Inflammation of the Prostate (Prostatitis)

Prostatitis is probably the most common prostate disorder, responsible for almost two million visits to the doctor in the United States each year and accounting for a quarter of all urinary or genital complaints by young and middle-aged men. Yet, little is known about the disorder. In fact, the term prostatitis, which translates to inflammation of the prostate, refers to a loose assemblage of syndromes characterized by urinary trouble, like burning or painful urination, and pelvic discomfort. Although it causes some of the same symptoms, prostatitis differs from an enlarged prostate (or BPH). However, it is possible to have both prostatitis and BPH at the same time.

Symptoms of prostatitis There are a number of types of prostatitis. The symptoms vary from type to type, and their severity differs from person to person. Common symptoms include: difficult, painful, or burning urination difficult, painful, or burning ejaculation pain in the perineum (the area between the scrotum and the anus) or the lower back.

What is prostatitis?

Some types of prostatitis are caused by bacterial infection. These conditions are often accompanied by the classic symptoms of infection, such as fever, chills, and muscle pain, as well as by urinary problems. As a result, they are relatively easy to diagnose and treat, usually responding well to antibiotics. However, such straightforward forms of prostatitis are rare. A study in the journal Urology suggests that bacteria are responsible for fewer than 10% of all cases of prostatitis.

Researchers simply don’t know what causes the remaining 90%. Little research has been done in this area, but potential culprits include difficult-to-detect bacteria, such as chlamydia and staphylococcus, immunological and inflammatory processes, depression and stress, and mechanical or neuromuscular problems in the pelvic muscles that irritate the general area. Indeed, as the last point illustrates, it’s not even known whether the disorder necessarily involves the prostate gland itself. This uncertainty makes the treatment of prostatitis often frustrating and occasionally impossible.

Prostatitis affects men of all ages, although it seems to be rare in prepubescent boys and most common in young to middle-aged men. Some doctors are concerned that prostatitis — especially the chronic variety, characterized by long-lasting bacterial infection — could interfere with fertility, although this is unproved. On the other hand, whatever the form, prostatitis doesn’t appear to increase your risk for prostate cancer, nor is it contagious. As far as we know, it can’t be transmitted sexually.

Diagnosing prostatitis

No single test or diagnostic procedure can confirm a case of prostatitis. Instead, if you experience urinary discomfort, like painful or burning urination or pain in the pelvic area, your doctor will look for signs of inflammation and infection by performing a digital rectal exam (DRE), getting a urine sample, and perhaps testing your prostate’s secretions.

An inflamed prostate feels swollen and mushy to the doctor, like an overripe piece of fruit. This finding strongly suggests prostatitis, although it’s not necessary for a diagnosis. In the variant of the disease known as prostatodynia, the gland feels normal.

The DRE is usually followed by a simple urine test to check for bacteria and white blood cells, which indicate an infection. If both bacteria and white blood cells are found, your condition is probably one of the bacterial forms. If only white blood cells are discovered, which is usually the case, you may have one of the nonbacterial types.

If no signs of infection or inflammation are found in your urinalysis, your doctor may want to test your prostate’s secretions directly. Doctors generally resort to this procedure only when necessary.

Treating prostatitis

The National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health, classifies prostatitis into four types, each with its own treatment approach.

Prostatitis: What’s your type?
Category	Definition	Symptoms	Comments
Type I (acute bacterial prostatitis)	Acute infection of the prostate.	Chills, fever, body aches, fatigue, pain in the lower back and genital area, urinary frequency and urgency (often at night), burning or painful urination and ejaculation.	Rare, but responds well to antibiotics.
Type II (chronic bacterial prostatitis)	Recurrent infection of the prostate.	Same as above, but symptoms often less pronounced.	More common and usually treatable with antibiotics, although the infection can be persistent.
Type III (chronic nonbacterial prostatitis/ chronic pelvic pain syndrome)	No demonstrable infection. Type IIIA (inflammatory): white blood cells in urine or prostate secretions. Type IIIB (noninflammatory): no white blood cells found in urine or prostate secretions.	Pain in the lower back and genital area, urinary frequency and urgency (often at night), burning or painful urination and ejaculation.	Represents more than 90% of all cases of prostatitis. No known cause. No clinically proven treatments. Type IIIA has signs of inflammation and tenderness. Type IIIB shows no signs of inflammation or tenderness.
Type IV (asymptomatic inflammatory prostatitis)	White blood cells are present, but not accompanied by any symptoms.	None.	Treatment usually unnecessary.
Adapted from: Executive Summary: Chronic Prostatitis Workshop, National Institute of Diabetes and Digestive and Kidney Diseases.