Prostatitis: Disorders of the Prostate

Prostatitis is a frequently painful condition that affects mostly young and middle-aged men. Doctors may have difficulty diagnosing prostatitis because the symptoms are not the same for every patient, and many of the symptoms-such as painful or burning urination and incomplete emptying of the bladder-could be signs of another disease.

What is the prostate?

The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. As the diagrams show, the prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine and semen pass out of the body. The prostate squeezes fluid into the urethra to help make up semen as sperm move through during sexual climax.

What are the types of prostatitis?

How is prostatitis diagnosed?

A doctor performs a digital rectal exam (DRE) by inserting a gloved and lubricated finger into the patient's rectum, just behind the prostate. The doctor can feel the prostate to see if it is swollen or tender in spots.

The doctor can diagnose the bacterial forms of prostatitis by examining a urine sample with a microscope. The sample may also be sent to a laboratory to perform a culture. In a urine culture, the bacteria are allowed to grow so they can be identified and tested for their resistance to different types of antimicrobials.

To confirm the prostate infection, the doctor may obtain two urine samples-before and after prostate massage. To perform a prostate massage, the doctor will insert a gloved and lubricated finger into the rectum, as in a DRE, and stroke the prostate to release fluids from the gland. The post-massage urine sample will contain prostate fluid. If that second urine sample contains bacteria or infection-fighting cells that were not present in the premassage urine sample, this suggests the prostate contains infection.

To diagnose chronic prostatitis/chronic pelvic pain syndrome, the doctor must rule out all other possible causes of urinary symptoms, such as kidney stones, bladder disorders, and infections. Since many different conditions must be considered, the doctor may order a full range of tests, including ultrasound or magnetic resonance imaging (MRI), biopsy, blood tests, and tests of bladder function.

If all other possible causes of a patient's symptoms are ruled out, the doctor may then diagnose chronic prostatitis/chronic pelvic pain syndrome. To aid in understanding the symptoms and measuring the effects of treatment, the doctor may ask a series of questions from a standard questionnaire, the NIH-Chronic Prostatitis Symptom Index.

How is prostatitis treated?

The bacterial forms of prostatitis are treated with antimicrobials. Acute prostatitis may require a short hospital stay so that fluids and antimicrobials can be given through an intravenous, or IV, tube. After the initial therapy, the patient will need to take antimicrobials for 2 to 4 weeks.

Chronic bacterial prostatitis requires a longer course of therapy. The doctor may prescribe a low dose of antimicrobials for 6 months to prevent recurrent infection. If a patient has trouble emptying his bladder, the doctor may recommend medicine or surgery to correct blockage.

Antimicrobials will not help nonbacterial prostatitis. Each patient will have to work with his doctor to find an effective treatment. Changing diet or taking warm baths may help. The doctor may perscribe a medicine called an alpha blocker to relax the muscle tissue in the prostate. No single solution works for everyone with this condition.

No treatment is needed for asymptomatic inflammatory prostatitis.