Prostatitis is inflammation of the prostate gland which known anatomically as walnut-sized gland situated below the urinary bladder in males. There are four major types of prostatitis found in the medical literature include acute bacterial prostatitis, chronic bacterial prostatitis, chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis.

Any kind of bacteria that can lead to urinary tract infection (UTI) can also lead to acute bacterial prostatitis. In addition, chlamydia and gonorrhea infections which result from unsafe sexual contact can cause prostatitis.

The possible causes of nonbacterial prostatitis include irritation, emotional problems, and sexual abuse. Risk factors that can lead to prostatitis include pelvic injury, infection, and unsafe sexual practices.

The prostate becomes larger, tender, and firm due to the inflammatory response which triggered by infection attacks. In acute bacterial prostatitis, an organism should be isolated and identified on culture.

The most common identified organism is Escherichia coli. Researchers are suggesting that nonbacterial prostatitis syndromes often result from interconnecting mechanisms include immunologic, neuroendocrine, inflammatory, and neuropathic mechanisms that initiated in a genetically or anatomically susceptible patient.

Signs and symptoms of bacterial prostatitis can start quickly and may include fever, chills, and flushing of the skin. Symptoms of chronic bacterial prostatitis often begin more slowly and show similarity with bacterial prostatitis, but less severe. Signs and symptoms of nonbacterial prostatitis include presence blood in the semen and in urine or pain with bowel movements or with ejaculation.

In order to diagnose prostatitis, a physician might ask questions in regard the medical history and symptoms as well as performing physical exam examination.Initial diagnostic tests might include urine, blood, and imaging tests.

Treatment of prostatitis will largely depend on the type of prostatitis. Antibiotics are the first choice when considering treatment for prostate infections. Treatment for nonbacterial prostatitis is challenging. The goal is to control symptoms because the original problem is hard to treat.

If not properly treated and managed, prostatitis can lead to several complications such as epididymitis and infertility. Some preventative measures that can be taken to reduce chances of developing prostatitis include maintaining good hygiene, safe sex practices, and physical exercises.

From an epidemiological standpoint, the prevalence of prostatitis range from 2.2 to 9.7%. Moreover, increasing risk of developing prostatitis symptoms was associated with individuals who have a history of sexually transmitted diseases.

Prostatitis is swelling (inflammation) of the prostate gland. The prostate gland is walnut-sized gland located below the urinary bladder in males and it is responsible for producing part of the seminal fluid, the fluid that helps carry sperm out of the body during ejaculation. Inflammation of prostate can develop in men of all ages but it usually affects men aged between 30 and 50.

There are four major types of prostatitis that can be studied separately, include:

• Acute bacterial prostatitis: This type appears suddenly and can result in signs and symptoms similar to flu, such as fever, chills, nausea, and vomiting. This type may be attributed to common strains of bacteria.
• Chronic bacterial prostatitis: This type appears when using antibiotics proved ineffective, and presence of the sign of developing recurrent or difficult-to-treat infections. No symptoms or only minor symptoms may manifest when infection occurs.
• Chronic prostatitis/chronic pelvic pain syndrome: The exact cause behind the occurrence of this type cannot be identified precisely and it is more likely that bacteria are not involved in developing the disease. The pattern of symptoms is varied from person to another, in some people, symptoms may appear in the stable pattern, while, symptoms can take the form of turning points from mild to severe in many other cases. In addition, this type can be classified into subcategories A and B according to presence or absence of inflammation.
• Asymptomatic inflammatory prostatitis: Usually, this type causes no apparent symptoms and no particular treatment is needed. This type only noticed by coincidence when performing diagnoses for another condition.

In case of bacterial prostatitis, the possible causes may include:

• Any kind of bacteria that can lead to urinary tract infection (UTI)
• Chlamydia and gonorrhea infections, which result from unsafe sexual contact.
• Infecting with E. coli bacteria and other common bacteria can cause prostatitis in men over age 35.
• Acute prostatitis may result from problems with the urethra or prostate, such as:

1. Clinical interventions such as placing urinary catheter, performing cystoscopy or prostate biopsy
2. Obstructions that prevent the flow of urine out of the bladder
3. Injury to perineum (area between the scrotum and the anus)
4. Prevention of foreskin retraction (phimosis)

In case of nonbacterial prostatitis, the possible causes may include:

• Infections include viruses, parasites, and less common types of bacteria, or infection with an organism that has not yet been identified.
• Muscular dysfunction in the pelvic floor or mechanical problems causing retention of prostatic fluid.
• An immune reaction result from a urinary constituent or from an antigen associated with certain organisms.
• Irritation resulted from chemicals or from the backup of urine flowing into the prostate.

• Emotional problems and stress may contribute to the problem.
• Neurological dysfunction in the lower urinary tract.
• Prostatic cysts, calculi, or interstitial cystitis.
• A history of bacterial prostatitis infection.
• Riding the Bicycle.
• Sexual abuse.

The majority of men with chronic prostatitis have the nonbacterial form. Issues concerning immune or nervous systems, or injuries to the prostate, may contribute to chronic nonbacterial prostatitis.

There are many risk factors which can lead to prostatitis.Some of these factors can be controlled while others cannot. Risk factors include:

• Age: Young or middle-aged individuals are more susceptible to prostatitis.
• History of the disease: Previous prostatitis occurrences can increase the possibility of having prostatitis in the future.
• Pelvic Injury: Trauma caused by bicycling or horseback riding might increase the possibility of having prostatitis.
• Urinary catheter: The recurrent use of the indwelling tube that inserted into the urethra to drain the bladder can make the individual more susceptible to prostatitis.
• Prostate biopsy: Conducting prostate biopsy to help diagnose cancer may increase the possibility of having prostatitis.
• Infection: Having HIV/AIDS, sexually transmitted infection (STI), or having any other bacterial infection in the bladder or in the urethra can contribute in developing the disease.
• Unsafe sexual practices and sexual abuse: Having anal sex without using condoms, for example, can make the person more susceptible to prostatitis.
• Other painful abdominal conditions: Developing other abdominal conditions such as irritable bowel syndrome (IBS) may elevate the possibility of having prostatitis in the future.

Previous or concurrent infection can cause bacterial prostatic infection. Nonbacterial prostatitis can result from spasms in the genitourinary tract or tension in the pelvic floor muscles.

The bacteria ascend into the prostate through the prostatic ducts coming from infected bladder, urethra, lymphatics, or blood. The prostate becomes larger, tender, and firm due to the inflammatory response which triggered by infection attacks. Usually, only a few of prostate’s excretory ducts show inflammation signs.

In acute bacterial prostatitis, the most common identified organism is Escherichia coli, but other gram-negative organisms, such as Klebsiella, Proteus, and Pseudomonas, in addition to gram-positive organisms such as Enterococcus species are often identified as well. Presence of other gram-positive organisms that made up normal skin flora has been recognized in many patients with suspected bacterial prostatitis.

Researchers often explain why bacterial prostatitis is so difficult to treat by assuming that the E. coli strains seen in chronic bacterial prostatitis gain a higher virulence factor and a greater degree of biofilm formation than the strains seen in less complicated urinary tract infections.

Furthermore, researchers are suggesting that nonbacterial prostatitis syndromes often result from interconnecting mechanisms include immunologic, neuroendocrine, inflammatory, and neuropathic mechanisms that initiated in genetically or anatomically susceptible patients.

• Signs and symptoms of bacterial prostatitis can start quickly and may include:

• Fever and chills
• Flushing of the skin
• The urinary symptoms of bacterial prostatitis include:

1. Bloody and foul-smelling urine
2. Weak urine stream accompany with burning or pain sensation
3. Difficulty starting to urinate or emptying the bladder

• Other symptoms may associate with this condition include:

1. Pain sensation in the testicles, in the abdomen above the pubic bone, in the lower back, or in the perineum.
2. Pain with bowel movements or ejaculation.
3. Blood in the semen.
4. Symptoms of epididymitis or orchitis such as testicle pain and tenderness.

• Symptoms of chronic bacterial prostatitis begin often more slowly and show similarity with those of bacterial prostatitis, but less severe. Some people may appear asymptomatic between bouts of prostatitis.
• Signs and symptoms of nonbacterial prostatitis include:

• Blood in the semen and in urine.
• Pain with bowel movements or with ejaculation.
• Problems with urinating.

Moreover, the common symptoms of chronic nonbacterial prostatitis are sharing the same characteristics with those of chronic bacterial prostatitis but excluding the fever.

• Asymptomatic inflammatory prostatitis has no symptoms and is usually discovered by chance when implementing tests for other conditions.

Diagnosis of prostatitis may involve:

• Medical history and physical exam: Physician may ask questions regarding medical history and symptoms as well as performing a physical examination, which may include a rectal examination performed by wearing a glove and insert a lubricated finger into the rectum to check for any abnormal findings.
• Initial diagnostic tests may include:

• Urine tests: The urine test will involve analyzing urine sample (urinalysis) to search for signs of infection in the urine.
• Blood tests: The blood test will involve analyzing a blood sample to search for signs of infection and other prostate problems. Prostate-specific antigen (PSA) levels may alter due to prostatitis or prostate cancer.
• Imaging tests: Physicians might order a CT scan of the urinary tract to provide more detailed information than plain X-rays or sonogram of the prostate which is the visual image produced by an ultrasound.
• Post-prostatic massage: Physicians might massage the prostate and test the secretions in rare cases. The physician may perform a digital rectal exam to examine the prostate as a part of the mentioned process.

Based on the reported symptoms and test results, the physician may conclude the particular type of prostatitis, which the patient developed.

1. For acute bacterial prostatitis, findings may include:

• The gland may be tender to palpation and feel hot to touch or possibly normal.
• Abnormal size, number, or consistency for inguinal lymph nodes in addition to urethral discharge.
• Symptoms of urinary tract infection and systemic infection, for instance, tachycardia and dehydration.

1. For chronic bacterial and non-bacterial prostatitis, the gland may feel normal, large or soft, or may be hard due to the accumulation of calcium.
2. Diagnostic criteria  for chronic non-bacterial prostatitis include:

• Symptoms suggestive of prostatitis such as pelvic discomfort or pain which may last for more than three months.
• Negative results indicating no presence of microbes in urine and in prostatic fluid.
• Presence or absence of leukocytes in prostatic fluid (to confirm the inflammatory feature of the disease).

1. For asymptomatic prostatitis, the inflammatory cells can be isolated on prostate biopsy or in case identifying leukocytes on semen analysis during a urologic evaluation that is performed for other conditions.

Treatment of prostatitis largely depends on the type of prostatitis.

• Treatment options for bacterial prostatitis: Antibiotics is the first choice when thinking about treatment for prostate infections. Antibiotics have to be taken for 2 to 6 weeks to treat acute prostatitis, while, antibiotics have to be taken up to 12 weeks to treat chronic prostatitis because the infection can come back. A patient may not show improvement even after taking antibiotics for a long time. Symptoms may come back when a patient stops taking the prescribed medications.

In addition, a tube to empty the bladder may be inserted through the abdomen (suprapubic catheter) or from inside the body if the patient complains from a swollen prostate gland that makes it hard to empty the bladder.

• Treatment options for nonbacterial prostatitis: Treatment for nonbacterial prostatitis is challenging. The goal is to control symptoms because the original problem is hard to treat. Many kinds of medications can be used in treating the condition such as:

1. Long-term antibiotics: To assert that the prostatitis is not caused by bacteria, long-term antibiotics can be suggested by physicians. Nonetheless, people who are not showing improvement by using antibiotics should stop taking antibiotics immediately.
2. Alpha-adrenergic blockers: At least 6 weeks are needed to prove the effectiveness of this type of drugs. Alpha-adrenergic blockers act mainly in relaxation of muscles of the prostate gland. The treatment possibility of this type is low in many cases.
3. Nonsteroidal anti-inflammatory drugs (NSAIDs): These drugs may include the using of aspirin or ibuprofen, which are used for relieving symptoms in some cases.
4. Muscle relaxers: Diazepam or cyclobenzaprine may contribute to decreasing spasms intensity in the pelvic floor. Moreover, stool softeners may be suggested to help reduce discomfort with bowel movements.
5. Transurethral resection of the prostate (TURP): A surgical procedure called transurethral resection of the prostate may be suggested in rare cases if medications show no encouraging progress. Mostly, this surgery is not suggested for younger men and it may result in retrograde ejaculation. Furthermore, incontinence, sterility, and impotence are expected complications of the surgery.

• Treatment options for asymptomatic prostatitis: There is uncertainty attached to the clinical significance of this type of prostatitis. Treatment of this type of prostatitis is based largely on the primary reason for the urologic evaluation.

• Alternative therapies: Alternative therapies that seem promising in reducing symptoms of prostatitis include:

1. Biofeedback:  Biofeedback technique is utilizing signals from sophisticated monitoring equipment to teach the patient how to control specific body functions and responses including relaxation of certain muscles.
2. Acupuncture: Acupuncture technique involves a very thin needle inserted through the skin to various depths at certain points on the human body. Improvement in the urinary flow and decreasing inflammation have been reported in some cases with chronic nonbacterial prostatitis when using this method of treatment.
3. Herbal remedies and supplements: Although many men take herbs and supplements, there still lack of evidence that proves herbs and supplements improve prostatitis. Some herbal/supplements treatments for prostatitis include rye grass (cernilton), green tea, onions, quercetin, beta-sitosterol, zinc, vitamin c, omega-3 fatty acids, pumpkin seeds, probiotics, African pygeum, saw palmetto, stinging nettle.

• Other treatments: Other treatment options or advices can be given to help improve prostatitis, such as:

1. To distract the pain, hot showers can be suggested.
2. Although not proven to be effective, prostate massage and relaxation exercises can be suggested in some cases.
3. To avoid bladder and urinary tract irritants, dietary changes could be implemented.
4. Physical medicine: Tightening and relaxing the pelvic floor muscles by doing Kegel exercises is suggested to improve pelvic muscle tone and help some men reduce urinary symptoms.

Complications of prostatitis can include:

• Inflammation of the epididymis (epididymitis) which known as the coiled tube attached to the back of the testicle.
• Focal accumulation of pus within the prostate gland (prostatic abscess).
• Infertility and semen abnormalities (mostly in chronic prostatitis).
• Presence of bacteria in the blood (bacteremia).

Some of the preventative measures that the individual can take to help to reduce the chance of developing prostatitis include:

• Good hygiene practices: Keeping the genitalia clean can greatly decrease the risk of developing an infection.
• Safe sex practices: Gonorrhea and other sexually transmitted diseases can play a role in initiating bacterial prostatitis. Using a condom and other safe sex practices can help reduce the risk of developing prostatitis.
• Less caffeine intake: Caffeine-containing products can trigger prostate irritation and worsen the symptoms of prostatitis.
• High fruits and vegetables intake: high levels of antioxidants, vitamins, and other nutrients can be found in a variety of fruits and vegetables.These ingredients help in fighting infections and inflammation.
• Drinking sufficient amount of water: Maintaining good prostate health, preventing dehydration, and urinary tract infections can be accomplished by drinking enough water.
• Maintain a healthy weight: Obesity is harmful to overall prostate health. Making the effort to lose some of these fatty pounds have to be considered.
• Regular physical activity: Prostatitis can be prevented by regular physical exercises which can contribute to overall health.
• Early treatment of urinary tract infection: Developing urinary tract inflammation can eventually lead to prostatitis and with other types of infection.Therefore; the early treatment of urinary tract infection is advisable to prevent the occurrence of several types of inflammation.

Usually, a course of antibiotics can treat acute prostatitis. Taking the full course of antibiotics is essential to ensure that the infection is treated entirely. Certain complications of acute prostatitis can occur but it is rare, complications such as acute urinary retention or prostate abscess.

In case of chronic prostatitis, the treatment is difficult because little is known about what the exact causes behind it. Mostly, treatment will take gradual path ranging from several months to years. There is a distinction between prostatitis and prostate cancer and there is no proven evidence that confirms developing one of them could lead to another.

• According to a study published in the International Journal of Antimicrobial Agents, the prevalence of prostatitis range from 2.2 to 9.7%. Moreover, increasing risk of developing prostatitis symptoms was associated with individuals who have a history of sexually transmitted diseases.
• According to a study published in the British Journal of Urology International, The prevalence of prostatitis reported in men living in northern Finland is 14.2%, this figure is quite high comparing to other parts of the world. This could be attributed to cold climate.
• According to a study published in the World Journal of Urology, prostatitis is a diagnosis in approximately 2,000,000 visits annually in the US, including 8% of all visits to urologists and 1% of all primary care physician visits. In addition, prostatitis-like symptoms result in significant morbidity rate among men in both Europe and Asia.