Diagnosis and Treatment for Prostatitis

How to diagnose and treat prostatitis?

The first step is to evaluate carefully the individual symptoms and signs, as no two cases are the same. It is important to exclude other possible causes including benign prostate enlargement (BPH) and prostate cancer in older men.

The Urologist will examine you looking for area of tenderness and this may include a prostate examination. Urine and semen samples may also be sent for evaluation. You will be asked to complete a questionnaire about your symptoms.

Treatment very much depends on the symptoms. Overall somewhere between 50-60% of all patients seen in outpatients will have troublesome urinary symptoms (LUTS). The most common sites of pain are perineal (63.3%) and testicular (57.6%). Other common problems are ejaculatory pain, pain in the pubic area and the tip of the penis. Treatment should very much be tailored to the individual symptoms presenting. This is of course not the case for acute bacterial prostatitis, which is uncommon and requires antibiotics (sometimes intravenous) often together with a period of Hospitalisation.

Treatment plan

Once your Doctor has determined the likely type of prostatitis and understands the symptoms that are most bothersome, a treatment plan can be prescribed.

Medications

Antibiotics
It is very often a course of antibiotics that are first considered (even sometimes with typeIIIprostatitis). Chronic types ofprostatitis require longer courses of antibiotics and only certain types of antibiotics are able to penetrate inside the prostate gland. Choosing the most appropriate antibiotic may be made easier with knowledge from previous urine or semen culture results. A longer course of 6 weeks, and even up to 3 months is sometimes required. Antibiotics do often appear to have a positive impact on urinary symptoms even when there is no evidence of bacterial infection for reasons that are unclear.

Alpha blockers
These tablets can improve the flow and have a positive impact on urinary symptoms. They relax the bladder outlet and are a good long-term strategy for those men complaining of LUTS including a poor flow. They may also help with bladder emptying.

Anticholinergics
If bladder storage symptoms such as urinary frequency and urgency of urination (and even sometimes incontinence) are a problem then these are worthy of consideration.

Analgesia
Painkillers such as the anti-inflammatory ibuprofen are often recommended. If there is associatedneuropathic pain away from the prostate gland then painkillers such asgabapentin andamitriptyline can be helpful.

Antidepressants
In severe cases chronic prostatitis can cause or be associated with depression. It is also important to consider the psychological effects of this condition.

Finasteride and Dutasteride
These tablets shrink the prostate by lowering the testosterone level within the prostate gland.

Physical Therapy

Special exercises and relaxation techniques can improve the symptoms of prostatitis, perhaps because tight or irritated muscles contribute to the condition.

Exercise is important – such as pelvic floor exercise
Biofeedback with a trained therapist can be of benefit - this helps to relax certain types of muscles and involves having electrodes attached and sensors to various parts of the body
Sitz baths – this involves soaking the lower half of your body in a bath of warm water
Prostatic massage - some men find this to be helpful. It is thought to relieve congestion by unplugging the tiny ducts blocked by inflammation. It is performed by a Urologist and is increasingly being undertaken under a brief general anaesthetic.

Surgical procedures

A prostatic massage is an option in some cases. Removal of the prostate gland is an option only in very select cases.

Self-care and alternative medicine

Unfortunately traditional treatments aren’t always effective for prostatitis and so men often experiment with various lifestyle changes. You may want to try any of the following:

Drink plenty of water
Limit or avoid alcohol or spicy foods
Urinate at regular intervals
Have regular sexual activity
If cycling use a ‘split’ bicycle seat

Alternative options – some men find saw palmetto or zinc supplements and quercetin helpful.