, is sometimes continued for 30 days or longer in order to prevent chronic prostatitis.

If the prostate is so swollen that it blocks urinary flow, the bladder may be drained with a procedure called cystectomy, in which a surgical opening is made into the bladder just above the pubic bone. Cystectomy is preferred to catheterization (inserting of a tube), as the latter carries the risk of introducing bacteria into the urethra.

Hospitalization might be necessary in serious cases, especially if bacteria have invaded the bloodstream. Occasionally, surgery may be required to drain an abscess of the prostate or even to remove pan of the gland.

Chronic bacterial prostatitis almost always involves recurring urinary tract infections. Antibiotics are usually prescribed, but even prolonged treatment often does not eradicate the source of the infection.

Chronic nonbacterial prostatitis is quite difficult to treat, although some patients do benefit from antibiotics. In such cases, researchers theorize that chlamydia or some other sexually transmitted organism may be responsible for the infection, but evidence for this is lacking. As a rule, treatment is aimed at alleviating symptoms with painkillers and anticholinergic drugs, agaiis that relax the muscles and block spasms that cause pain and retention of urine in the bladder.

Alternative Therapies

Certain alternative therapies can ease symptoms of prostatitis and may help prevent recurrent attacks.

Herbal Medicine. The extract and flower pollens of saw palmetto are popular European herbal remedies for prostatitis and they are gaining popularity among American herbalists. A decoction made by simmering equal amounts of gravel root, sea holly, and hydrangea root is said to alleviate chronic prostatitis. Buchu, a diuretic herb, also may be beneficial. Goldenseal root, parsley, juniper berries, uva-ursi, slippery elm bark, and ginseng are all used by Western herbalists to help relieve the symptoms of prostate problems.

Hydrotherapy. Sitting in a hot tub, particularly a whirlpool bath, is helpful in alleviating the discomfort of nonbacterial prostatitis. The usual procedure is to sit in 6 to 8 inches of warm to hot' water for about 15 minutes at least 3 three times a day.

Naturopathy and Nutrition Therapy. It's best to avoid alcohol, caffeine, and ll spicy foods, which cause bladder and urethral irritation and can further aggravate prostatitis. Some nutritionists advise eliminating acidic foods such as tomatoes. They may also recommend zinc supplements or unsweetened cranberry juice, especially for chronic prostatitis accompanied by cystitis.

Self-Treatment

Drinking two to three quarts of water daily will stimulate urine flow and help prevent cystitis, inflammation of the urinary bladder. Bed rest is important during an acute attack. Aspirin, acetaminophen, or ibuprofen can be taken to alleviate pain.

Doctors generally advise abstaining from sexual intercourse until symptoms have disappeared completely.

Other Causes of Urinary Symptoms

An enlarged prostate and prostate cancer produce symptoms similar to those of prostatitis. Urethritis and cystitis also can cause difficult and painful urination.