What are the different types of prostatitis and how are they treated?
Bacterial prostatitis
Acute bacterial prostatitis represents only 5% of all prostatitis. It is caused by bacteria and is the easiest to diagnose and effectively treat, although severe complications may develop if not treated quickly. Acute bacterial prostatitis is diagnosed by rapid and severe urinary symptoms (including inability to urinate), associated with fever, chills, muscle aches, back pain, and malaise. It can usually be confirmed by urine and blood culture tests to identify bacteria. Antibiotics and drainage of the bladder result in quick relief, but treatment should persist for many weeks to prevent a more serious situation from arising.
Chronic bacterial prostatitis is slow to develop but persistent, lingering for months and reappearing over years. It is a common form of prostatitis, and is often caused by an underlying problem in the prostate that becomes the focus for bacteria in the urinary tract. It commonly causes frequent urinary tract infections in men. Chronic bacterial prostatitis is a bit more difficult to confirm. One must prove that there are signs of infection, either by finding bacteria in prostate fluid or urine collected immediately after prostate massage. In addition, there must be signs of white blood cells (leukocytes) in these fluids. Antibiotics can be used to treat this condition, but it may take many courses and many years to completely clear up.
Non-Bacterial Prostatitis
Chronic nonbacterial prostatitis is an inflamed prostate without bacteria and is the form of prostatitis least understood. Urinary tract infections are not experienced by men with this form of prostatitis. Chronic prostatitis develops more slowly than acute prostatitis and its symptoms are more annoying than dangerous, and may disappear and then reappear later on. These include frequent and strong urges to urinate (“frequency” and “urgency”), some slowing of the urinary stream, and an ache or pain in the genitals, rectum, lower abdomen, or lower back. Nonbacterial prostatitis is diagnosed when no bacteria are found in the urine or prostate fluid, but white blood cells may be present as an indicator of inflammation.
Treatment of chronic nonbacterial prostatitis includes long-term antibiotics and anti-inflammatory drugs. In addition, some men have found that avoidance of irritants of the urinary tract (caffeine, alcohol, spicy foods, and smoking) may speed their recovery. Frequent ejaculation (even if uncomfortable) may be helpful for some men.
For each individual with this form of prostatitis there may be a different treatment. Stress often aggravates this condition, and measures to reduce stress, including pelvic floor physiotherapy or relaxation, are often needed.
Chronic pelvic pain disorder (CPPD) seems like chronic non-bacterial prostatitis, but the prostate is usually normal on examination and there are no signs of infection or inflammation in prostate fluid or urine. CPPD can often be confused with, or made worse by, spasms in the pelvic floor muscles (similar to a headache related to neck muscle pain) or pelvic/hip malalignment. CPPD may be associated with nerve type of pain. Treatment of this situation often involves anti-inflammatory medications, regular ejaculation, dietary modification, prostate or pelvic massage, pelvic floor exercises, physiotherapy, nerve pain medication (e.g. gabapentin or pregabalin), hot baths (or, if heat does not work, applying ice packs to area between your testicles and anus), and by avoiding constipation, as large, hard bowel movements can press on the sore prostate and can be quite painful.
It is very important for a man with CPPD to understand that his prostate is not infected and he should not be labeled as having “chronic prostatitis”. Slow or limited recovery and many different treatments may lead to depression and lower libido, with the pain of the disorder making it difficult to enjoy sexual relations.
