Prostatitis and Chronic Prostatitis
Prostatitis is an inflammation of the prostate gland and is an umbrella term for a group of prostate disorders that share common symptoms including chronic prostatitis (CPPS).
Men with this disorder experience extremely debilitating symptoms that, until recently, were thought to be caused mainly from a bacterial infection of the prostate gland. It is now known, however, that bacterial infection accounts for only a very small fraction, about 5 percent, of cases of prostatitis. The cause of bacterial prostatitis is obvious, and generally easy to diagnose; infection with some type of bacteria (usually E. coli).
But doctors and clinicians have never been able to figure out why some men develop the more common, nonbacterial form of this disease called chronic pelvic pain syndrome, or CPPS. This nonbacterial form may last for several weeks or longer, only to disappear and then flare up again. Nearly 95 percent of men who are mistakenly told that they have “prostatitis” are believed to actually have this chronic variant.
According to the Professional Guide to Diseases, 9th ed., as many as 35 percent of men older than 50 have chronic prostatitis and about 50 percent of males will be diagnosed with this disease at some point during their lives.
There are an estimated 2m outpatient visits (people seeking treatment only) each year and according to the National Institutes of Health, prostatitis accounts for 25% of all office visits involving the genitourinary system by young and middle-aged men.
The National Institutes of Health (NIH) have placed the different types of this disease into four categories (see chart).
Three of the four different types of prostatitis—acute bacterial prostatitis, chronic bacterial prostatitis, and chronic nonbacterial prostatitis/chronic pelvic pain syndrome – have similar symptoms, yet there are a few notable differences among them. Generally, symptoms include a strong urge to urinate, difficulty starting the urinary stream, a weak urinary stream, dribbling, frequent nighttime urination, and pain and/or burning when urinating.
Acute bacterial prostatitis (Category 1), the least common of the four but the most serious, is also characterized by pain when ejaculating and pain in the pelvic area. Men of any age can get it, but it mostly strikes middle-aged and older men. Because it is caused by bacteria that can travel throughout the body, acute bacterial prostatitis can also cause nausea, vomiting, and chills. Antibiotics are the usual course of treatment.
Chronic bacterial prostatitis (Category 2) is similar to acute bacterial, but it lasts for months and is also caused by bacterial infection. Urinary tract infections are a common additional symptom in chronic bacterial. This form is also treated with antibiotics. Long-term complications may include infertility and abnormal semen. Between episodes of this disease, men who have chronic bacterial prostatitis may have no, mild, or severe symptoms because the symptoms can come and go. This makes the disease difficult to diagnose because the bacteria do not always appear in the urine. It remains a mystery why some men suffer from chronic prostatitis while others do not. One theory is that some men are more susceptible to infections or the bacteria manage to “hide” in the prostate and elude antibiotics that would have destroyed them. Long-term complications of chronic bacterial prostatitis include infertility, abnormalities of the semen, and reduced quality of life.
Chronic nonbacterial prostatitis / chronic pelvic pain syndrome (Category 3) is the most common form of this disorder and may also be accompanied by blood in the urine. Category 3 can be subdivided into two groups. In type 3a (IIIa), there is inflammation and a significant number of white blood cells in the prostate. This is the most common of all the types of prostatitis. In type 3b (IIIb), there is no inflammation.
To meet the official diagnosis of chronic prostatitis, symptoms must be present for at least three months, and they tend to come and go. Like chronic bacterial prostatitis, experts do not know why men get this nonbacterial form of the disease. Some propose that it is caused by germs that go undetected, while others suggest it is associated with nerve or muscle function in the area of the prostate, a renegade immune system, substances such as uric acid that move from the blood into the prostate and irritate the gland, pressure exerted on the prostate from nearby diseased tissue, and psychological stress. Over time, the disease can cause semen abnormalities, infertility, and a poorer quality of life. While symptoms improve without treatment for some men, others turn to a variety of options, including medications to relax muscles in the prostate, pain relievers, prostatic massage, and avoiding foods that may trigger symptoms. Alternative medicine approaches include hot baths, biofeedback, acupuncture, supplements and relaxation exercises. If symptoms become unbearable, TURP and TUMT are additional treatment options.
Asymptomatic inflammatory prostatitis (Category 4) is found in men who have an elevated PSA, an inflamed prostate, but no symptoms of prostatitis. This form of prostatitis is treated with antibiotics, after which the PSA levels usually return to normal four to six weeks later.