Prostatitis/Chronic Pelvic Pain in Men
What is it?
Prostatitis is an inflammatory or infectious condition of the prostate gland which is located below the bladder. As the urine exits the bladder during urination, it passes through the prostate urethra. Therefore, prostatitis is commonly presents with urinary symptoms.
Symptoms of prostatitis:
- Burning with urination
- Urinary frequency, urgency, incontinence
- Pain during ejaculation or erection
- Back pain
- Blood in the urine
- Pain above the pubic bone or behind the scrotum (perineum)
Why does it occur?
- Bacterial infection
- Inflammation of the prostate
- Sexually transmitted infections
- Abnormal function of the muscles surrounding the prostate
How is it evaluated and why?
Your urologist will perform a full examination including evaluation of the prostate (digital rectal exam). They will likely send urine tests and may add blood tests to evaluate your PSA (a blood test that can be abnormal in conditions like prostatitis). In addition, they may perform ultrasound imaging of the bladder or prostate and may ask to perform a cystoscopy (small camera procedure into the bladder) to rule out other causes of your symptoms.
Prostatitis is typically classified into four categories
- Acute Bacterial prostatitis: typically patient have significant urinary symptoms, pelvic pain and urine testing reveals significant bacteria in the urine
- Chronic Bacterial Prostatitis: recurrent infections in the urine. Symptoms may be more prolonged but lower grade
- Inflammatory Chronic Pelvic Pain syndrome (nonbacterial prostatitis): typically symptoms are similar to acute prostatitis but no bacteria can be identified in the urine however there is often evidence of inflammation. This condition may recur periodically or persist life long
- Non-inflammatory Chronic Pelvic Pain syndrome: chronic urinary symptoms and pelvic pain with urine testing negative for infection and inflammation. May recur periodically or persist life long
Treatment for prostatitis can vary. If infection is present then antibiotics are used to treat the infection. It is important to discuss expectations and treatment of symptoms with your urologist as some forms of prostatitis are chronic and may require lifelong management. Below are some therapies for prostatitis. You urologist may combine one or more techniques to help manage your symptoms.
- Anti-inflammatory medications (advil, motrin)
- Alpha blockers (Flomax)-assist with urine flow through the prostate
- Phytotherapy: Saw Palmetto, Quercetin (500 mg twice daily), Bee Pollen extract
- Oral Zinc therapy-may help antibacterial properties in prostate
Diet changes: avoid caffeine, spicy foods, acidic foods
- 5 Alpha reductase inhibitors (Finasteride or Dutasteride): helps chronic prostatitis
- Muscle Relaxants: To relax muscles around pelvis
- Biofeedback: physical therapy to help manage symptoms
- Medications for overactive bladder