American Medical Association Family Medical Guide - American Medical Association [554]
Diagnosis
Diagnosis of prostatitis is usually based on the symptoms, a physical examination, and the results of urine tests. A doctor may perform a digital rectal examination, in which he or she inserts a gloved, lubricated finger into the rectum to feel the prostate gland. If you have symptoms of an acute bacterial infection, your doctor probably will not perform a digital rectal examination because manipulation of the prostate gland can release bacteria into the bloodstream.
Your doctor may perform a test called prostatic localization to diagnose chronic bacterial prostatitis. In this test, the doctor asks you first to urinate and collect the first few drops of urine. You then will collect a midstream sample of urine (in which you urinate for several seconds before collecting the sample of urine). The doctor then performs a digital rectal examination and massages the prostate gland to release prostatic fluid, which is collected. Finally, another urine sample, which also contains some of the prostatic fluid, is taken. The doctor compares all of the samples to confirm the presence of an infection, identify the microorganisms that are causing it, and determine the best treatment. The samples are grown in a laboratory and examined to determine if the infection is in the urethra, the bladder, or the prostate.
In some cases, a doctor may also examine the prostate gland with a cystoscope (a flexible, lighted, viewing tube) inserted through the urethra. An accurate diagnosis is important because different types of prostatitis require different treatments.
Digital rectal examination
For a digital rectal examination, your doctor will probably ask you to stand and bend forward at the waist. He or she will insert a gloved, lubricated finger into your rectum to feel for any abnormalities in the prostate gland. The examination may also be performed while you lie on your side with your knees bent toward your chest.
Treatment
To treat bacterial prostatitis, doctors prescribe antibiotics. If your symptoms are severe, your doctor may recommend bed rest and nonsteroidal anti-inflammatory drugs to relieve pain and inflammation. You may be admitted to the hospital for treatment if your urethra becomes blocked, if you have a high fever that leads to dehydration, or if the bacteria spread to other parts of your body. Because it is difficult to eliminate bacteria from the prostate gland, your doctor may prescribe antibiotics to take for 4 to 6 weeks. For chronic infections, antibiotics are taken for several months. Doctors rarely perform surgery for chronic bacterial prostatitis and only as a last resort—usually when the condition makes you unable to urinate (causing urinary retention) or causes kidney problems.
Nonbacterial prostatitis is not treated with antibiotics. To help relieve the symptoms of nonbacterial prostatitis, your doctor may recommend the following:
• Take over-the-counter nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, or naproxen to relieve pain and inflammation.
• Soak in a warm bath.
• Avoid caffeine, alcohol, and spicy foods, which can irritate the prostate gland.
• Exercise regularly and practice relaxation techniques such as deep breathing and meditation to help relieve stress-related pain.
Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) is noncancerous enlargement of the periurethral glandular tissue of the prostate (the portion of the prostate gland immediately surrounding the urethra). As the prostate becomes larger, it can tighten around the urethra and block the flow of urine. Starting urination is difficult, and the urine stream is weak. The blockage may cause the bladder muscles to enlarge and the bladder to become irritable, causing contractions of the bladder that result in a frequent urge to urinate. Eventually the muscles are no longer able to