Enlarged Prostate

Prostatitis

What is prostatitis?

Prostatitis is inflammation of the prostate gland and sometimes the area around it. It is not cancer.

Only men have a prostate gland. It sits in front of the rectum and below the bladder. The gland wraps around the urethra, the tube that carries urine out of the body. The prostate makes the fluid part of semen.

Types of prostatitis

  • Chronic prostatitis . This is the most common type of prostatitis. Symptoms may get better and then come back without warning. Healthcare providers do not know why this happens. There is no cure, but you can manage symptoms.
  • Acute bacterial prostatitis . This is the least common type of prostatitis. It happens in men at any age. It often starts suddenly and has severe symptoms. It’s important to get treatment right away. You may find urination difficult and very painful. Other symptoms include fever, chills, lower back pain, pain in the genital area, frequent urination, burning during urination, or urinary urgency at night. You may also have aches and pains all over your body.
  • Chronic bacterial prostatitis . This type is fairly uncommon. It is an infection that comes back again and again, and is hard to treat. Symptoms are like a mild form of acute bacterial prostatitis. But they last longer. Often you have no fever.
  • Asymptomatic inflammatory prostatitis . This is prostatitis with no symptoms. Your healthcare provider often diagnoses it during an exam for another health problem. He or she may diagnose it if you have infection-fighting cells in your prostate fluid or semen.

What causes prostatitis?

Prostatitis is most often caused by bacteria. They spread from the rectum or from infected urine.

You can't get prostatitis from another person. It is not an STD. But it can result from several STDs.

Who is at risk for prostatitis?

You can get prostatitis at any age. But some things raise your risk:

  • Recent bladder or urinary tract infection, or other infection in the body
  • Injury to the area between the scrotum and the anus
  • Abnormal urinary tract anatomy
  • Enlarged prostate
  • Recent test where a catheter or scope was put into the urethra

What are the symptoms of prostatitis?

These are the most common symptoms of prostatitis:

  • Need to urinate often
  • Burning or stinging while urinating
  • Pain when urinating
  • Less urine when you urinate
  • Rectal pain or pressure
  • Fever and chills (often only with an acute infection)
  • Pain in your lower back or pelvis
  • Discharge through the urethra during bowel movements
  • Erectile dysfunction or loss of sex drive
  • Throbbing sensations in the rectal or genital area

The symptoms of prostatitis may look like other health conditions or problems. Always see your healthcare provider for a diagnosis.

How is prostatitis diagnosed?

Your healthcare provider will review your past health and sexual history. He or she will also do a physical exam. Other tests may include:

  • Urine culture. This test collects prostatic fluid and urine. They are checked for white blood cells and bacteria.
  • Digital rectal exam (DRE) . In this test, the healthcare provider puts a gloved finger into the rectum to check the part of the prostate next to the rectum. This is done to look for swelling or tenderness.
  • Prostate massage . The healthcare provider massages your prostate gland to drain fluid into the urethra. This fluid is then checked under a microscope to look for inflammation or infection. This test is often done during a digital rectal exam (DRE).
  • Semen culture. A semen sample is tested in the lab for bacteria and white blood cells.
  • Cystoscopy . A thin, flexible tube and viewing device is put into the penis and through the urethra. Your healthcare provider uses the device to look at your bladder and urinary tract for structure changes or blockages.
  • Transrectal ultrasound. A small hand-held device (transducer) is inserted into the rectum next to the prostate to show images of the prostate.
  • CT scan. This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs.

How is prostatitis treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment depends on what type of prostatitis you have.

Chronic prostatitis

You may take antibiotics until infection can be ruled out. Depending on the symptoms, other treatments may include:

  • Medicines to help relax the muscles around the prostate and bladder, decrease inflammation, and ease pain
  • Prostate massage to release the fluid that is causing pressure in the prostate
  • Heat from hot baths or a heating pad to help ease discomfort

Chronic bacterial prostatitis

Treatment often means taking antibiotics for 4 to 12 weeks. This type of prostatitis is hard to treat and the infection may come back. If antibiotics don’t work in 4 to 12 weeks, you may need to take a low dose of antibiotics for a while. In rare cases, you may need surgery to remove part or all of the prostate. This may be done if you have trouble emptying your bladder.

Acute bacterial prostatitis

For this type of prostatitis, you often take antibiotics for 2 to 4 weeks. It’s important to take the full course of antibiotics, even when you don’t have symptoms. This is to stop the growth of antibiotic-resistant bacteria. You may also need pain medicines. You may be told to drink more fluids. In severe cases, you may need to stay in the hospital.

Always see your healthcare provider for more information about the treatment of prostatitis.

Key points about prostatitis

  • Prostatitis is inflammation of the prostate gland caused by infection. It can be one of several types.
  • Prostatitis is not contagious and is not an STD.
  • Any man can get prostatitis at any age. Symptoms of prostatitis may include urinating more often, burning or stinging during urination, pain during urination, and fever and chills.
  • Your healthcare provider often diagnoses prostatitis by your symptoms and by checking your urine and semen for signs of infection.
  • Antibiotics are used to treat prostatitis. In rare cases, you may need surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Benign Prostatic Hyperplasia

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia (BPH) is also called benign prostatic hypertrophy. It’s when the prostate gland becomes very large and may cause problems passing urine. BPH is not cancer, and is a common part of aging.

The prostate gland is found only in males. It’s located in front of the rectum and below the bladder. It wraps around the urethra, the tube that carries urine out of the body. The prostate's job is to make some of the fluid that protects and nourishes sperm cells in semen. This makes the semen more liquid.

BPH can raise PSA (prostate-specific antigen) levels. PSA is made by the prostate and can be measured with a blood test. An increased PSA level does not mean you have cancer, but the higher the PSA level, the higher the chance of having cancer.

Some of the symptoms of BPH and prostate cancer are the same, but BPH is not cancer and does not develop into prostate cancer.

What causes BPH?

The cause of BPH is not known. The prostate goes through 2 main periods of growth. In early puberty, it doubles in size. Then, around age 25, the prostate starts to grow again and continues to grow throughout most of a man's life.

The continuing growth of the prostate may not cause problems until much later in life, when the second period of growth may result in BPH. It is a common problem for men starting in their 60s, and it is more likely for men in their 70s and 80s to have some symptoms of BPH.

What are the symptoms of BPH?

As the prostate grows, it presses against the urethra, the tube that carries urine out of the body. This interferes with urination. At the same time, the bladder wall becomes thicker and irritated, and begins to contract, even when it contains only small amounts of urine. This can cause more frequent urination. These changes cause the bladder muscle to weaken. It may not empty fully and leave some urine behind. This leads to symptoms.

The following are the most common symptoms of BPH:

  • Leaking or dribbling of urine
  • Trouble starting urine stream
  • More frequent urination, especially at night
  • Urgency to urinate
  • Holding urine (cannot pass urine)
  • An interrupted, weak stream of urine

These problems may lead to one or more of the following if BPH is not treated:

  • Loss of urine control
  • Kidney damage
  • Blood in the urine
  • Bladder damage
  • Urinary tract infections
  • Bladder stones
  • Inability to pass urine at all

The symptoms of BPH may look like other conditions or medical problems. Always talk with a healthcare provider for a diagnosis.

How is BPH diagnosed?

Diagnosing benign prostatic hyperplasia (BPH) in its earlier stages can lower the risk of complications. Your healthcare provider will review your medical history and do a physical exam. Other tests may include:

  • Urine tests. To check for infection.
  • Digital rectal exam. A procedure in which the healthcare provider puts a gloved finger into the rectum to feel the part of the prostate next to the rectum.
  • Ultrasound (also called sonography).An imaging test that uses high-frequency sound waves to create images of the prostate and nearby organs on a computer screen.
  • Cystoscopy. A thin flexible tube and viewing device is put into the penis and through the urethra to examine the bladder and urinary tract for structure changes or blockages.
  • Urine flow study. A test in which the man urinates into a device that measures how quickly the urine is flowing. Reduced flow may suggest BPH.
  • Post void residual. A test like an ultrasound that measures that amount of urine in the bladder after urination.

How is BPH treated?

With time, BPH symptoms usually need some kind of treatment. When the prostate is just mildly enlarged, treatment may not be needed. In fact, research has shown that, in some mild cases, some of the symptoms of BPH get better without treatment. The need to start treatment will be decided by your healthcare provider after careful evaluation of your symptoms. Regular check-ups are important, and they’re needed to watch for developing problems.

Treatment for BPH may include:

Surgery

To remove only the enlarged tissue that is pressing against the urethra (the tube that carries urine out of the body), with the rest of the inside prostate left intact. Types of surgery often include:

  • Transurethral surgery. No outside incision (cut) is needed. The surgeon reaches the prostate by putting an instrument through the urethra.
    • Transurethral resection of the prostate (TURP). A resectoscope—a thin, narrow tube is put into the urethra through the penis. The surgeon uses tools through the resectoscope to remove the prostate tissue blocking the urethra one piece at a time. The pieces of tissue are carried into the bladder and flushed out at the end of the operation.
    • Transurethral incision of the prostate. A procedure that widens the urethra by making small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself.
  • Laser surgery. Using laser instruments to cut away the prostate tissue blocking the urethra. The laser fiber is passed through the urethra to the prostate.
  • Open surgery. Surgery that requires an incision (cut) in the skin; often done when the gland is very big, when there are complicating factors, or when the bladder has been damaged and needs to be repaired.

Nonsurgical treatments

These may include:

  • Transurethral microwave thermotherapy (TUMT). Microwaves are used to heat and destroy prostate tissue to reduce urinary frequency and urgency. A thin flexible tube is put into the urethra to get the microwaves to the right parts of the prostate.
  • Medicines. To shrink or at least stop the growth of the prostate without using surgery, or to make the muscles around the urethra looser so urine flows more easily.
  • Water-induced thermotherapy. Heated water is sent through a soft flexible tube into the urethra to heat and destroy prostate tissue.
  • Prostatic stents. Stents are narrow tubes put through the urethra into the narrowed area where they are allowed to expand, like a spring, to push back the prostate tissue and widen the urethra. Stents may be used when other treatments have not worked.

What are the complications BPH

Delay in treatment can cause permanent bladder damage that cannot be treated.

Living with BPH

Management of BPH may include:

  • Lifestyle factors. Limit fluids in the evening, empty your bladder before going to bed, and don’t take diuretics (water pills) that are active at night. Not smoking can also help ease BPH symptoms.
  • Dietary factors. Avoid or decrease alcohol, coffee, and other fluids. This is especially important after dinner. A higher risk for BPH has been linked to a diet high in zinc, butter, and margarine. Men who eat lots of fruits are thought to have a lower risk for BPH.
  • Avoiding medicines that worsen symptoms. Decongestants and antihistamines can slow urine flow in some men with BPH. Some antidepressants and diuretics can also worsen symptoms. Talk with your healthcare provider if you are taking any of these medicines.
  • Kegel exercises. Repeated tightening and releasing the pelvic muscles is called Kegel exercises. These can help prevent leaking urine. Practice these exercises while urinating to train the specific muscle. To do Kegels, contract the muscle until the flow of urine decreases or stops and then release the muscle.

Key points about BPH

  • BPH is when the prostate gland becomes very large and may cause problems passing urine.
  • The cause of BPH is not known. Growth of the prostate may not cause problems until much later in life.
  • As the prostate enlarges, it presses on the urethra. This causes symptoms such as changes in urination.
  • BPH may not need treatment. If needed, treatment includes medicines, and various procedures and surgeries used to remove the part of the prostate that’s pressing on the urethra.
  • Management of benign prostatic hyperplasia (BPH) may include lifestyle changes.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Prostate Problems and Related Urinary Symptoms

Prostate Problems and Related Urinary Symptoms

Cross section of enlarged prostate gland blocking urine in bladder.Many men have problems with the prostate at some time in their lives. The prostate gland is part of the male reproductive system. It’s located just below the bladder. The prostate surrounds the urethra (the tube that carries urine and semen out of the body). The main function of the prostate gland is to add fluid to the semen. When problems occur in the prostate, the bladder and urethra are often affected as well. The most common prostate problems are described below.

BPH

BPH (benign prostatic hyperplasia) develops when changing hormone levels cause the prostate to grow larger. This often starts around age 50. Excess tissue can block the urethra, making it harder for urine to flow. The enlarged prostate can also press on the bladder, so you may need to urinate more often. Other symptoms include straining during urination, a weak urine stream, urinating more at night, incontinence, dribbling at the end of urination, and feeling that the bladder isn’t emptying all the way. Note that BPH is not cancer and does not cause cancer.

How BPH affects the bladder

Pushing to urinate through a narrowed urethra can cause the bladder walls to thicken or stretch out of shape. A stretched bladder may have problems emptying all the way. If urine stays in the bladder longer than it should, you may develop an infection or bladder stones. Also, the kidneys can’t drain properly into a bladder that doesn’t empty completely. This can lead to kidney failure. Pressure from urine buildup can also cause leaking of urine (called overflow incontinence).

Other prostate problems

  • Prostatitis is an infection or inflammation that causes the prostate to become painful and swollen. The swelling narrows the urethra and can block the bladder neck. Prostatitis can cause a burning sensation during urination. You may also feel pressure or pain in the genital area. In some cases, prostatitis can cause fever and chills, and can make you very sick.

  • Cancer occurs when abnormal cells form a tumor (a lump of cells that grow uncontrolled). Some tumors can be felt during a physical exam, others can’t. Prostate cancer often causes no symptoms at all, especially in its early stages. Prostate symptoms are more likely to be caused by a problem that is NOT cancer.

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