Thursday, March 1, 2012

Prostate Inflammation in Aging Men

What is prostate inflammation?

Men, especially those over 50, often get alarmed at just the mention of the prostate, and rightfully so; prostate cancer is the most common form of cancer in men. However prostate inflammation, also known as prostatitis, can affect men of all ages. According to the National Institutes of Health, prostatitis is accountable for the medical visits of 25 percent of young and middle-aged men involving their urinary and genital systems. In fact, chronic prostatitis (which means it doesn't go away) is the number-one reason men under the age of 50 visit a urologist. In some cases, chronic prostatitis follows an attack of acute prostatitis. Chronic prostatitis may also be related to other urinary tract infections. Prostatitis is considered chronic if it lasts more than three months.

The symptoms of prostatitis are uncomfortable at best; more often they are extremely painful and can also be dangerous. Symptoms may include pain and swelling in the area of the prostate, fever, chills, pain in the lower back, burning or painful urination, a need to urinate frequently and get up in the night, dribbling, fatigue and body aches, and pain with ejaculation. Prostatitis can severely affect the quality of life. Rigorous activity, sports, exercise - even sitting for any length of time in an office, theater or at a sporting event - may become too painful to tolerate. And as for sex - it's simply not an option.

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What is the prostate gland?

The prostate is a small organ located at the base of the bladder and wrapped around the urethra, the tube that empties the bladder through the penis. It sits in front of the rectum, and the back portion of the organ can be felt during rectal examination by a health care practitioner.

The prostate's purpose is to help with the male reproductive system. It makes up to 70% of the fluid that is ejaculated during intercourse, mixing its secretions with the sperm that are made in the testicles. The prostate also contracts at the time of ejaculation to prevent retrograde (or backward) flow of semen into the bladder.

Because of its location, the symptoms of any prostate problem tend to be associated with the bladder and can include urgency to urinate, frequency of urination, burning with urination (dysuria), poor urine flow, or inability to begin a urine stream.

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Types and symptoms

There are four categories of prostate inflammation: acute bacterial, chronic bacterial, chronic pelvic pain syndrome, and asymptomatic inflammatory. Each of these categories has different symptoms, ranging from mild to severe. The symptoms of prostate inflammation include:

  1. Acute bacterial. Acute bacterial prostatitis is described as a sudden bacterial infection that leads to prostate inflammation. Although this is least common form of prostatitis but the symptoms are usually severe. Patients with this condition have an acute urinary tract infection with increased urinary frequency and urgency, need to urinate a lot at night, and have pain in the pelvis and genital area. Acute bacterial prostatitis requires prompt treatment, as the condition can lead to bladder infections, abscesses in the prostate or, in extreme cases, completely blocked urine flow. Left untreated, the condition can cause confusion and low blood pressure, and may be fatal. The condition is usually treated in the hospital with intravenous antibiotics, pain relievers, and fluids. Because acute prostate infection often is associated with infections in other parts of the urinary tract, symptoms may include the following:
  • Increased urinary frequency.
  • Urgency to pass urine.
  • Pain with urination.
  • Difficulty producing a normal stream.
  • Pain in the genital area.
  • Pain with ejaculation.
  • High fever and chills.
  • Generalized malaise and fatigue.

  1. Chronic Bacterial. This condition is the result of recurrent urinary tract infections that have entered the prostate gland. It is thought to exist for several years in some men before producing symptoms. The diagnosis of this condition is often challenging. It's often difficult to find the bacteria in the urine. Treatment includes antibiotics for four to 12 weeks and other treatment for pain. Sometimes men are given suppressive low-dose, long-duration antibiotic therapy. Symptoms of chronic bacterial prostatitis may be similar to acute bacterial prostatitis, but are usually less intense. They include the following:
    • Increased urinary frequency along with pain and difficulty urinating.
    • Pain in the lower back, testes, epididymis, or penis.
    • Sexual dysfunction.
    • Low-grade fever, joint pains, and muscle aches.
    • Examination may reveal urethral discharge and tender testes, or epididymis.

  1. Chronic pelvic pain syndrome. Chronic pelvic pain syndrome, also called chronic nonbacterial prostatitis is the most common of the categories since it accounts for 90 percent of the prostatitis cases. Chronic pelvic pain is sometimes confused with the chronic inflammation of the bladder. If you suffer from this ailment, you will experience genital and urinary pain three of the past six months. Patients have no bacteria in their urine, but may have other signs of inflammation. The condition can be confused with interstitial cystitis (a chronic inflammation of the bladder). You may feel pain on one or both sides of your pelvis, or all over the pelvic area. The pain may increase or decrease with certain body positions or activities. Sitting or standing for a long time, moving your bowels, having sex, or urinating may worsen your pain. Other common signs and symptoms include:
  • Burning feeling when you urinate.
  • Feeling that your bladder has not completely emptied after passing urine.
  • Needing to urinate right away.
  • Passing urine more often than usual or you need to wake up at night often to urinate.
  • Trouble starting to urinate, or passing little amounts of urine or none at all.
  • Premature or painful ejaculation. Ejaculation is the forceful release of semen from the penis.
  • Unable to have or maintain erection. An erection is when the penis gets stiff so that sexual intercourse (sex) is possible.
  • Not being able to get your female sexual partner pregnant when you are trying to have a baby.
  • Backache, headache, neck pains, or pain in the legs.
  • Feeling tired most of the time or getting tired very easily.
  • Urine or semen that is pink or red.

  1. Asymptomatic inflammatory. You will not have any symptoms when you have this illness, hence why it is asymptomatic. These patients are discovered when the prostate is biopsied for other situations such as a reason (possible cancer) for elevated PSA (prostate specific antigen) tests, or infertility. However, if the biopsy shows only inflammatory tissue changes and no cancer or other likely cause (infectious agents) for the asymptomatic inflammatory changes, then the patient is diagnosed with asymptomatic inflammatory prostatitis.

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Risk Factors

Bacterial infections cause only about 5%-10% of cases of prostatitis. In the other 90%-95%, due to chronic pelvic pain syndrome or asymptomatic inflammatory prostatitis described above, the cause is not known.

At one time, infectious prostatitis was believed to be a sexually transmitted disease, but more recent research suggests that only a small number of cases are passed on through sex.

Certain conditions and medical procedures increase the risk of developing prostatitis. You are at higher risk for getting prostatitis if you:
  • Recently have had a medical instrument, such as a urinary catheter (a soft, lubricated tube used to drain urine from the bladder) inserted during a medical procedure
  • Engage in rectal intercourse
  • Have an abnormal urinary tract
  • Have had a recent bladder infection
  • Have an enlarged prostate

Other causes may include autoimmune disease (an abnormal reaction of the body to the prostate tissue).        

Treatment for Prostatitis

Treatments vary among urologists and are tailored to the type of prostatitis you have. Correct diagnosis is crucial and treatments vary. It's important to make sure your symptoms are not caused by urethritis (inflammation of the urethra) or some other condition that may lead to permanent bladder or kidney damage.

Treatments can include:
  • Anti-inflammatory medicines along with warm sitz baths (sitting in two to three inches of warm water). This is the most conservative treatment for chronic prostatitis.
  • Antibiotic medicine for infectious prostatitis. These drugs are not effective treatments for noninfectious prostatitis. For acute infectious prostatitis, patients usually need to take antibiotic medicine for 14 days. Almost all acute infections can be cured with this treatment.
  • For chronic infectious prostatitis, antibiotic medicine is taken for a longer period of time, usually four to 12 weeks. About 75% of all cases of chronic infectious prostatitis clear up with this treatment. For cases that don't, taking antibiotics at a low dose for a long time may be recommended to relieve the symptoms.
  • Pain medications.
  • Muscle relaxants.
  • Surgical removal of the infected portions of the prostate. A doctor may advise this treatment for severe cases of chronic prostatitis or for men whose swollen prostate is blocking the flow of urine.
  • Supportive therapies for chronic prostatitis, including stool softeners and prostate massage.

Other treatments for chronic noninfectious prostatitis include the use of the alpha blocker drugs such as Hytrin and Cardura. These drugs relax the muscles of the prostate and bladder to improve urine flow and decrease symptoms. Other drugs that lower hormone levels, such as Proscar, may help to shrink the prostate gland in some men.

Some people may benefit from avoiding spicy foods and caffeinated or acidic drinks. Activities that aggravate the condition, such as bicycling may need to be eliminated as well.

Many cases of abacterial (nonbacterial) prostatitis (also considered chronic pelvic pain syndrome) respond to a mix of treatments that include exercise, myofascial trigger point release, progressive relaxation, stress reduction, meditation, and counseling.

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Prostatitis is a treatable disease. Even if the problem cannot be cured, you can usually get relief from your symptoms by following the recommended treatment. Be sure to follow the full course any prescription you are given, even if you no longer have any symptoms. With infectious prostatitis, for example, the symptoms may disappear before the infection has completely cleared.

Sources and Additional Information:

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