prostatitis is the most common urologic diagnosis in men under 50 and the third most common in men over 50. in fact five percent of men between the ages of 20 to 50 suffer from prostatitis or have had it once and 2 million visits occur annually in the united states for prostatitis i'm dr rena malek urologist and pelvic surgeon and today we're going to cover everything you need to know about prostatitis we're going to talk about symptoms the different types of prostatitis the diagnosis and the treatment so if you like what you're learning here make sure
you subscribe and share this channel with your friends [Music] so what are the symptoms well symptoms most commonly include pain and where can that pain be well it can be in the lower part of your belly in the penis itself in the testicles in the perineum which is the area between the scrotum and the anus or when you're urinating sometimes if you have what we call acute prostatitis this can be accompanied by other symptoms like fever nausea or vomiting so it's a pretty uncomfortable and sometimes really serious condition actually it's a little bit complicated because
there's different types of prostatitis so if someone tells me they have prostatitis i have to figure out is it because they have a bacterial infection is it because of inflammation or is it because of something else so first we divide it into two halves one is if there is any evidence of a bacterial infection and that can be acute or chronic if you have acute bacterial prostatitis usually you can be very very sick you can have fevers you can have chills you can have nausea you can have vomiting and sometimes you can also have difficulty
emptying your bladder in addition to having difficulty urinating and occasionally pain with urination sometimes people can feel symptoms like having to go very often gotta go gotta go needing to go frequently and not being able to hold off going to the bathroom the other type of bacterial prostatitis is when it's chronic so sometimes you'll have these symptoms for a long period of time but you won't be as sick you won't necessarily have fevers or chills or nausea or vomiting but you may have all the other symptoms i mentioned sometimes this can follow an acute episode
so if you had an episode where you got really really sick and got treated but the symptoms never went away it could become a chronic problem or it can be because of a history of diabetes because of having a recent sort of procedure or surgery on the urinary tract having issues with urination not emptying completely or even just having a larger prostate than normal can sometimes put you at higher risk of getting chronic bacterial prostatitis and so why do people get chronic infections it's because these bacteria can get into the prostate which is really difficult
for antibiotics to penetrate and very difficult for your immune system to get rid of the other kind of prostatitis the other half of it is non-bacterial prostatitis and this can be chronically due to inflammation or a non-inflammatory process but again symptoms can be very similar if you fall into this category of a non-bacterial prostatitis and you've had symptoms for three of the last six months and these have been ruled out for any sort of infectious cause you may have what's called chronic pelvic pain syndrome this is essentially all the symptoms that i mentioned before and
sometimes also symptoms of sexual dysfunction like premature ejaculation or erectile dysfunction while this is sometimes called prostatitis it's really unclear if this is caused by the prostate or other factors so what causes prostatitis a lot of the times it's due to bacterial infection and one of the reasons people get bacterial infections is something we call intraprostatic ductal reflux and essentially what that is is instead of having urine flow forward out the p-tube or urethra it actually reflexes or goes back into the prostate causing potentially bacteria to then get into the prostate that way and then
causing the bacterial prostatitis we discussed before and some things that can potentially put you at risk for this as we mentioned before is prior surgery that maybe goes in the urethra having foreskin that doesn't retract can allow urine to get trapped and form kind of a high pressure system and sometimes unprotected anal intercourse can also be a higher risk for getting prostatitis and having a catheter or even a condom catheter can put you at higher risk for this ductal reflux and lastly if you have abnormal bladder function either due to having an enlarged prostate where
you're constantly trying to push urine out in a high pressure way and it's having difficulty emptying or if you have a neurologic condition sometimes that makes this pressure in the bladder and urine flowing through the prostate more elevated that can also put you at higher risk other potential causes might be issues with the immune system issues with the pelvic floor musculature which i've talked about many times is high toned pelvic floor musculature which can cause difficulty in emptying your bladder and lots of issues with pain and sometimes psychological factors as well another big one as
i've mentioned many times is that procedures or surgeries around that area can put you at risk but specifically prostate biopsy which i've talked about before in previous videos specifically recently i talked about in a grey's anatomy reaction video and this in a very small subset of patients can lead to a prostatitis which can make people very very sick which is why it's really important to take antibiotics before you get a prostate biopsy so what happens when you come to the doctor well first of all we're going to ask you a lot of questions where is
the pain when does it happen how long have you had it have you ever had any sexually transmitted infections what is your urination normally like how often do you urinate do you have any symptoms of needing to go very often or having to rush to the bathroom do you wake up at night do you ever feel like you have to wait till your bladder empties does it stop and start do you have a weak stream or sometimes do you feel like you don't empty your bladder and of course we'll ask if you've had any recent
procedures one thing that is not very common in the united states but may be common in other countries if you've had tuberculosis this can also actually infect the prostate and cause symptoms as well once we've gotten your history we'll then do an examination which includes a digital rectal exam i've talked about this before in a reaction video to try guys so make sure you check that out however if you are very very ill and have a fever and chills and we suspect very highly that you have acute bacterial prostatitis we may skip that step or
do it extremely gently because doing any sort of aggressive massage or pressing on that area can cause bacteria to then translocate or get into the bloodstream and cause you to get even more sick we will also check a urinalysis and urine culture so we may also check a post-void residual with a bladder ultrasound to see how well you're emptying the bladder and if you're having testicular pain we may also order a scrotal ultrasound to make sure there's no masses or lesions in the testes other things depending on your presentation if you have a lot of
abdominal pain or back pain we may order some imaging of the abdomen as well as mris of the spine so how do we diagnose prostatitis well mostly it's from urinalysis and urine culture but how do we get urine from the prostate specifically so typically in the clinic most often most urologists will perform what's called a two glass test and what that means is we'll have you urinate like you normally would into a cup and check that we'll also then do a prostate massage after which will then collect another urine sample and that will help us
see if there's specifically bacteria or white cells or other signs of inflammation in the urine from the prostate versus from the bladder so now let's get down to how we treat it of course for acute bacterial prostatitis we want to treat you with antibiotics typically if you are in the hospital you get intravenous antibiotics if you're outpatient and you're not very sick we can treat you with oral antibiotics and typically we'll tailor those to the urine culture so when we get a urine culture we get to see exactly what bacteria grows as well as what
antibiotics will be sensitive or will be able to treat that bacteria and typically different from having a bladder infection or urinary tract infection prostate infections need to be treated for a longer period of time usually between four to six weeks in order to make sure that the antibiotic actually penetrates through the prostate completely and similarly for chronic bacterial prostatitis will also put you on a longer course of antibiotics if however you don't improve on those antibiotics and your urine culture is negative then giving you more antibiotics is not likely to help and then we need
to move on to these other things and consider a non-bacterial cause of the prostatitis so number one treatment that's often offered is called alpha blocker medication these are most commonly called cancelocin or alphazosin and these work by relaxing the prostate as well as relaxing the bladder neck this helps reduce that high pressure urination we talked about earlier and hopefully helps alleviate some of these symptoms in addition to this we can sometimes use a short course of anti-inflammatory medications like specifically non-steroidal anti-inflammatories which commonly include ibuprofen or naproxen sometimes people can use things like steroids or
immunosuppressive medications although those are less commonly used there's also some data to suggest that five alpha reductase inhibitors may help and the way these work is by reducing the conversion of testosterone to intraprostatic dht or dihydrotestosterone and because of that cause shrinkage of the prostate one of the causes that sometimes may result in these symptoms is high tone pelvic floor dysfunction and these patients pelvic floor physical therapy or going to a certified physical therapist to help teach you how to relax those muscles can be tremendously helpful so what about prostate massage i know a lot
of you guys ask about this and previously this actually used to be the mainstay of treatment for prostatitis it used to be that you'd go to your urologist and get a prostate massage for 10 minutes three times a week and the reason they thought this would work is because actually massaging the prostate would help drain some of those ducts that may be occluded allow better penetration of antibiotics and potentially improve circulation to the prostate initial studies showed this was beneficial but more modern studies have not shown a benefit so we no longer do this practice
and other therapies that have some little bit of data on them but are not widely used include posterior tibial nerve stimulation which is actually a treatment for overactive bladder where a small needle is placed in the ankle and stimulated to stimulate the tibial nerve which travels up to the nerve roots that then stimulate the bladder other things that have also been looked at include acupuncture which is similar extracorporeal shock wave therapy which i've talked about for erectile dysfunction but they've looked at it using it on the perineum and shown some mild benefits in patients with
chronic prostatitis and lastly using some tricyclic antidepressants like nortriptyline or amitriptyline have been shown to have some benefit as well as some bioflavonoids and pollen extracts have been looked at in very small studies as well overall this is a challenging issue for a lot of people that can cause a lot of discomfort and a lot of stress i hope this video was helpful to you if it was make sure you share it and comment below let me know what you thought as always remember to take care of yourself because you're worth it [Music] [Applause] [Music]
you
