Prostatitis Health Article

Diagnosis

Most often the symptoms and physical findings are enough to form a diagnosis of prostatitis. When the examiner inserts a finger in the rectum, the swollen prostate can be felt; it may be extremely tender when probed. Squeezing the gland slightly will produce a few drops of fluid that may be cultured to learn whether bacteria are present. The fluid typically contains a large number of white blood cells, especially the cells used to fight off infection (macrophages). Note: too much pressure on the prostate can force bacteria into the blood and cause a serious general infection. Many patients with chronic bacterial prostatitis also have recurring urinary tract infections (diagnosed by examining and culturing urine samples). These infections can be an important clue to the diagnosis. If doubt remains, the urologist may insert a special instrument called a cystoscope through the penis to directly view the prostate from inside and see whether it looks inflamed.

Treatment

Acute prostatitis is first treated with antibiotics. Even though it may be difficult for drugs to actually get into the inflamed prostate, most patients do quickly get better. If intravenous antibiotics are needed or the bladder is retaining urine, a hospital stay may be necessary. Broad-spectrum antibiotics that work against most bacteria are used first. At the same time tests are done with samples of prostatic fluid to determine which bacterium is causing the infection, so that drugs can be prescribed to fight the specific germ. In chronic cases, the best results are obtained with a combination of the antibiotics trimethoprim and sulfamethoxazole. Oral antibiotics should be given for 1–3 months; longer, if necessary. If a fungus or some other organism is causing infection, special drugs are available. If chronic prostatitis continues despite all medical efforts and is seriously affecting the patient's life, the prostate may be removed surgically.

Nonbacterial prostatitis requires other measures to relieve urinary symptoms. These measures include drugs that fight inflammation (steroids or nonsteroids) and a type of drug called an alpha-blocker that reduces muscle tension. Reduced muscle tension eases urine flow, allowing the bladder to empty. A narrowed urethra may be widened by placing a collapsed balloon at the site of obstruction and expanding it. This procedure is called balloon dilation. The effects of such dilation are usually temporary. Some physicians believe that stress is an important factor in prostatitis, and therefore prescribe diazepam (Valium) or another tranquilizer. The type of prostatitis known as prostatodynia is usually treated with a combination of muscle relaxing drugs, heat, special exercises, and sometimes a tranquilizer.

There are a number of "tips" for relieving symptoms of prostatitis. They are especially helpful early on, before antibiotics have a chance to cure infection, or for patients with chronic or non-bacterial prostatitis:

• Hot sitz baths. Exposing the perineum to very hot water for 20 minutes or longer often relieves pain.
• Ice. When heat does not help, ice packs, or simply placing a small ice cube in the rectum, may relieve pain for hours.
• Water. A patient who has to urinate very often may want to cut back on his fluid intake but this will cause dehydration and increase the risk of bladder infection. Instead, it is best to drink plenty of water.
• Diet. Most doctors recommend cutting out—or cutting down on—caffeine (as in coffee or tea), alcohol, and spicy or acid foods. Constipation should be avoided because large, hard bowel movements may press on the swollen prostate and cause great pain. Bran cereals and whole-grain breads are helpful.
• Exercise. It is especially important for patients with chronic prostatitis to keep up their activity level. Simply walking often will help (unless walking happens to make the pain worse).
• Frequent ejaculation. Ejaculating two or three times a week often is recommended, especially when taking antibiotics.