What Is Prostatitis and How Painful Is It?

Prostate pain

Imagine minding your own business one day when suddenly, you have the sensation of someone jabbing a hot poker behind your testicles.  That's one way acute prostatitis presents, burning, hot pain between the anus and the testicles.  It can affect urination, bowel movements; it makes it tough to sit down, sleep, concentrate, exercise, or do many otherwise normal activities.  This is a condition that affects many men from ages 20 well into old age.

  Prostatitis is quite simply inflammation and/or infection of the prostate gland.

The prostate makes semen and sits between the anus and the bladder, deep in the pelvis.  It forms the first part of the urethra as urine exits the bladder, goes through the prostate on its way out of the urethra.  We don't know exactly what causes prostatitis.  It is divided into a few categories.  Acute bacterial prostatitis is an infection of the prostate gland that causes pain, urinary difficulties, occasionally fevers and can lead to a systemic infection.  This condition usually responds to antibiotics and often resolves completely.  It usually affects men that have a change in their normal voiding patterns or men that have jobs that prevent frequent urination.  Pilots, police officers, long haul truckers all are at increased risk of acute bacterial prostatitis.  Chronic bacterial prostatitis happens when acute prostatitis does not completely resolve and the bacteria burrow into the prostate gland and set up walls called biofilms which makes antibiotic therapy less effective.

  Chronic nonbacterial prostatitis is a difficult diagnosis to make.  Essentially, when a man has all the symptoms of prostatitis but no bacteria can be found in the urine or prostate fluid, he gets the diagnosis of nonbacterial prostatitis.  This condition falls within a spectrum of chronic pelvic pain and has a different treatment pathway.

The prostate is surrounded by numerous pelvic muscles and these muscles can get irritated and go into spasm causing pressure and pain on the prostate.  This is similar to people who get low back pain and muscle spasms in the back that lead to severe pain.  Pelvic floor pain can respond to certain kinds of muscle relaxants, pelvic floor physical therapy and even the age old therapy of prostate massage.

Nutritional therapy for prostatitis also plays a role.  Avoiding chemical irritants to the bladder like coffee, acidic drinks like orange juice, alcohol consumption and spicy foods can make symptoms better in some men.  Physical exercise and frequent ejaculation are also good ways to alleviate symptoms of prostatitis.

Many medications, other than antibiotics, have been prescribed for prostatitis with variable results.  There is a class of medicines called alpha blockers that can relax the smooth muscle in the prostate and provide urinary relief to men with prostatitis.  The medical literature is divided on the efficacy of this approach but alpha blockers are a well-tolerated class of medication with few side effects.

Prostatitis is a frustrating condition for both the patient and the urologist as there is really no one cure and often, treating the condition is a process of trial and error.  Be patient with the therapy and be willing to try multiple modalities to find the best long term therapy for you.  More important, evaluate your overall lifestyle as stress, poor eating and lack of exercise can all make symptoms worse. 

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