As a man ages, it is common for the prostate gland to enlarge. Doctors call this condition of enlarged prostate “benign prostatic hyperplasia” (BPH or prostatitis for short). Prostatitis, a disease of the prostate gland, can cause pain in the groin, painful urination, difficulty urinating and related symptoms. The prostate gland produces components of semen, the fluid that helps support and transport sperm. The gland, about the size and shape of a walnut, sits directly below the bladder and surrounds the urethra, the tube that transports both semen and urine to the penis.
As the prostate enlarges, the layer of tissue surrounding it stops it from expanding. This causes the prostate gland to press inward against the urethra like a clamp on a garden hose, narrowing the space for urine to pass. In addition, the bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself. Urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with an enlarged prostate. A doctor can tell an enlarged prostate during a finger prostate exam.
Prostate infections are relatively common and usually occur in men in their 30s, 40s, and 50s. Prostatitis isn’t a single condition but a group of disorders with related symptoms. Some forms of prostatitis are generally well understood. This is especially true of those related to bacterial infections and can usually be treated effectively . These types of prostatitis account for about 5 to 10 percent of all cases.
More common forms of prostatitis aren’t as well understood and are more difficult to diagnose and treat. Some medications help manage the symptoms, and new therapies are under investigation.
Types of Prostatitis
The National Institutes of Health classification for prostatitis divides it into four categories. These are based on such factors as cause, typical course of the disease, immune system activity and symptoms. The four categories are:
Category 1: Acute bacterial prostatitis
Category 2: Chronic bacterial prostatitis
Category 3: Chronic prostatitis/chronic pelvic pain
Category 4: Asymptomatic inflammatory prostatitis
Prostatitis symptoms vary depending on the type of prostatitis you have. In general, the symptoms are related to pain or discomfort in the pelvic region, problems with urination and problems with ejaculations. Signs and symptoms may include:
Pain or burning sensation when urinating (dysuria)
Difficulty urinating, such as dribbling or hesitant urination
Frequent urination, particularly at night (nocturia)
Urgent need to urinate
Pain in the abdomen, groin or lower back
Pain in the area between the penis and rectum (perineum)
Pain or discomfort of the penis or testicles
Specific symptoms of the four categories.
- Acute bacterial prostatitis. You may have symptoms associated with the sudden onset of infection:
General feeling of being unwell
- Chronic bacterial prostatitis. The key feature of chronic bacterial prostatitis is frequent urinary tract infections. Between episodes of these infections, a person with chronic bacterial prostatitis may have no symptoms, mild symptoms or severe symptoms.
- Chronic prostatitis/chronic pelvic pain. The condition is generally considered chronic if the symptoms last for at least three months. For some men, the symptoms remain about the same over time, and for others the symptoms go through cycles of being more and less severe. Symptoms sometimes improve over time without treatment.
- Asymptomatic inflammatory prostatitis. If you have asymptomatic inflammatory prostatitis, you have no symptoms. Inflammation of the prostate gland is found only by chance when you’re undergoing tests for other conditions.
- Bacterial prostatitis. The most frequent causes of acute and chronic bacterial prostatitis are common strains of bacteria. The bacteria are likely transported in urine that “leaks” from the urethra and into the prostate. Chronic bacterial prostatitis may be the result of small amounts of bacteria that “hide” in the prostate and aren’t eliminated with treatments.
- Chronic prostatitis/chronic pelvic pain. No single factor has been clearly identified as a cause of chronic prostatitis. Some men with chronic prostatitis/chronic pelvic pain have no evidence of inflammation of the prostate.
More than one factor may be at work. Possible causes of chronic prostatitis/chronic pelvic pain may include:
Immune system disorder
Nervous system disorder
Pressure on prostate from other diseased tissue
Treatments and drugs
We, of course, will be recommending natural alternatives to help with prostrate problems in other articles. However, several drugs are currently used as prostate medicine.
Proscar (finasteride) is the most commonly used -by Proscar;
Avodart Dutasteride, by GlaxoSmithKline;
Dutas – Generic Dutasteride by Dr. Reddy’s;
Fincar – Generic Proscar by Cipla;
Flomax – Tamsulosin Hydrochloride by Boehringer Ingelheim;
Proscar – Finasteride (5mg) by Merck;
Calutide – Generic Casodex by Cipla;
Cytomid – Generic Flutamide by Cipla.
Acute bacterial prostatitis is treated with antibiotics. If you have severe symptoms, you may be hospitalized to receive injections of the drug. After your condition has improved, you will continue with oral antibiotics. The total course of treatment is usually two to four weeks. You should take all of the prescribed drugs as directed even if you’re feeling better.
Chronic bacterial prostatitis is also treated with antibiotics. The duration of treatment is often longer and may need to be repeated if infection occurs again.
Chronic prostatitis/chronic pelvic pain is difficult to treat effectively. Current therapies that may help manage symptoms include the following:
Alpha blockers are medications that help relax the bladder neck and the muscle fibers where your prostate joins your bladder. This treatment may lessen symptoms, such as painful urination. Alpha blockers include alfuzosin (Uroxatral) and doxazosin (Cardura). Common side effects include headaches and a decrease in blood pressure.
Pain relievers such as aspirin or ibuprofen (Advil, Motrin, others) may make you more comfortable. You should discuss with your doctor what doses you can safely take because overuse of pain medication can cause serious side effects including abdominal pain, intestinal bleeding or ulcers.
Prostatic massage by your physician using a lubricated, gloved finger a procedure similar to a digital rectal exam may provide some symptom relief. Although this therapy has been used for many years, experts still disagree on the effectiveness of the treatment.
Other treatments studied in small clinical trials show potential for improving symptoms of chronic prostatitis/chronic pelvic pain, but more research is needed to understand their benefits. These treatments include heat therapy with a microwave device and drugs based on certain plant extracts.
When to see a doctor
The symptoms of prostatitis are similar to many other diseases affecting the urinary tract and the male sexual organs. Many of these can have serious consequences if left untreated, and they usually affect your everyday life and general well-being. If you experience any pelvic pain, difficult or painful urination, or painful ejaculations, see your doctor to get an accurate diagnosis and prompt, appropriate treatment.