Acute prostatitis is completely different to chronic prostatitis or prostatodynia. It is a sudden, acute, severe febrile illness caused by bacterial infection of the prostate gland. It is treated with antibiotics. Unlike chronic prostatitis, antibiotic treatment is almost invariable successful. If patients are very ill at presentation then they are treated with intravenous antibiotics. The quinolones, such as ciprofloxacin or ofloxacin, are the most effective at penetrating the prostatic tissue. Treatment is usually for two weeks.
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Acute prostatitis may occasionally be complicated by the development of a prostatic abscess. In this instance the patient’s temperature will not settle despite antibiotic treatment. The prostatic abscess is usually exquisitely tender to palpation via a rectal examination. A prostatic abscess is usually drained via a trans-urethral resection.
Some treatments or therapies are common to all types of prostatitis:
Antibiotics are used in most treatments, even for non-bacterial prostatitis.
Quinolones such as ciprofloxacin are the most widely used antibiotics
Stool softeners might be prescribed to reduce the discomfort of bowel movements.
Doctors will recommend that patients urinate frequently and completely, and may insert a catheter if the swollen prostate results in blockage.
Increasing fluid intake to two or more litres per day to decrease constipation can help flush the bacteria from the body.
Avoiding alcohol, caffeine, hot spicy foods, foods and drinks high in acid, and stopping smoking will help reduce irritation of the bladder.
Warm baths may provide some relief from pain, particularly lower back pain and pain in the genital area.
In all treatment of prostatitis, it is essential to monitor the patient after antibiotic therapy is complete, to ensure there is no lingering infection.
Treatments specific to chronic prostatitis
Chronic bacterial prostatitis is treated with a trial of antibiotics. The quinolones are the most effective. These drugs have a broad spectrum of anti-bacterial activity and penetrate the prostatic tissue well. Treatment is usually for as long as six to eight weeks. Surgery has no role.
Treatments specific to non-bacterial prostatitis / chronic male pelvic pain syndrome
Chronic non-bacterial prostatitis is also treated with a trial of antibiotics in the hope that there may be an underlying infectious cause. The quinolones are the most effective. These drugs have a broad spectrum of anti-bacterial activity and penetrate the prostatic tissue well. Treatment is usually for as long as six to eight weeks.
Treating non-bacterial prostatitis is a long process usually aimed at relieving symptoms. Pelvic floor exercises are sometimes helpful since spasms of the pelvic floor muscles are thought to be responsible for some symptoms.
Alpha-blockers, muscle relaxants and anti-inflammatory agents, as well as complementary medicine alternatives may be used.
Surgery has no role in the treatment of chronic non-bacterial prostatitis or prostatodynia.
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