Infections - Frequently Asked Questions

What symptoms should cause me to seek medical advice?

Common signs to look for include difficulty in passing urine, a weak flow or a flow that stops and starts, having to wait before you go, urgency or frequency, or having to get up at night to urinate.

How does bacterial prostatitis become chronic?

Plumbing problems can throw a monkey wrench into the defense system. Myriads of ducts permeate the prostate gland like the branches of a tree. At the end of each duct are balloon-like outpouchings called acini. These ducts drain the prostate and dump their secretions into the urethra. If these acini or ducts become blocked, they become distended. Distension causes pain and inflammation. Furthermore, blocked prostatic ducts prevent antibacterial factor, antibiotics, and immune cells from reaching trapped bacteria. As a result, the prostatic ducts and surrounding prostatic tissue becomes infected, inflamed, and scarred. Collectively these changes cause chronic pelvic pain, painful ejaculation, and chronic prostate infection. In addition, debris trapped within obstructed prostatic ducts can harden and form stones, which can contribute to chronic infection by interrupting the smooth flow of prostate secretions. Prostatic stones also promote chronic infection by serving as a hideout for marauding bacteria. Finally, bacteria have some tricks of their own which contribute to the chronic nature of bacterial prostatitis. Bacteria are able to avoid annihilation by coating themselves with a thick, slimy material called a biofilm.

How does bacterial prostatitis differ from non-bacterial prostatitis?

The short answer is the presence (bacterial) or absence (non-bacterial) of bacteria. Otherwise they are very much alike. With the exception of fever and chills (which is seen with acute bacterial prostatitis), men with other types of chronic prostatitis have similar symptoms including urgent, frequent, and painful urination, and physical complaints such as genital, pelvic, and lower abdominal pain.

The physical examination is also similar between the various categories of chronic prostatitis. Findings range from a normal prostate exam to varying degrees of swelling and tenderness.

How do doctors differentiate between non-bacterial and bacterial prostatitis?

In theory, laboratory tests can be used to differentiate between the two varieties. However, urine tests are usually unremarkable even though bacteria may be present, just not detectable. Furthermore, although microscopic examination of expressed prostatic secretions (abbreviated EPS) can differentiate between the various types of prostatitis, most urologists (95%) don’t bother to perform this simple examination. Instead they diagnose and treat prostatitis based on the presenting symptoms.

How are prostatic secretions obtained?

These secretions are expressed by milking (massaging) the prostate gland during a digital rectal exam. Repeated milking of the prostate causes secretions to flow from the prostatic ducts into the urethra and out the tip of the penis. The EPS are then collected on a glass slide and examined under the microscope for the presence or absence of bacteria and special scavenger cells called leukocytes. Swarms of leukocytes indicate inflammatory changes within the prostate. The secretions can also be cultured. If bacteria grow, it cinches the diagnosis of bacterial prostatitis and directs therapy; if they don’t, it can prevent the inappropriate use of antibiotics.

What causes non-bacterial prostatitis?

Various theories have been proposed over the years to explain the cause of non-bacterial inflammatory prostatitis (category IIIa). As mentioned above, it may be due to an occult bacterial infection that can’t be detected. Although unproven, other theories include genetic factors, hormonal imbalance, aging, chemical irritants, fungal infections, and an autoimmune response (where the body makes antibodies against itself). In the final analysis, though, the exact etiology of chronic prostatitis remains obscure in most cases.

The etiology of its non-inflammatory cousin (category IIIb) is just as mysterious. Although opinions vary, non-inflammatory prostatitis (also called prostatodynia, which literally means pain, ‘dynia’, in the prostate) is blamed on muscle spasms of the pelvis muscles (called the levator ani muscles), external urethral striated sphincter muscle (muscle used to stop urination), and muscles that surround the bladder neck (place where the prostate and bladder connect). Chronic muscle spasms produce a noxious breakdown product called lactic acid, which irritates surrounding tissue and causes pain. Stress is also a factor since it induces muscle spasms. Finally, muscle spasms cause pain because they cause urine to reflux into the prostate during voiding, which inflames sensitive prostatic tissue.

What changes occur as the prostate ages?

The prostate gland surrounds the tube (urethra) that passes urine. With age, this may become a source of problems for a couple reasons. The prostate tends to grow larger with age and may squeeze the urethra or a tumor can make the prostate bigger.

These described changes, or an infection, can occur and lead to problems passing urine. In some cases, men in their 30s and 40s may begin to experience a few of these urinary symptoms and need medical attention. Others may not experience symptoms until much later in life. Regardless of age, tell your doctor if you experience any urinary problems.

What steps can I take to help prevent prostate problems?

Eliminate bladder irritants, new window will open.
Moderate physical exercise and regular ejaculation also appear to contribute to prostate health.

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