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Chronic Prostatitis - An Overview

by Donald Feeney, MD

The term "chronic prostatitis" describes a somewhat vague and poorly understood condition that affects many men, usually in young or middle age.  The prostate gland is a chestnut-shaped glandular tissue surrounding the connection of the outlet of the urinary bladder and the urethra or urine tube that carries the urine to the outside.  Its function is to produce much of the fluid in semen.

Chronic prostatitis may best be described as an inflammatory infection of the prostate gland with persistent irritative symptoms while urinating, and dull, persistent pain and discomfort in the groin, lower abdomen or between the legs.  There is usually no fever or symptoms affecting other parts of the body.  Although these symptoms may occur after an attack of acute bacterial prostatitis that has been treated, many of the young and middle-aged men afflicted with this condition do not have any history of a prior acute infection involving the prostate or urinary system.  Physical examination by a rectal exam may reveal a slightly swollen or boggy prostate or a normal feeling prostate.  Examination of a urine sample does not usually show any white blood cells or other evidence of a bladder or urethral infection.

It is not considered necessary for the doctor to order any x-rays, ultrasound examinations or other imaging procedures as these are not necessary to make the diagnosis and do not add any useful information.  The collection of prostate secretions by massage through the rectum often does reveal an increased number of white blood cells and occasionally bacteria may be found by running lab tests on the cultures.   

The treatment consist of antibiotics administered over a rather long period of time, since the symptoms tend to last many days and even weeks.  The reason why the duration of the treatment might have to be up to 12 weeks is because it is somewhat difficult for the antibiotics to actually get into the prostate.  The symptoms may be somewhat relieved by mild pain control medication such as non-steroidal inflammatories (for example, Aleve) as well as taking warm tub baths once a day.  Such measures should also be continued for up to 12 weeks just like the antibiotic treatment.

One important part of any treatment is having the doctor reassure the man about the benign nature of chronic prostatitis.  Although it is somewhat difficult to cure, it carries no long-term dangers.  It is not cancer, nor a precursor to cancer; it will not render the man sexually impotent or sterile. Without emphatic reassurance of these facts by the doctor, many men become anxious and fearful when this disease strikes them and seems to persist for weeks. This fear and anxiety may indeed impede the healing process and prolong the symptoms.

It is uncertain why some men develop chronic prostatitis.  Some experts in the field believe a prior acute urinary or prostate infection results in these patients becoming more susceptible to chronic prostatitis. Other experts blame stress, excessive fatigue or even dietary indiscretions. It is true that some men suffer a recurrence of chronic prostatitis after ingesting alcohol, caffeine or certain foods.  There is no confirming evidence of these factors, but doctors will usually advise patients to avoid activities and substances that tend to worsen the symptoms or precipitate a recurrence.

It is wise to emphasize again that chronic prostatitis has never been shown to lead to an increased chance of the patient developing either cancer of the prostate or the benign enlargement of the prostate with its associated urinating problems in later life.  It certainly is a distressing, somewhat persistent condition but is treatable and has no lasting effects.

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