Chronic bacterial prostatitis (patient information)

For the WikiDoc page for this topic, click here

Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
Chronic bacterial prostatitis is swelling and irritation (inflammation) of the prostate gland that develops slowly and continues for a long period of time. It is a chronic infection of the prostate gland.

What causes Chronic bacterial prostatitis?
Chronic prostatitis is usually caused by a chronic bacterial infection of the prostate gland. It may occur with or follow:

The most common bacteria species that cause chronic prostatitis include:
 * Acute prostatitis
 * Epididymitis
 * Urinary tract infection that often returns (is recurrent)
 * Urethritis


 * Escherichia coli
 * Enterobacter cloacae]]
 * Klebsiella pneumoniae
 * Proteus species

Who is at highest risk?

 * Age over 30
 * Certain sexual practices (such as anal sex without a condom)
 * Excessive alcohol intake
 * Injury to the perineum (the area between the scrotum and anus)
 * These factors may cause congestion of the prostate gland, which produces a breeding ground for bacteria.

Other possible causes are related to stress and tightness of the pelvic muscles.

What are the symptoms of Chronic bacterial prostatitis?
Symptoms of chronic prostatitis are similar to those of acute prostatitis but are not as severe. They usually begin more gradually. Patients may have no symptoms in between episodes, or they may experience mild symptoms all the time.

Symptoms may include:

Subtle symptoms may include:
 * Blood in the urine
 * Decreased urinary stream
 * Delayed start of urination (urinary hesitancy)
 * Frequent urination
 * Incontinence
 * Low-grade fever
 * Pain or burning with urination


 * Low back pain
 * Pain in the perineum or pelvic floor
 * Pain with bowel movement
 * Pain with ejaculation
 * Testicular pain

When to seek urgent medical care?
Call your health care provider if you have symptoms of chronic prostatitis.

Diagnosis
A physical examination may show:

Discharge from the urethra Enlarged, mildly tender prostate Enlarged or tender lymph nodes in the groin area Swelling and tenderness of the scrotum During a physical exam, the prostate gland may feel normal, or large and soft (boggy).

Urine specimens may be collected for urinalysis and urine culture.

Other tests may include:

Culture of prostate secretions Semen analysis Other possible tests are:

Pressure flow studies Cystoscopy Transrectal ultrasound Prostate-specific antigen (PSA)

Treatment options
Treatment options for chronic prostatitis include a combination of medication, surgery, and lifestyle changes.

MEDICATIONS
Chronic prostatitis is treated with a long course (6 - 12 weeks or longer) of antibiotics. Trimethoprim-sulfamethoxazole (Bactrim or Septra) and ciprofloxacin (Cipro) are commonly used. Other antibiotics that may be used include:

Carbenicillin Erythromycin Nitrofurantoin Tetracycline Most antibiotics do not get into the prostate tissue well. Often, the infection continues even after long periods of treatment. After antibiotic treatment has ended, it is common for symptoms to return.

Sometimes small stones form in the prostate gland, making it harder to clear the infection.

Stool softeners may be recommended to reduce discomfort with bowel movements.

Nonsteroidal anti-inflammatory medications, NSAIDs such as Aleve and Motrin, and alpha adrenergic blockers, such as doxazosin (Cardura), tamulosin (Flomax), or terazosin (Hytra), may also be used.

SURGERY
Transurethral resection of the prostate may be necessary if antibiotic therapy is unsuccessful or the condition keeps returning. This surgery is usually not performed on younger men because it carries a risk of retrograde ejaculation, which can lead to sterility, impotence, and incontinence.

Prostate massage and myofascial release are other treatments that may help this condition.

OTHER THERAPY:
Frequent and complete urination is recommended to decrease the symptoms of urinary urgency. If the swollen prostate restricts urine flow through the urethra, the bladder may not empty. Inserting a suprapubic catheter, which allows the bladder to drain through the abdomen, may be necessary.

DIET:
Avoid substances that irritate the bladder, such as alcohol, caffeinated beverages, citrus juices, and hot or spicy foods.

Increasing the intake of fluids (64 - 128 ounces per day) encourages frequent urination. This will help flush bacteria from the bladder.

MONITORING:
See your health care provider for an exam after you finish taking antibiotics to make sure that the infection is gone.

Where to find medical care for Chronic bacterial prostatitis?
Directions to Hospitals Treating Acute tubular necrosis

What to expect (Outlook/Prognosis)?
It is common for symptoms to return.

Possible complications
If the prostate is very large, it can slow urine flow through the urethra and cause the backward flow (reflux) of urine toward the kidneys, which can cause kidney damage.

If the flow of urine completely stops, it is considered an emergency.

Prevention
Avoiding urinary tract infections and sexually transmitted diseases can help prevent chronic prostatitis. Finish the full course of antibiotic treatment to reduce the chance of the condition returning.