Dealing with chronic prostatitis.

If you’ve had acute prostatitis you may get chronic prostatitis if the condition recurs.  Chronic prostatitis is not usually caused by bacteria but can come about because of a previous infection which leaves the prostate vulnerable.

Other causes of chronic prostatitis.

  • Any problem that causes urine to irritate the prostate.
  • Chemical irritation to the area.
  • Problems with your pelvic floor muscles.
  • Nerve problems in the lower urinary system.
  • Sexual abuse
  • Rather than bacteria it could be caused by a tiny parasite called trichomonads.  This is rare but it can be passed on by having sex with an infected female partner.
  • Viral infection.
  • If bacterial infection is the cause then it is by more unusual bacteria (called ureaplasma or mycoplasma bacteria).
  • Psychological factors and stresses.

What are the symptoms of chronic prostatitis?

The symptoms are quite similar to acute prostatitis but don’t include the fever etc and rapid onset.

Symptoms include:

  • Problems when trying to pee – the stream takes a while to start or you feel you still need to pee when you’ve finished (urinary retention)
  • The stream of pee is weaker than normal
  • Bad smelling urine
  • Low abdominal pain, just above the pubic bone
  • Pain in the lower back
  • Pain in/under the testicles
  • Pain around the anus
  • Pain when you pass bowel movements
  • Pain on ejaculation
  • Blood in the semen.

What tests will the doctor do for chronic prostatitis?

We talked about a lot of the tests and exams for prostatitis in the article on bacterial prostatitis.  Most of these will be returned as normal but the prostate may feel swollen when the doctor examines it by DRE (digital rectal examination).  Digital means ‘finger’ in medical terms.

You can see from picture here, for the DRE exam the doctor will put a gloved and well lubricated forefinger into the back passage to feel the gland, as you lie on your side.  It’s not very comfortable or dignified but won’t take long.

A urine test sent to the lab may have red or white blood cells in it.

A semen sample shows a high white cell count and low sperm count and the sperm will have poor motility.

You may have an ultrasound scan or X-ray to rule out other problems with the urinary tract.

The doctor will ask you about your medical history to see if a previous acute prostatitis could have caused your current symptoms.

How is chronic prostatitis cured?

Treatment is difficult and the aim may be to control the symptoms you’re experiencing.

  • If it’s suspected that the cause is bacteria then you may be given long term antibiotics and it’s important to stay on the course and complete it.  Talk to your health care provider if you have any concerns about your antibiotics.
  • In people who have small stones in the prostate it may be appropriate to remove the gland with a surgical operation.  This is unusual and not usually carried out in younger men.
  • Drugs called alpha-blockers can also help.  They take about 6 weeks to work and don’t work for everyone.  Examples of these are Alfuzosin (Uroxatral), Doxazosin (Cardura),Silodosin (Rapaflo), Tamsulosin (Flomax), Terazosin (Hytrin). They work by relaxing the muscle tissues in the prostate and can improve urinary symptoms.
  • Meds that are thought to shrink the prostate may also work.  Examples are finasteride (Proscar).
  • To relieve symptoms of urinary retention (the bladder not emptying properly when you pee) you may need to use a catheter. Your health care provider will teach you how to do this.
  • Take time to empty your bladder completely.  Urine left in the bladder can cause infection which will add to your problems.
  • Warm baths will help to relieve pain/discomfort.
  • Take stool softeners to make your bowel movements more comfortable if that’s been a problem.
  • Take pain killers such as paracetamol or non steroidal anti inflammatory drugs (NSAIDs) as needed.  Pay attention to the warnings on the packet and don’t exceed the allowed dose.
  • Avoid alcohol, caffeine and citrus foods or drinks, and avoid spicy foods, all of which can irritate the bladder.

Symptoms may last for some time or may come in bouts – episodes that come and go.  Take your specialist’s advice for the management of the condition.

If you’re worried about your symptoms or medical problem but don’t want to seek professional help because you feel embarrassed, silly or that it’s your fault, read this page now:  How to talk to a doctor about an embarrassing problem.

Elspeth Raisbeck

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