DEAR MAYO CLINIC: What can you tell me about prostatitis? What are the treatment options?

ANSWER: A lot of men are familiar with certain prostate-related problems, such as the risk of prostate enlargement and prostate cancer. But prostatitis is a painful syndrome that men seldom hear about.

Prostatitis is a general term for infection or inflammation of the prostate gland, which is located just below the bladder. There are several forms of prostatitis. Although these disorders generally aren't life-threatening, they're less understood than other prostate-related conditions and tend to be somewhat difficult to diagnose and treat.

The risk of prostatitis increases if you've had a recent infection of the bladder or urethra, recently had a catheter inserted through your urethra, or tend to not empty your bladder completely or frequently enough. In a small number of men, vigorous activities such as jogging, bicycling, horseback riding or heavy lifting may promote prostatitis.

Although prostatitis is more often seen in men between 18 and 50, it can affect older men, too. As many as 12 percent of men in the United States see a doctor sometime during their lives due to prostatitis.

Prostatitis can be challenging to diagnose. A digital rectal exam (DRE) helps your doctor to determine if the gland is inflamed or infected. The gland may be massaged after which you may be asked to void in order to collect fluid from the prostate to check for infection or inflammation. Massage -- and even an exam -- aren't recommended if you have a very acute infection.

There are four forms of prostatitis, and the signs and symptoms vary:

--Acute bacterial prostatitis -- The least common but most evident form of the disease is acute bacterial prostatitis. This is due to infection most often from bacteria normally found in the urinary tract or large intestine. It typically shows up with sudden signs and symptoms. These may include fever, chills, flulike symptoms, lower back and genital- area pain, urinary urgency, frequent urination, blood-tinged urine, painful ejaculation, difficulty urinating due to pain, a burning sensation, or diminished flow of urine. Immediate medical care is important, as serious problems may develop.

--Chronic bacterial prostatitis -- This, too, is due to bacterial infection, although what causes it is less certain. It sometimes develops after acute prostatitis, possibly due to bacteria in the urinary tract or from a bloodborne infection. Signs and symptoms are very similar to the acute form, although often less severe and with more gradual onset.

--Chronic pelvic pain syndrome (formerly called chronic prostatitis) -- The most common type of prostatitis is also the most difficult to diagnose and treat because the cause isn't fully known. The spectrum of signs and symptoms is very similar to the chronic bacterial form except that no bacteria are detectable in urine or prostate fluid, and it's unlikely a fever will develop. Treatment focuses on breaking the cycle of recurrent and persistent signs and symptoms due to inflammation or pelvic floor pain.

--Asymptomatic inflammatory prostatitis -- There are no symptoms with this type. It may be discovered while looking for the cause of elevated prostate-specific antigen (PSA).

Treatment is geared to the form of prostatitis. Antibiotics are used to treat all forms of symptomatic prostatitis. For the acute bacterial form, a few weeks of antibiotics may be all that's needed, depending on how well you respond.

The duration of antibiotic treatment for the chronic bacterial form usually takes longer -- from weeks to months -- and may need repeating if the infection returns.

When the prostate gland has been infected, calcium deposits also may occur, which can make it difficult to get effective levels of antibiotics in to the prostate tissue. In some men, a daily antibiotic therapy may be needed for an extended period to control infection and reduce recurrence.

Other medications that may provide symptom relief include:

--Alpha blockers, which can help improve urine flow.

--Nonprescription pain relievers, which may ease discomfort and possibly help break the pain cycle brought on by sensitized nerves.

--Muscle relaxants, which may help relieve pelvic muscle spasm that can accompany the pain.

In addition, a trained therapist can teach you specific exercises and relaxation techniques to relieve lower pelvic muscle tension. Stress-reduction techniques, such as biofeedback, may help. Applying warm compresses or soaking in warm water also may help.

-- Lance Mynderse, M.D., Urology, Mayo Clinic, Rochester, Minn.

Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care.

 

 

Supporting Survivors of Suicide Loss: Therapy Can Ease Grief, Guilt
Harvard Health

More than 30,000 Americans, and roughly one million people worldwide, die by suicide each year. The aftermath of grief and bereavement extends much further, with a conservative estimate of six survivors left behind for every suicide death.

Treating Low Back Pain Remains a Challenge
Harvard Health

Back pain is remarkably common. It affects most people during a lifetime. While most back pain gets better quickly, chronic back pain is also common. Yet, the cause of chronic back pain is often uncertain. Even worse, treatment is often ineffective. That's why so many people turn to transcutaneous electrical nerve stimulation (TENS)

When Should You Seek Emergency Care for Chest Pain
Harvard Health

If you have chest pain or discomfort, how do you know if it's serious enough to warrant emergency medical attention? A few general pointers to help

Hypoglycemia: Breaking the Vicious Cycle
Katrina Bertol

Do you ever find yourself feeling faint and irritable when you've skipped a meal? Do you feel fatigued, depressed or worried when you don't have enough food or gone too long between meals? Do you crave sugars and carbohydrates and feel immediate relief after eating them? You may be suffering from hypoglycemia, a common result of poor dietary choices and in some cases, genetics.

Depression Sometimes Expressed at a Young Age
Stephen Whiteside

Certainly kids can suffer from depression. If you're concerned about your child, a good first step would be to visit the doctor to discuss and evaluate the situation. Sometimes, symptoms that appear to be depression may be caused by an underlying medical condition. If the problem is depression, effective treatments for children are available.

(c) 2010 Mayo Clinic