The term prostatitis is applied to a series of disorders, ranging from acute bacterial infection to chronic pain syndromes, in which the prostate gland is inflamed. Patients present with a variety of symptoms, including urinary obstruction, fever, myalgias, decreased libido or impotence, painful ejaculation and low-back and perineal pain. Physical examination often fails to clarify the cause of the pain. Cultures and microscopic examination of urine and prostatic secretions before and after prostatic massage may help differentiate prostatitis caused by infection from prostatitis with other causes. Because the rate of infection is high, a therapeutic trial of antibiotics is often in order even when patients do not appear to have bacterial prostatitis.
One author has described prostatitis as "a wastebasket of clinical ignorance" because so many poorly characterized syndromes are diagnosed as prostatitis. The spectrum of prostatitis ranges from straightforward acute bacterial prostatitis to complex conditions that may not even involve prostatic inflammation. These conditions can often be frustrating for the patient and the clinician. If the patient responds to therapy, antibiotics are continued for at least three to four weeks, although some men require treatment for several months. A patient who does not respond might be evaluated for chronic nonbacterial prostatitis, in which nonsteroidal anti-inflammatory drugs, alpha-blocking agents, anticholinergic agents or other therapies may provide symptomatic relief.
Treatment of Prostrate Infection
There are a number of "tips" for relieving symptoms of prostatitis. Several treatments are especially helpful early on, before antibiotic methods have a chance to cure infection, or for patients with chronic or non-bacterial prostatitis:
- Hot sitz baths and nonsteroidal anti-inflammatory drugs (NSAIDs) may provide some symptom relief. Some men may notice aggravation of symptoms with intake of alcohol or spicy foods and, if so, should avoid them. In men with irritative voiding symptoms, anticholinergic agents or alpha-blocking agents may be beneficial.Reassurance can be helpful for these men, and it's important that they know their condition is neither infectious nor contagious and isn't known to cause cancer or other serious disorders. Some men benefit from counseling and other approaches helpful in chronic pain syndromes. Exposing the perineum to very hot water for 20 minutes or longer often relieves pain as well.
- A small, randomized controlled trial of allopurinol (Zyloprim) found potential benefit, but the study didn't have either enough study subjects or adequate design to demonstrate a convincing benefit. Other therapies, such as thrice weekly prostate massage, have been proposed, although the supportive data are limited.
Transurethral microwave thermotherapy did relieve symptoms in a small, randomized control trial. Valium (diazepam) worked about as well as minocycline in one small trial; however, patients taking valium received more courses of antibiotics in follow up. Other reported, but untested, therapies include biofeedback, relaxation techniques and muscle relaxants.
- Ice. When heat does not help, ice packs, or simply placing a small ice cube in the rectum, may relieve pain for hours.
- Water. A patient who has to urinate very often may want to cut back on his fluid intake, but this will cause dehydration and increase the risk of bladder infection. Instead, it is best to drink plenty of water.
- Diet. Most doctors recommend cutting out—or cutting down on—caffeine (as in coffee or tea), alcohol and spicy or acidic foods. Constipation should be avoided because large, hard bowel movements may press on the swollen prostate and cause great pain. Bran cereals and whole-grain breads are helpful.
- Exercise. It is especially important for patients with chronic prostatitis to keep up their activity level. Simply walking often will help (unless walking happens to make the pain worse).
- In all seriousness, frequent ejaculation can help alleviate the symptoms of prostatitis. Ejaculating two or three times a week often is recommended, especially when taking antibiotics.
- Nonbacterial prostatitis requires other measures to relieve urinary symptoms. These measures include drugs that fight inflammation (steroids or nonsteroids) and a type of drug called an alpha-blocker that reduces muscle tension. Reduced muscle tension eases urine flow, allowing the bladder to empty.A narrowed urethra may be widened by placing a collapsed balloon at the site of obstruction and expanding it. This procedure is called balloon dilation. The effects of such dilation are usually temporary. Some physicians believe that stress is an important factor in prostatitis, and therefore prescribe Valium (diazepam) or another tranquilizer. The type of prostatitis known as prostatodynia is usually treated with a combination of muscle relaxing drugs, heat, special exercises and sometimes a tranquilizer.
- Men at increased risk for sexually transmitted disease might benefit from medications that also cover Chlamydia infection. Medications that are labeled for treatment of prostatitis include carbenicillin (Miostat), cefazolin (Ancef), cephalexin (Keflex), cephradine (Velosef) and minocycline (Minocin). Most experts recommend that treatment of acute bacterial prostatitis be continued for three to four weeks to prevent relapse.
- The duration of therapy has also not been well studied. If the patient is responding clinically and the pathogen is sensitive to treatment, most experts recommend that antibiotic therapy be continued for three to four weeks to prevent relapse, although a longer course is sometimes necessary. In a limited survey of primary practitioners and urologists, it was found that most of them use TMP-SMX as the first-line agent in treating prostatitis (of any type). About 40 percent of urologists and 65 percent of primary care physicians treated patients for only two weeks.
- Extremely ill patients, such as those with sepsis, should be hospitalized to receive parenteral antibiotics, usually a broad-spectrum cephalosporin and an aminoglycoside. Supportive measures, such as antipyretics, analgesics, hydration and stool softeners, may also be needed Some urologists place suprapubic catheters in patients who have severe obstructive symptoms from an acutely inflamed prostate gland.
- Acute prostatitis is first treated with antibiotics. Even though it may be difficult for drugs to actually get into the inflamed prostate, most patients do quickly get better. If intravenous antibiotics are needed or the bladder is retaining urine, a hospital stay may be necessary.Broad-spectrum antibiotics that work against most bacteria are used first. At the same time, tests are done with samples of prostatic fluid to determine which bacterium is causing the infection, so that drugs can be prescribed to fight the specific germ. In chronic cases, the best results are obtained with a combination of the antibiotics trimethoprim and sulfamethoxazole.Oral antibiotics should be given for 1–3 months; longer, if necessary. If a fungus or some other organism is causing infection, special drugs are available. If chronic prostatitis continues despite all medical efforts and is seriously affecting the patient's life, the prostate may be removed surgically.
- Although no test is diagnostic for acute bacterial prostatitis, the infecting organism can often be identified by culturing the urine. Initially, antibiotic selection is empiric, but the regimen can be modified once pathogen susceptibilities are available. Patients respond well to most antibiotics, although many cross the blood-prostate barrier poorly. The inflammation caused by ABP may actually allow better penetration of antibiotics into the organ.
- It's difficult to interpret the few controlled trials of antibiotic treatment for bacterial prostatitis because of poor case definition, low rates of follow up and small numbers. Based on case series and laboratory studies of antibiotic penetration in animal models, standard recommendations usually include the use of a tetracycline, trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim, Septra) or a quinolone.
- The possibility of a prostatic abscess should be considered in patients with a prolonged case that doesn't respond to appropriate antibiotic therapy. The examiner can often detect an abscess as a fluctuant mass on rectal examination. Computed tomography, magnetic resonance imaging or transrectal ultrasonography usually provide an adequate image of the prostate to evaluate for abscess. Transurethral drainage or resection is usually required.
Symptoms of Prostrate Infection
Men with this disease often have chills, fever, pain in the lower back and genital area, urinary frequency and urgency (often at night), burning or painful urination, body aches and a demonstrable infection of the urinary tract, as evidenced by white blood cells and bacteria in the urine. Acute prostatitis may be a complication of prostate biopsy.
Acute prostatitis is relatively easy to diagnose due to its symptoms that suggest infection. The organism may be found in blood or urine, and some times in both. Common bacteria are Escherichia coli, Klebsiella, Proteus, Pseudomonas, Enterobacter, Enterococcus, Serratia and Staphylococcus aureus. This can be a medical emergency in some patients and hospitalization with intravenous antibiotics may be required. A complete blood count reveals increased white blood cells.
Sepsis from prostatitis is very rare, but may occur in immunocompromised patients; high fever and malaise generally prompt blood cultures that are often positive in sepsis. A prostate massage should never be done in a patient with suspected acute prostatitis, since it may induce sepsis. Since bacteria causing the prostatitis is easily recoverable from urine, prostate massage isn't required to make the diagnosis. Rectal palpation usually reveals an enlarged, exquisitely tender, swollen prostate gland that's firm, warm and, occasionally, irregular to the touch.
Now that you know most everything there is to know about prostrate infection, your reproductive health should be safe once again. Just remember to make use of these tips to give you an idea of what to do, but to ultimately consult your doctor in the end, because the professionals always know best.
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