By Dr. Jason Lomboy and Dr. Marc Greenstein, Advanced Urology

Summary

Do you have pelvic pain? Is this pain associated with bothersome urinary symptoms? Have you been to multiple doctors for a “urinary tract infection” and/or taken multiple rounds of antibiotics, but have had no relief? If you are male, you may be experiencing these symptoms due to prostatitis. You do not have to live with these symptoms! Call Advanced Urology today to make an appointment with one of our specialists. We know that talking about prostate and urinary issues can be awkward or embarrassing. Our physicians and staff commonly treat prostatitis and will make you as comfortable as possible from the moment you arrive. Our state-of-the-art facilities have cutting edge diagnostic and therapeutic technologies to give you back your quality of life quickly.

Call today to set up your appointment with one of the specialists at Advanced Urology and get back to feeling like yourself again. Don’t wait for relief.

What is inflammation of the prostate (prostatitis)? What are the risk factors for prostatitis?

Prostatitis means literally “inflammation of the prostate”. The prostate gland is found in men and is located just below the urinary bladder (the urethra runs through it) and in front of the rectum. Its main purpose is reproductive, to add many of the necessary nutrients to semen and sperm to facilitate fertilization with an egg. When this gland becomes inflamed or swollen, prostatitis is what results. The term prostatitis is used as a general term to describe this inflammation although the causes of the inflammation may differ.

When the prostate is inflamed, urination may be difficult or painful. Difficult urination can mean multiple frequent trips to the restroom, urge to urinate, getting up at night to urinate, straining to urinate, and starting and stopping urination. Men who have prostatitis may also experience pain symptoms in the greater pelvic area, testicles, and/or anorectal region. The pain may have a sudden onset or symptoms may develop gradually.

Risk factors for prostatitis are typically younger men over older men, although it can occur in a man at any age. Men who have had prostatitis before or more likely to experience it again in their lifetime. Neglecting treatment for prostatitis can result in chronic pain that is difficult to treat. In addition, neglecting prostatitis that could be due to an infection could lead to bacteremia (bacteria in the bloodstream) or a prostate abscess, both which can be dangerous conditions.

If you are experiencing any of these problems, it is important to see a specialist at Advanced Urology to quickly diagnose and begin treatment for your condition.

Different types of prostatitis

There are several different types and causes for inflammation of the prostate (prostatitis):

• Acute Bacterial Prostatitis (ABP): As the name suggests, this type of prostatitis is caused by a bacterial infection originating from anywhere in the urinary tract. ABP typically has a quick onset and can include symptoms such as fever, chills, muscular pain. It may also cause a dull pain in the testicles, behind your scrotum, or in your low back. Often you can have urgency with urination and bowel movements as well as other difficult urination symptoms. This can become a serious condition (especially if you are having fevers), so if you notice any of these symptoms, contact your urologist immediately.

• Chronic Bacterial Prostatitis (CBP): This type is typically a milder infection compared to acute bacterial prostatitis. Symptoms are also milder and can last for months on end without getting better or worse. Many patients with CBP have seen several doctors who prescribe rounds of antibiotics that seem to improve their symptoms, but then symptoms return after stopping treatment. In some cases, CBP develops after a UTI or an acute bacterial prostatitis. Typically, fever and chills with CBP are rare. However, bothersome urinary and bowel symptoms as well pain symptoms persist.

• Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): While this type of prostatitis shares many characteristics with bacterial prostatitis, it is not caused by an infection. It is not clearly understood what causes CP/CPPS, but several triggers have been linked to an increased risk. These include nerve damage, injury, and stress. Other immune disorders and irritable bowel syndrome (IBS) have also been linked to the condition. Patients do not typically have severe urinary symptoms with CP/CPPS (though they can still exist with other conditions). The hallmark symptom of CP/CPPS is long-lasting pain in your penis, scrotum, lower abdomen, perineum, and/or lower back.

What are the Symptoms of Prostatitis?

You may have prostatitis if you have any of the following symptoms:

• Dysuria (pain or burning while urinating)
• Pain with ejaculation
• Urinary hesitancy (Difficult to start urinating)
• Urinary intermittency (Starting and stopping while urinating)
• Nocturia (frequent nighttime urination)
• Urinary retention (inability to urinate or incomplete urinating)
• Urinary or Bowel Urgency (Unable to postpone needing to go)
• Urinary or Bowel Incontinence (Accidents)
• Cloudy or blood urine or ejaculate
• Pain in the pelvic area, lower back, groin, penis testicles, and/or anorectal area
• Flu-like symptoms (high fever, muscle aches, chills, and joint pain)
• A “pulling” or muscle tightness sensation behind your scrotum

If you have any of these symptoms, you should not wait! Seek care with a specialist at Advanced Urology today!

What to Expect When Seeking Treatment for Prostatitis: Diagnosis & Testing

If you are experiencing any of the symptoms of prostatitis, it is important that you seek care with a urologist today. You may have already started an online search for “prostatitis treatment near me”. Advanced Urology has many locations throughout the Greater Atlanta area to help you get your normal manhood back quickly.

When you arrive at one of our many facilities with ample free parking and warm, welcoming staff, your urologist will take time to understand your medical history and symptoms. Your doctor will examine you and then will likely recommend several tests and diagnostics, which are all completed within each of our state-of-the-art facilities.

The following tests and diagnostic methods are commonly used:

• Urinalysis: The test is a quick test that can determine signs of an active infection, as well as the presence of blood in the urine, signs of kidney disease or other medical problems.

• Urine culture: This test is a definitive test that confirms that presence of bacteria in the urine. This test may take several days to result as any bacteria in your urine have to be grown in a culture to be identified. If there are bacteria, an additional test will determine what antibiotics will kill that pathogen.

• Urine molecular PCR testing: We are pleased to now offer state-of-the-art PCR testing where we can quickly identify both common and rare pathogens as well as quickly determine the antibiotics that will or won’t kill the pathogen. This is often recommended when prior standard cultures are negative and/or antibiotics have not been helpful, yet a persistent infection is suspected.
• Imaging: As part of your evaluation, you will likely undergo an imaging study, which are also performed inside our facilities. We commonly use an ultrasound to assess the size and amount of swelling in the prostate. In some cases, a CT scan or MRI may be required.

• Cystoscopy: This study is when a narrow camera is placed into the urethra and bladder. It may be recommended to evaluate the inside of the urethra that runs through the prostate so that we can best assess what treatments would be most helpful to address your problem.

• Urodynamics: This is a study performed in our clinics by a special nurse in which we test the functional status of the bladder. In other words, we are able to assess your bladder sensation, capacity, whether the bladder is squeezing too little or too much, and whether the urethra and pelvic muscles (“the outlet”) are relaxing sufficiently to allow normal urination. This test may be performed with or without imaging and also helps to assess what treatments would be most helpful to address your problem.

Treatment options for prostatitis

Similar to many other medical problems, prevention is key to treatment of prostatitis. Though there is no specific linked activity known to cause prostatitis, there are behaviors that can decrease the likelihood of developing prostatitis.

To reduce your risk:

• Do not wait to see your urologist if you have symptoms of a urinary tract infection. Often prostatitis can develop from lack of treatment for a UTI.

• Use a well-padded seat when cycling or doing any type of activity involving a saddle.

• Drink enough fluids to keep your bladder flushed and free from concentrated urine, which can irritate and inflame the lower urinary tract.

• If you are given any antibiotics for UTI, ensure you complete the entire course. Poor compliance can lead to chronic bacterial prostatitis.

• Quit smoking. Smoking has been shown to weaken the immune system and may decrease the likelihood you could respond to antibiotics.

• Reduce alcohol and caffeine intake. Both have been linked to an irritated bladder and increased production of urine.

Treatment of prostatitis depends on the type of prostatitis you are suffering from. Common treatments for prostatitis include:

• Antibiotics: These medications can help to eliminate any infection that could be causing inflammation in the prostate. It is not uncommon for you to take a longer than usual course of antibiotics when you have prostatitis.

• Anti-inflammatory medications: These drugs help to reduce the amount of inflammation in your prostate and may significantly help manage your pain associated with prostatitis. In addition to ibuprofen, Celebrex or Mobic may commonly be prescribed for prostatitis symptoms.

• Alpha blockers: These medications work by relaxing the smooth muscle of the prostate and are known to improve the inflammation associated with prostatitis as well as help alleviate many of the irritative urinary symptoms one may have with prostatitis.

• Muscle relaxants: If your doctor suspects your pain could be related to neuropathic (nerve-related) pain or pain associated with pelvic floor dysfunction, these medications can help relax muscle groups that are causing pain.

• Pelvic floor physical therapy (PFPT): Pelvic floor physical therapy is often recommended when your pain symptoms are attributed to muscle pain and is commonly recommended in combination with muscle relaxant medications. With PFPT, you work with a specialist to teach you how to relax muscle groups that are causing pain and inflammation.

It is important to remember that not all prostatitis is treated the same. At Advanced Urology, your specialist will take the time to understand your problem and develop a patient-specific plan to help get you to your treatment goal. If the initial medications or treatments are not helpful, make an appointment to see your urologist again so that he or she can consider the next line of treatment options for you.