Prostatitis

What is it?

An uncomfortable or painful inflammation or infection of the prostate gland.

What are the main symptoms?

• Pain and difficulty when peeing.
• Having to pee more often or more urgently.
• Feeling unwell, possibly with chills and fever.
• Aches and pains in the lower back, lower abdomen, thighs and/or genitals.
• Pain on ejaculation.

What's the risk?

Prostatitis — inflammation or infection of the prostate — can affect any adult male but is most common in men aged 20—50.

What causes it?

• Acute bacterial prostatitis is a sudden infection, usually caused by bacteria spreading from the intestines or travelling up the urethra. This form of prostatitis is characterised by a sudden illness with high fever, pain in the lower back and beneath the testicles, and by quite marked symptoms when passing urine.
• Chronic prostatitis is the term doctors use when a bacterial infection keeps flaring up. The symptoms when passing urine are similar but the condition is usually less severe than for acute bacterial prostatitis.
• Sometimes the prostate becomes inflamed although there appear to be no bacteria present. Doctors call this chronic non-bacterial prostatitis but do not really understand why it happens.
• In a related condition, known as prostatodynia, men suffer from the symptoms of prostatitis but without any obvious inflammation of the prostate.

How can I prevent it?

Prevention of prostatitis is difficult and more research is needed before effective advice can be given.

Should I see a doctor?

• Seek help as soon as you experience symptoms.
• You are likely to be given a digital rectal examination (DRE).
• Swabs may be taken to check for bacteria or any other micro-organisms.
• A blood test can tell if your white cells counts are raised, indicating that you have an infection.
• A urine sample will be sent off for testing.

What are the main treatments?

• Acute bacterial prostatitis is treated by antibiotics, usually taken for at least four weeks.
• A longer course of antibiotics — three months or more — is generally required to treat chronic bacterial prostatitis.
• Sometimes the infection causes so much swelling that urination is impossible. Then you would be admitted to hospital to have a catheter temporarily inserted into the bladder to ease the flow.
• Painkillers can also help, especially anti-inflammatories (e.g. ibuprofen). These can be taken whether the infection is bacterial or not.
• Prostatodynia can be helped with a combination of painkillers and drugs known as alpha-blockers. These relax the smooth muscle cells in the prostate and allow easier passage of urine. This may help prevent urine entering up into the ducts of the prostate (one possible explanation for this condition). 

How can I help myself?

• Take zinc supplements or eat zinc-rich foods, such as oysters and other shellfish or pine nuts and pumpkin seeds. Some doctors believe that low zinc levels in the prostate may cause a predisposition to prostatitis. However, it must be said that research has not shown that oral zinc supplements can actually raise the level of zinc in the prostate.
• Try natural remedies such as saw palmetto and rye pollen tablets, or supplements such as Prosta-Q which contains quercetin, a bioflavanoid found naturally in onions and green tea.
• Sitting in a hot bath may provide pain relief and help reduce swelling.
• Identify things which trigger attacks of non-bacterial prostatitis: spicy foods, nicotine, alcohol and caffeine are typical culprits. If stress is a trigger, try some relaxation techniques.
• Regular ejaculations may help relieve congestion in the prostate gland.

What's the outlook?

• Once you start taking antibiotics for acute bacterial prostatitis your symptoms should start to improve within a few days, but complete the course to make sure you are clear of all infection.
• You may have to persist with antibiotics for much longer to have an effect on chronic bacterial prostatitis. Anti-inflammatory painkillers, such as ibuprofen, should help to reduce swelling, pain and inflammation.
• Chronic non-bacterial prostatitis can be difficult to clear up completely.

Who else can help?

NHS Direct Online has 'Best Treatment' sections on both prostate cancer and enlarged prostate. The Best Treatment resource, which the NHS is running in conjunction with the British Medical Journal, provides information on the most common health conditions including explanations of the pros and cons of elective surgery procedures, details of other treatments available, and advice on pre-and post-operative care. It is for a general readership.