Prostatitis and BPH

The prostate is a relatively small gland, similar in size and shape to a walnut, but it can cause big problems if it grows or becomes infected. Prostatitis and benign prostatic hyperplasia (BPH) are two common conditions that affect the prostate. Although both can lead to pain and difficulty urinating, these conditions often have different causes.

Read on to learn more about these two conditions.

The prostate is part of the male reproductive system. The main job of this walnut-shaped gland is to add fluid to semen. The prostate is just below the urinary bladder, and it surrounds the most upstream portion of the urethra. The urethra is the tube that carries urine from the bladder to the opening at the end of the penis.

Prostatitis refers to inflammation of the prostate. It can be caused by a traumatic injury to the prostate or by bacteria that got into the prostate from urine or during sex.

Prostatitis can be acute or chronic. Acute prostatitis tends to start quickly. Chronic prostatitis tends to last or come and go over a longer period of time.

An inflamed prostate without any symptoms is called asymptomatic prostatitis. This condition is often discovered when diagnosing something else.

BPH causes a person to have an enlarged prostate. This condition becomes more common as men age. As the prostate enlarges, it squeezes and blocks the urethra, making it hard to empty the bladder completely.

Prostatitis is more likely to affect men ages 50 or younger. BPH usually occurs in men over age 50.

Symptoms of prostatitis will vary depending on the cause. Common symptoms include:

Chronic bacterial prostatitis typically causes the following symptoms:

The symptoms of this condition don’t always relate to the size of the prostate. A slightly enlarged prostate can sometimes cause more severe symptoms than a very enlarged one.

The symptoms of BPH may include:

  • a frequent need to urinate, especially at night
  • an urgent need to urinate
  • trouble starting a urine stream (hesitancy)
  • a weak or dribbling urine stream
  • unintentional loss of urine, also known as incontinence
  • an inability to urinate
  • pain during urination

See your primary care provider if you’re having pain, burning, or trouble urinating. They may refer you to a urologist, a doctor who treats urinary health disorders in both men and women. This specialist also treats issues of the male genital system, including prostate problems.

During the exam, the doctor may insert a gloved, lubricated finger into your rectum. This test is called a digital rectal exam (DRE). It helps your doctor feel if part of your prostate is swollen or enlarged.

During the DRE, your doctor may massage your prostate to cause fluid from the prostate to be secreted into your urine in order to check for a cause of prostatitis, such as an infection. They may also test your blood, semen, and urine.

Your doctor may order an ultrasound, which is a scan that uses sound waves to create a picture of your prostate. They may also perform urodynamic tests, which measure your ability to empty your bladder.

Your treatment for prostatitis will depend on the cause. Antibiotics are often used to treat bacterial prostatitis. If you have a more severe infection, you may need to get antibiotics through your vein. You may have to take antibiotics for two weeks or longer until the infection clears up.

Other treatments you and your doctor may consider include:

  • alpha-blockers, which are medicines that relax the muscles around the prostate and help you urinate more easily
  • nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) or aspirin (Bufferin), for pain relief
  • prostate massage

You can also soak in a warm bath or sit on a cushion to ease the pressure on your prostate.

BPH is treated with medications that shrink the prostate and reduce urinary symptoms.

Drugs called 5-alpha-reductase inhibitors block conversion of testosterone to a substance that contributes to the benign prostate growth, called dihydrotestosterone (DHT). These drugs include dutasteride (Avodart) and finasteride (Proscar).

Drugs called alpha-blockers (selective alpha-1 antagonists) can help relax the prostate and bladder neck, and improve urine flow. These drugs include doxazosin (Cardura), tamsulosin (Flomax), and terazosin (Hytrin).

Your doctor may prescribe one of these drugs or a combination of them.

If medications don’t help or your symptoms are severe, your urologist may recommend a less invasive procedure to destroy the extra prostate tissue and widen the urethra within the prostate. The procedure may use one of the following:

  • heat with radiofrequency ablation
  • microwave energy
  • high-intensity ultrasound waves
  • electric current vaporization

Surgery is a longer-term solution. During BPH surgery, the doctor uses a cutting wire loop or laser to cut away the excess prostate tissue.

You can usually use antibiotic therapy to treat acute bacterial prostatitis. You should start to feel better within a couple of weeks.

Chronic prostatitis can be more difficult to treat. Even after treatment, your symptoms can return over and over again.

You may need to try more than one treatment to relieve the symptoms of BPH. Your doctor may recommend that you keep taking certain medicines in the long term to keep your BPH under control.

Some of the treatments used to shrink the prostate and relieve urinary symptoms can cause side effects such as retrograde ejaculation and erectile dysfunction. Discuss the possible benefits and risks of your chosen treatment so you’ll know what to expect.