Prostatitis Health Article

Definition

Prostatitis is an inflammation of the prostate gland, a common condition in adult males. Often caused by infection, prostatitis may develop rapidly (acute) or slowly (chronic).

Description

Prostatitis may be the symptom-producing disease of the genitourinary tract for which men most often seek medical help. About 40% of visits to a specialist in genitourinary problems (urologist) are for prostatitis. Forms of prostate inflammation include acute and chronic bacterial prostatitis and inflammation not caused by bacterial infection. A painful condition called prostatodynia, which may be caused by abnormal nerves or muscles in the region, is also thought to be a form of prostatitis. The chronic bacterial form is sometimes experienced by men whose sex partners have a bacterial infection of the vagina, making this a sexually transmitted disease. Other cases occur when small stones form within the prostate and become infected. Sometimes infection is caused by poor hygiene, surgical procedures, or even swimming in polluted water.

The sexually transmitted disease gonorrhea may sometimes cause prostatitis, and tuberculosis may spread to the prostate. Parasites and fungi may infect the prostate gland. Some men whose prostatitis is not caused by any microorganism have microscopic collections of cells called granulomas in their prostate tissue. Whether viruses also may cause prostatitis is debatable.

Causes and symptoms

However the inflammation may begin, it causes blockages in the tiny glands within the prostate so that secretions build up, and the prostate swells. In acute cases, this swelling can occur very suddenly and cause considerable pain. When prostatitis develops gradually, trouble with the flow of urine may be the first symptom. Small stones may form, because the body attempts to neutralize bacteria by coating them with calcium. These stones may become infected themselves and make the condition worse.

Symptoms and signs that are typically experienced by men with prostatitis include:

• Difficulties in urinating. Most urinary problems are caused when the swollen prostate blocks the tube that carries urine from the bladder to the outside of the body (urethra). Patients feel the need to urinate more often than usual, often urgently. Urination is sometimes painful. It is hard to start the flow of urine and difficult to totally empty the bladder. Patients wake up at night to urinate. The stream may be weak or split. Dribbling after attempts to urinate may leave embarrassing wet spots on clothing. In severe prostatitis blood or sand-like particles (small calcium collections) may be passed in the urine.
• Pain. Besides pain when urinating, caused by prostate swelling, stimulation of nerves in the prostate gland may cause pain in the penis, one or both testicles, the lower stomach, the low back, and the area between the scrotum and the anus (perineum). Some patients experience pain during or after ejaculation, whenever they sit down or walk, or during bowel movements.
• Sex and fertility. The pain of prostatitis can make it impossible to enjoy sex. Men with prostatitis may be troubled by early release of sperm (premature ejaculation). Occasionally there is blood in the semen. Some of the drugs prescribed to ease the flow of the urine can dampen the desire to have sex. Because the normal prostate secretions make up part of the semen, prostatitis may lower fertility by severely lowering the number of sperm and making them less mobile.
• Psychological problems. A man with prostatitis who feels that nothing can be done and he "just has to live with it" may experience serious depression. Low sexual desire certainly contributes to depression.

A person with acute prostatitis may suddenly develop fever and chills, along with rapidly developing urinary symptoms and pain in the perineum or low back. This state is a medical emergency that demands immediate medical help.

Diagnosis

Most often the symptoms and physical findings are enough to form a diagnosis of prostatitis. When the examiner inserts a finger in the rectum, the swollen prostate can be felt; it may be extremely tender when probed. Squeezing the gland slightly will produce a few drops of fluid that may be cultured to learn whether bacteria are present. The fluid typically contains a large number of white blood cells, especially the cells used to fight off infection (macrophages). Note: too much pressure on the prostate can force bacteria into the blood and cause a serious general infection. Many patients with chronic bacterial prostatitis also have recurring urinary tract infections (diagnosed by examining and culturing urine samples). These infections can be an important clue to the diagnosis. If doubt remains, the urologist may insert a special instrument called a cystoscope through the penis to directly view the prostate from inside and see whether it looks inflamed.