Chronic Prostatitis

Chronic Prostatitis describes a recurrent irritating set of urinary symptoms due to swelling of the prostate that is not usually explained by any other cause.

These Symptoms of Chronic Prostatitis may be:

  • Burning in the urine, or at the tip of penis
  • Smouldering pain in the perineum region
  • Heaviness of pelvic region
  • Backache.
  • Painful ejaculation
  • Dysuria or burning
  • Genital tingling especially at tip of penis

All these symptoms may or may not be associated with difficulty in urination. Although a previous such difficulty or infection may have triggered it.

It is commoner than estimated and tends to affect the younger male generation.

Although none of these symptoms may be very severe in their own nature but it’s the persistence of these symptoms along with exacerbation with psychological stressors which bother most patients.

There can be exacerbation on excessive two wheeler drives, or prolonged sitting in office that may precipitate symptoms.

In others, periods of acute psychological stress can unguard latent prostatitis symptoms.

Evaluation

Chronic prostatitis must be differentiated from an acute episode of prostatitis in which there is an acute infection of the prostate gland and can be due to preexisting urinary blockade or immunosuppression or diabetes.

The diagnosis of Chronic prostatitis is subdivided into bacterial prostatitis in which a bacteria or infection can be isolated or non bacterial prostatitis.

The latter is further differentiated based on presence of inflammation or pus cells (Inflammatory) or Non Inflammatory although clinical principles to treat do not differ.

 Expressed prostatic secretion by prostatic massage may yield some evidence

Depending upon the presence of bacteria or inflammation in form of pus cells the disease is classified further.

A general Urological exam , Ultrasound, assessment of pelvic floor tone, Urofowmetry and occasionally Urodynamics may be needed.

Management

The first line of therapy is a long course of antibiotics if not tried before.

The infection in the prostate is very resistant to treatment because of formation of biofilm inside and the difficult penetration of most drugs into the prostate.

Along with these medications drugs to help ease out urine may help such as alpha blockers. Flow of urine needs to normalize for prostatitis to resolve.

Regular ejaculation helps release of blocked secretions and helps in containing the swelling.

Other medications such as neuromodulators can help relieving symptoms which are non infections and non specific or those patients which have a psychological trigger.

Pelvic floor relaxation exercises may help people who have biofascial triggers or difficult voiding precipitated by suboptimal relaxation of muscles.

Other known therapies are Shock wave therapy using special generators.

Phytotherapy or plant extracts

For some cases a Botox injection into the pelvic floor may achieve some relaxation and pain relief.

Pelvic floor physiotherapy and biofeedback may help myofascial points that trigger symptoms.

And above all patient education that the condition needs prolonged treatment but is unlikely to be life threatening helps patient persevere to the treatment.

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