What Does "Prostatitis" Mean?
"Prostatitis" means inflammation of the prostate. This is a condition quite common in adult men and is associated with urinary symptoms and pain. The following information will answer your questions on prostatitis, as well as about the prostate itself.

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What is the Prostate? What is its Purpose?
The prostate is part of the male reproductive system. It is located just below the bladder and in front of the rectum. The prostate is normally small in size, about the size and shape of a chestnut. The prostate wraps around a tube called the urethra. The urethra carries urine from the bladder out through the prostate and then the penis. The prostate is mostly made up of muscular and glandular tissues. Its function is to produce and deposit some of the enzymes, proteins and sugars into the fluid of the ejaculate or semen. These substances help to protect and nourish sperm. During the male orgasm (climax), muscular contractions squeeze the prostate's fluid into the urethra. Sperm, which are produced in the testicles, are also propelled into the urethra during orgasm. The sperm-containing semen leaves the penis during ejaculation.

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Types of Prostatitis
There are three types of prostatitis:

• acute (bacterial) prostatitis
• * chronic (bacterial) prostatitis
• * non-bacterial prostatitis

Acute Bacterial Prostatitis is caused by bacteria and is treated with antibiotics. Acute bacterial prostatitis comes on suddenly, and its symptoms can be severe. Symptoms can include fever and chills . If severe, a visit to the emergency room may be necessary and hospitalization is frequently indicated.

Chronic Bacterial Prostatitis is also caused by bacteria and also requires antibiotics. Unlike an acute prostate infection, the only symptoms of chronic bacterial prostatitis may be recurring bacterial cystitis (bladder infection).

Nonbacterial Prostatitis is not caused by bacteria--its cause is not known. Antimicrobial medications are not effective for this type of prostatitis. Treatments, described later, may be helpful in some cases. One sub-category of this syndrome includes "Chronic Pelvic Pain Syndrome". Another sub-category may include a disorder common in women known as "Interstitial Cystitis".

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How Does Prostatitis Develop?
Despite their names, acute and chronic bacterial prostatitis are not contagious and are not considered be sexually transmitted diseases. Your sexual partner cannot catch this infection from you. The way in which the prostate becomes infected is not clearly understood. The bacteria that cause prostatitis may get into the prostate from the urethra by backward flow of infected urine into the prostate ducts or from rectal bacteria. Certain conditions or medical procedures increase the risk of contracting prostatitis.

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You are at Higher Risk for Getting Prostatitis if You:

• Recently had a medical instrument, such as a urinary catheter (a soft, lubricated tube used to drain urine) inserted into the bladder,
• Have an abnormal urinary tract,
• Have had a recent bladder infection,
• Have an enlarged prostate.

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What are the Symptoms of Prostatitis?
The symptoms of prostatitis depend on the type of syndrome you have. You may experience no symptoms or symptoms so sudden and severe that they cause you to seek emergency medical care. Symptoms, when present, can include any of the following: fever, chills, urinary frequency, frequent urination at night, difficulty urinating, burning or painful urination, perineal (referring to the perineum, the area between the scrotum and the anus) and low-back pain, joint or muscle pain, tender or swollen prostate, blood in the urine, or painful ejaculation.

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Are the Symptoms of Prostatitis Found in Other Disorders?
The symptoms of prostatitis resemble those of other infections or prostate diseases. Thus, even if the symptoms disappear, you should have your prostate checked. For example, benign enlargement of the prostate (benign prostatic hyperplasia or BPH) may produce urinary tract symptoms similar to those experienced with prostatitis. Similarly, urethritis, an inflammation of the urethra (often caused by an infection), may also give rise to many of the symptoms associated with prostatitis.

Still another condition that overlaps the syndrome of prostatitis is prostatodynia (painful prostate). Patients with prostatodynia have pain in the pelvis or in the perineum. Such pain may result from a prostate problem, but the pain can have a variety of different causes including muscle spasms or other musculoskeletal conditions. This is a component of Chronic Pelvic Pain Syndrome. Yet another term your doctor may mention in discussing your prostate problem is prostatosis, a more vague word, which simply means "a condition of the prostate. Because of the connections between the urethra, the bladder, and the prostate, conditions affecting one or the other often have similar or overlapping symptoms.

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How is Prostatitis Diagnosed?
To help make an accurate diagnosis, several types of examinations are useful. The prostate is an internal organ, so the physician cannot look at it directly. Because the prostate lies in front of the rectum, however, the doctor can feel it by inserting a gloved, lubricated finger into the rectum This simple procedure, called a digital rectal examination, allows the physician to estimate whether the prostate is enlarged or has lumps or other areas of abnormal texture.

Digital Rectal Examination: This examination is essential in detecting early prostate cancer, which is often without symptoms. Therefore, the American Urological Association has recommended a yearly prostate examination for every man over age 40 and an immediate examination for any man who develops persistent urinary symptoms If your physician suspects that you have prostatitis or another prostate problem, he or she may refer you to a urologist (a doctor who specializes in diseases of the urinary tract and the male reproductive system) to confirm the diagnosis.

Prostate Massage: The test that must be performed when prostatitis is suspected is prostate massage, during which prostatic fluid is collected. While performing the digital rectal examination, your doctor may vigorously press on the prostate to force prostatic fluid out of the gland and into the urethra. Although prostate massage is not particularly painful, you may feel some discomfort depending on the sensitivity of your prostate. The prostatic fluid is then analyzed under a microscope for signs of inflammation and infection.

The Three-Glass Urine Collection: This test can be used to measure the presence of white blood cells and bacteria in the urine and prostatic fluid.. You will be asked to collect two urine samples separately: the first ounce of the urine you void (urine from your urethra) and then another sample of flowing, midstream urine (urine from your bladder). You will then almost empty your bladder by urinating into the toilet. At this point, your doctor will massage your prostate and collect on a slide any secretions that appear.. You will then collect in a third container the first ounce of urine that remains in your bladder Examination of these samples will help your physician determine whether your problem is an inflammation or an infection and whether the problem is in your urethra, bladder, or prostate. If an infection is present, your doctor will also be able to identify the type of bacteria involved so that the most effective antimicrobial medication can be prescribed.

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How do I know Which Type of Prostatitis I Have?
Acute bacterial prostatitis is the easiest of the three conditions to diagnose because it comes on suddenly and the symptoms require quick medical attention. Not only will you have urinary problems, but you may also have a fever and pain and, frequently, blood in your urine. Chronic bacterial prostatitis is associated with repeated urinary tract infections, while nonbacterial prostatitis is not. In fact, if you do not have a urinary tract infection or a history of one, you probably do not have chronic bacterial prostatitis. Other symptoms, if any, may include urinary problems such as the need to urinate frequently, a sense of urgency, burning or painful urination, and possibly perineal and low-back pain. Nonbacterial prostatitis is more common than bacterial prostatitis. It may cause no symptoms, or its symptoms may mimic those of chronic bacterial prostatitis. If you have nonbacterial prostatitis, however, it is unlikely that you will have urinary tract infections.

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Why is Correct Diagnosis So Important?
Because the treatment is different for the three types of prostatitis, the correct diagnosis is very important. Nonbacterial prostatitis will not clear up with antimicrobial treatment, and bacterial prostatitis will not go away without such treatment. In addition, it is important to make sure that your symptoms are not caused by urethritis or some other condition that may lead to permanent bladder or kidney damage.

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How is Prostatitis Treated?
Your treatment depends on the type of prostatitis you have. If you have acute bacterial prostatitis, you will usually need to take antimicrobial medication for 7 to 14 days. Almost all acute infections can be cured with this treatment. Analgesic drugs to relieve pain or discomfort and, at times, hospitalization may also be required. If you have chronic bacterial prostatitis, you may require antimicrobial medication for a longer period of time--often 4 to 12 weeks. About 60 percent of all cases of chronic bacterial prostatitis clear up with this treatment. For cases that don't respond to this treatment, long-term, low-dose anti-microbial therapy may be recommended to relieve the symptoms. Other medications including anti-inflammatory medications, alpha blocker medication, and proscar may be helpful as well. In some cases, surgical removal of the infected portions of the prostate may be advised.

If you have nonbacterial prostatitis, you do not need antimicrobial medication. Depending on your symptoms, you may receive one of a variety of treatments. If your condition responds to muscle relaxation, you may be given an alpha blocker, a drug that can relax the muscle tissue in the prostate and reduce the difficulty in urination. Warm tub baths are sometimes helpful. Changes in diet such as eliminating caffeine, spicy foods, and chocolate may also be helpful.

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Will Prostatitis Affect Me or My Lifestyle?
Prostatitis is a treatable disease. Even if the problem cannot be cured, symptoms can often be relieved with treatment. Prostatitis is not a contagious disease.

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In Summary:

• Correct diagnosis is key to management of prostatitis
• Treatment should be followed even if you have no symptoms
• Having prostatitis does not increase your risk of getting any other prostate disease and specifically does not increase the risk of cancer; however, in order to minimize the risks of prostate cancer, regular prostate checkups are recommended at least once a year after age 40.