Prostatitis Diagnosis

  • Diagnosis

    Prostatitis is an inflammation of the prostate gland, and tends to be more common in older men Figure 01. The prostate is a gland about the size and shape of a chestnut that surrounds the urethra at the point where the urethra connects to the bladder. Prostatitis occurs when this gland becomes infected. Acute prostatitis strikes suddenly, and produces severe symptoms; chronic prostatitis may result from repeated infections, and is generally less severe.

    Click to enlarge: The Prostate Gland

    Figure 01. The Prostate Gland

    Prostatitis is usually caused by a bacterial infection. Bacterial prostatitis is caused by E. coli in 80% of cases; however, many other types of bacteria can also invade the urinary tract and cause prostatitis.

    Bacteria can enter the urethra during catheter use, or can transfer from the rectum.

    Nonbacterial prostatitis results in the same symptoms as prostatis caused by bacteria. Most often present in young, sexually active men, nonbacterial prostatitis occurs when a man has the signs and symptoms of prostate inflammation, but no evidence of bacterial infection.

    Acute prostatitis tends to strike suddenly, producing fever, chills, and pain Table 01. If you have acute prostatitis, you may have difficult and painful urination, and may also feel the need to urinate frequently. Urinating may produce a burning sensation. You may feel pain between the base of your penis and your rectum (perineal area), in and around the base of your penis, behind the scrotum, and in your lower back. Your rectum may feel full, producing the urge to evacuate your bowels.

    Chronic prostatitis comes on more slowly, with less severe symptoms Table 01. Symptoms of chronic prostatitis include lower back pain, discomfort in the perineal area, pelvic pain, mild difficulty and pain upon urination, frequent urination, and inability to empty the bladder completely. Often men with chronic prostatitis will experience no symptoms, but will be diagnosed based on their recurrent urinary tract infections.

    Table 1.  Symptoms of Prostatitis

    Acute prostatits Chronic prostatitis
    FeverChillsDifficulty and pain upon urinatingPus or blood in the urinePain in the area between the base of the penis and the anus, the testicle, around the base of the penis, or behind the scrotumFeeling of fullness in the rectumFrequent urination Difficulty and discomfort upon urinationNeed to urinate frequentlyDiscomfort in the pelvic or perineal area

    Enlargement of the prostate is common in men over the age of 50, and causes an increased risk for developing prostatitis. Prostatitis is more common in men over the age of 50; especially in those who have an enlarged prostate gland, which can interfere with complete urine drainage. Incomplete urine drainage makes infection more likely because pooled urine provides a hospitable breeding ground for bacteria.

    Men who must use a catheter to empty the bladder are more prone to prostatitis. Using a catheter may predispose men to prostatitis, as bacteria may be introduced into the urethra through the catheter itself. In addition, catheters often fail to fully drain the bladder. The resulting pooled urine in the bladder provides a breeding ground for bacteria that may proliferate into an infection.

    Your physician will ask about your symptoms, and will conduct a prostate exam and urine test to confirm a diagnosis. Gently palpating the prostate gland will help your physician to determine whether you have prostatitis. In acute prostatitis, the gland will be tense or boggy, and will feel extremely tender. Fever is also very common. A urine sample and bacterial stain and culture may be sufficient to confirm the diagnosis.

    Symptoms of chronic prostatitis are less defined, and are more difficult to diagnose. To diagnose chronic prostatitis, your physician will usually compare levels of bacteria in a series of urine tests, which will identify the cause and location of your urinary tract infection. The physician will ask for a specimen from the morning's first urination (called first-void), and a midstream specimen. The amount of bacteria in these samples will be compared with a urine sample taken after the physician massages your prostate. Your doctor will also culture secretions expressed from the prostate. He or she will do this in the office by inserting a gloved finger into your rectum, and gently pushing on your prostate. If high level of bacteria are found in the sample that comes from a prostate massage, and again in a urine sample following the massage, then you will likely be diagnosed with prostatitis. The same series of tests may identify an increased number of white blood cells in the expressate and postmassage urine in nonbacterial prostatitis, which suggests inflammation and infection.

    Prostate massage is generally not recommended for acute prostatitis, as it could injure the gland and cause the bacteria to spread to the circulatory system.

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