Infections

Prostatitis

Technically, the term prostatitis implies inflammation (‘itis’) of the prostate. Even so, inflammation isn’t always present. Neither is infection, even though most patients and many of their physicians assume that prostatitis is caused by a bacterial infection. Unfortunately, the term prostatitis has become a wastebasket term that physicians use to explain any undiagnosed symptom or condition that might possibly emanate from the prostate. Translated, this means that men are often told that they have prostatitis, when they don’t.

How common is prostatitis?
Prostatitis affects millions of men. It is the most common reason that men under the age of fifty, and the third most common reason that men over the age of fifty, see a urologist.

What are the different types of prostatitis?
In an effort to standardize terminology, the National Institutes of Health proposes dividing prostatitis into four main categories: Acute bacterial prostatitis (category I); chronic bacterial prostatitis (category II); chronic abacterial (nonbacterial) prostatitis (category III), which is subdivided into inflammatory (IIIA) and non inflammatory (IIIB) prostatitis (collectively known as ‘chronic pelvic pain syndrome’); and asymptomatic inflammatory prostatitis (category IV, detected in the absence of symptoms when prostate tissue is removed for another reason; for instance, an elevated PSA). Prostatitis is inflammation of the prostate gland.

Acute (severe) infectious prostatitis: As the name implies, acute bacterial prostatitis is caused by a bacterial infection that develops acutely (suddenly). Men often experience fever and chills and an explosive onset of voiding symptoms such as urgent, frequent, and painful urination. The prostate is hot and swollen. If acute bacterial prostatitis isn’t treated promptly, bacteria can overwhelm the body’s defense mechanisms and become a life-threatening emergency.
Chronic (long-lasting) infectious prostatitis: This also may be caused by a bacteria. Stress, caffeine, nicotine, or alcohol may worsen the condition. Symptoms may include repeat bladder infections, frequent urination, and pain in the lower abdomen or low back. 

Chronic bacterial prostatitis is usually, but not always, preceded by an acute bacterial infection. The infection becomes chronic if the body’s defenses are unable to eradicate the offending bacteria. The presentation of chronic bacterial prostatitis is different than the acute version. That’s because a small pocket of smoldering bacteria, not an overwhelming bacterial infection, causes chronic bacterial prostatitis. Therefore, chronic bacterial prostatitis isn’t a medical emergency; it’s not life threatening. Nevertheless, chronic bacterial prostatitis can make life miserable. Men with chronic bacterial prostatitis often suffer recurrent urinary tract infections, chronic pelvic pain, problems with sexual function, plus a variety of voiding difficulties.
Noninfectious prostatitis: This form of prostatitis is not caused by a bacteria and therefore antibiotics are not helpful. This is the most common type of prostatitis. It may be exacerbated by stress and/or irregular sexual activity. Stress may cause the pelvis muscles to tighten and cause pain. Increased pressure during voiding may cause urine to back up into the ducts resulting in a form of chemical prostatitis. The prostate gland produces fluid for semen and infrequent ejaculation may cause the ducts to become clogged with secretions.

Prostatitis is not contagious to your sexual partner. The symptoms of prostatitis are similar to those of benign prostatic hyperplasia (enlargement of the prostate) or urethritis (inflammation of urethra). It is important to see your physician for a prostate examination so that the proper treatment may be initiated.

Where do the bacteria come from?
They come from infected bladder urine or infected urethral secretions. (The urethra is the tube that carries urine from the bladder through the prostate to the outside.) In addition to infected bodily fluids, acute bacterial prostatitis can be caused by manipulation of the urinary tract; for instance, anytime a catheter (soft drainage tube) or an instrument such as a cystoscope (a device that urologists use to ‘look’ inside the bladder) is passed from outside, through the urethra, into the bladder. Unsafe sexual practices such as anal intercourse can also cause bacterial prostatitis. In addition, when the smooth flow of urine is interrupted, bacteria can get back-washed into the ducts (tubes) that drain the prostate.

Can bacterial prostatitis be prevented?
Yes, the prostate is capable of killing most of the bacteria before they can gain a foothold. It does this by secreting a sticky substance called antibacterial factor. Secreted by cells that line the prostatic ducts, this antibacterial fluid ‘slimes’ and kills bacteria on contact. Researchers have determined that zinc is the active component of antibacterial factor.
In addition to secreting antibacterial factor, the prostate enlists the help of the immune system to ward off bacterial interlopers. Infection fighting cells called lymphocytes, monocytes, and eosinophils kill bacteria by either swallowing them whole or by poisoning them with toxic substances such as hydrogen peroxide. Once the bacteria have been annihilated, the prostate helps in the clean-up process by secreting additional fluid into the prostatic ducts. This fluid washes cellular debris and bacteria from the ducts and dumps them into the urethra. Urination then washes the secretions to the outside.

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