Prostatitis is a challenging problem to diagnose and treat in men. Prostatitis refers to infection or inflammation of the prostate gland which cause symptoms such as pain in the perineum (the area behind the scrotum and in front of the anus), pain on urination or discomfort down the penile shaft, going often, having to rush and sometimes pain above the pubic bone like the feeling of a full bladder. Traditionally the causes of prostatitis are divided into bacterial and non-bacterial, although bacterial prostatitis is fairly uncommon. Causes of non-bacterial prostatitis are difficult to define in most cases, but can include chronic infection, which turns into inflammation without the presence of bacteria, an enlarged prostate with blocked ducts and inflammation, chronic pressure on the perineum such as from bicycle riding, and other factors.
The diagnosis is suggested by the history and other investigations, including an elevated PSA test (prostate specific antigen), urine test showing white blood cells but no infection, and particular findings on an MRI scan of the prostate.
Many urologists will offer a treatment course of 6 weeks of antibiotics as a first step (usually ciprofloxacin or norfloxacin), sometimes together with an anti-inflammatory like voltaren or an alpha-blocker, which relaxes the muscles at the top of the prostate and improves the urine flow and bladder emptying.
Surgery is not usually needed for treatment of prostatitis, unless part of the cause is considered to be enlargement of the prostate with blockage to urine outflow.
Symptoms of prostatitis can also be mimicked by other non-urological problems, such as pudendal nerve entrapment, a condition in which a nerve deep in the pelvis becomes inflamed or compressed between surrounding ligaments and muscles, usually as a result of chronic poor posture while seated. The treatment for this issue is referral to a physiotherapist.