The Prostate Gland
Your prostate is a walnut-shaped gland that lies immediately beneath your blad- der surrounding the urethra, the tube inside the penis that carries urine out of your body. It secretes a ﬂuid that becomes part of semen. The gland can easily become inﬂamed during an infection, causing soreness, swelling, frequent uri- nation, and a burning sensation while urinating. The prostate gland also can become enlarged, a condition called benign prostatic hyperplasia, which is a com- mon problem in older men. An enlarged prostate gland can cause a number of bothersome problems when urinating, including hesitancy or straining to urinate; a weak stream of urine; dribbling; retention of urine; or the inability to control urination, also called incontinence. Other common symptoms include frequent urination, feeling an urgent need to urinate, and excessive urination at night.
If you have any of the symptoms of prostate enlargement, you should not feel embarrassed about talking them over with your doctor. You don’t need to change your lifestyle to avoid situations, such as going to the movies, when it might be difﬁcult to go for long periods without urinating. Effective surgical and drug treatments exist to help alleviate your symptoms.
The most feared prostate problem is prostate cancer, which now affects one in ﬁve men during his lifetime and is a leading cause of cancer death in American men. With early diagnosis and treatment, however, prostate cancer is curable.
Because the prostate lies in front of the rectum, the doctor can feel the prostate by inserting a gloved, lubricated ﬁnger into the rectum. This is called a digital rectal examination. It allows the doctor to determine whether the prostate is enlarged or has lumps or other areas of abnormal texture that he or she can feel.
Prostatitis is inﬂammation of the prostate gland. There are three basic forms of prostatitis: bacterial prostatitis, nonbacterial prostatitis, and prostatodynia.
Bacterial prostatitis, also called infectious prostatitis, is divided into two types: acute and chronic. Acute bacterial prostatitis is a rare but serious disease caused by bacteria in the prostate gland. The bacteria may originate from an infection in another part of the body, such as infections in the sinuses or the ears, or from an infection in another part of the urinary tract. Chronic bacterial pro- statitis is a recurring prostate infection that usually results when acute bacterial prostatitis has not been treated successfully. It tends to occur in older men who have an enlarged prostate gland. Nonbacterial prostatitis, the most common form
of the disease, is similar to chronic bacterial prostatitis, except that no bacteria are present. Prostatodynia is pain in the prostate caused by inﬂammation, which is not accompanied by infection or swelling.
The symptoms of bacterial and nonbacterial prostatitis are similar. They include the following:
• discharge of ﬂuid from the penis
• pain or itching deep within the penis or at the head of the penis
• discomfort during urination
• fever, pain in the groin area, lower-back pain, and difﬁcult urination that is often accompanied by a burning or an itching sensation
• a frequent urge to urinate without passing much urine
• blood in the urine
A diagnosis of prostatitis is usually based on the symptoms, a urinalysis, and a physical examination. When the doctor performs a digital rectal examination, the prostate may feel swollen and tender to the touch. If there are symptoms of acute bacterial infection, the digital rectal examination may not be done because manipulation of the prostate may release bacteria into the bloodstream.
To diagnose chronic bacterial prostatitis, a urine culture is done. In this test, the doctor takes one routine urine sample and one midstream urine sample (the person urinates for several seconds before collecting the sample of urine). A digital rectal examination is performed, and the prostate gland is massaged to release prostatic ﬂuid. Another urine sample, which contains the released pro- static ﬂuid, is taken. The samples are then compared to see if the infection is in the prostate or in the urethra.
In a few cases, a cystoscopic examination may be performed to conﬁrm a diagnosis. A cystoscope is a ﬂexible, lighted viewing tube that is inserted into the urethra. Proper diagnosis is essential for treating prostatitis because the various forms of the disease require different treatments.
Bacterial prostatitis is treated with antibiotics, along with bed rest and painkillers, if symptoms are severe. Hospitalization may be required if the ure- thra becomes blocked, the fever leads to dehydration, or if bacteria spread to other parts of the body. It is difﬁcult to rid the prostate gland of infection. Infec- tions often seem to disappear shortly after treatment begins, but bacteria often hide within the soft tissues of the prostate. Therefore, antibiotic therapy may be required for up to a month.
For chronic infections, it is common to take antibiotics for several months. Surgical therapy is performed only as a last resort for chronic bacterial prostati- tis—usually when the condition causes urinary retention (inability to urinate) or kidney problems.
Antibiotics are not effective for treating nonbacterial prostatitis. Prostatodynia is often treated with over-the-counter medications such as aspirin or ibuprofen.
Muscle relaxants are sometimes prescribed because prostatodynia is considered stress-related. The following steps may lessen the symptoms of nonbacterial prostatitis:
• Avoid coffee, alcohol, and spicy foods if they seem to aggravate the prostate gland.
• Cut back on excessive driving, cycling, heavy lifting, and vigorous exercise that may put stress on your prostate area.
• Practice relaxation techniques such as deep breathing exercises and medita- tion.
• Soak in a warm bath. The warm water increases blood ﬂow, which decreases inﬂammation.