Prostatitis

Prostatitis

What is Prostatitis?

Prostatitis refers to the pain and swelling or inflammation of the prostate gland, and is the most common urinary tract issue faced by men below the age of 50 in Singapore. That being said, men of any age can have prostatitis and it may or may not be caused by an infection. 

The prostate gland is part of the male reproductive system. It lies under the bladder and surrounds the urethra. The prostate produces semen which is the fluid that protects the sperm while it is transported toward the female egg.

What are the types of Prostatitis in Singapore?

Prostatitis can be bacterial or non-bacterial, and either acute or chronic.

  • Acute bacterial prostatitis – a bacterial infection of the prostate that develops suddenly,  causing severe pain and difficulty urinating.
  • Chronic bacterial prostatitis – a bacterial infection that occurs for months or is recurring in cycles of more than three months. 
  • Chronic prostatitis/chronic pelvic pain syndrome – lasting or recurring pelvic/ perineal/ thigh/ testicular/abdominal/back pain or painful urination (dysuria) with no evidence of infection. This is the most common type of prostatitis.
  • Asymptomatic inflammatory prostatitis – a condition where there could be signs of an inflamed prostate but cause no obvious symptoms.

What are the common causes of Prostatitis in Singapore?

Prostatitis can result from a bacterial infection that has spread from other parts of the urinary or reproductive systems. Possible causes and risks of prostatitis include: 

  • A past bacterial prostatitis infection
  • Infection caused by urine flowing back into the prostate
  • Nerve problems in the lower urinary tract 
  • Autoimmune diseases
  • Pelvic floor muscle spasms
  • Psychological stress

What are the common symptoms of Prostatitis in Singapore?

Symptoms of prostatitis depend on the type of prostatitis you may have.

Acute bacterial prostatitis 

This is a severe condition that requires immediate medical care. Some symptoms are:

  • The urgent need to urinate
  • Inability to pee
  • Fever and chills
  • Flu-like symptoms
  • Cloudy urine 
  • Pain around the base of the penis or behind the scrotum 

Chronic bacterial prostatitis

This is a milder form of prostatitis that can affect a patient for months or may come and go. Some symptoms are:

  • Frequent urge to urinate, especially at night (nocturia)
  • A sensation of “heaviness” behind the scrotum
  • Blood in the semen 
  • Difficulty urinating or a weak urine stream
  • Pain when ejaculating 
  • Pain when urinating
  • Lower back pain

Chronic prostatitis or chronic pelvic pain syndrome

This is the most common type of prostatitis, often with symptoms similar to bacterial prostatitis. However, it is not caused by a bacterial infection and is usually idiopathic, which means there is no known cause. 

The patient may experience chronic pain in either the tip of the penis, scrotum, perineum (between the scrotum and rectum) or the lower abdomen. They may also suffer from pain during urination or ejaculation. Other uncommon presentations are groin or thigh pain or even burning sensations down these areas.

Asymptomatic prostatitis 

As its name suggests, asymptomatic prostatitis is indicated by an inflamed prostate without symptoms. 

If you experience any of these symptoms, please consult your urologist immediately for a proper diagnosis and treatment.

When should I see a doctor?

Visit a doctor if you have symptoms of prostatitis, such as pelvic pain, difficulty or pain during urination, or painful ejaculation. If you experience sudden and severe symptoms of prostatitis, you may have acute prostatitis, which requires prompt assessment and treatment to prevent further problems. If you have persistent symptoms, you may be referred to a urologist who will evaluate your condition.

What can I expect during my first consultation?

Your urologist will conduct a physical examination, review your symptoms and medical history, and order tests for an accurate diagnosis.

How is Prostatitis diagnosed?

Initial diagnostic tests could include:

  • Urine and semen tests – A urine or semen sample is analysed to look for signs of infection in your urine (urinalysis)
  • Blood tests – A blood sample is taken to look for signs of infection or other prostate problems (eg PSA)
  • Digital rectal examination – Your health care provider will insert a gloved finger into the rectum to detect inflammation of the prostate. The size and any abnormality of the prostate will also be assessed.
  • Prostatic specimen test – The prostate is massaged to release prostate fluid which will be sent for bacterial testing
  • Imaging tests – In some cases, a CT scan of your urinary tract and prostate or an MRI of your prostate might be ordered.

What are the treatment options for Prostatitis in Singapore?

Treatment might vary according to the underlying cause of Prostatitis. 

Antibiotics

A course of antibiotics for bacterial infection is the most common treatment for prostatitis. The medication will be based on the type of bacteria causing your infection and whether your condition is acute or chronic. You should finish the entire course of antibiotics to ensure that the infection clears completely. A prolonged course of antibiotic may be required.

Alpha-blockers

These medications help relax the bladder neck and the muscle fibres where your prostate joins your bladder. This treatment could manage symptoms of painful or difficult urination. 

Anti-inflammatory agents/Analgesia

Drugs such as paracetamol and ibuprofen may relieve pain and swelling. 

Non-drug treatments

  • Sitz baths – Soak in a warm bath to relieve symptoms
  • Physiotherapy and Biofeedback – Relaxation techniques to relieve spasms and pain in the pelvic muscles
  • New treatments (experimental)- Extracoporeal shockwave therapy (ESWT) and acupuncture may be helpful in cases when medications do not work.

Can Prostatitis be cured?

Acute bacterial prostatitis can be cured with proper treatment. However, there is a possibility of the condition recurring. Waxing and waning of symptoms may occur from time to time.

What complications can arise if I leave Prostatitis untreated?

Depending on the type of prostatitis, possible complications include: 

  • Bacterial infection of the blood which can be serious and life-threatening
  • Inflammation of the epididymis, the coiled tube attached to the back of the testicle 
  • Retention of urine which requires a catheter to drain the urine. This is usually temporary.
  • A pus-filled cavity in the prostate requiring drainage.
  • Infection that spreads to the upper pelvic bone or lower spine
  • Sexual dysfunction, such as erectile dysfunction
  • Changes in sperm and semen that may cause infertility

It would be good to note that prostatitis is not a precursor to prostate cancer and does not increase your risk of prostate cancer. 

Serum PSA (prostate-specific antigen) may be raised during prostatitis episodes. Do not be alarmed but a repeat serum PSA will be required during follow-up consultations.

Summary

Prostatitis, the inflammation of the prostate gland, can be acute or chronic, and a bacterial or non-bacterial infection. It could be caused by bacteria or other conditions of the urinary system. A physical exam and diagnostic tests will be conducted to rule out other diseases. An early diagnosis allows you to start treatment, commonly antibiotics or other medications, to prevent further complications. 

Chronic prostatitis waxes and wanes and requires patience during treatment. Having a sympathetic urologist and a resilient mind are crucial in the process of treating chronic prostatitis!

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Dr. Fiona Wu 2

Dr Fiona Wu
Consultant Urologist

MBBS (S'pore), MRCS (Edin), MMED (Surg),
MMED (Clinical Investigation),
FRCS (Urol) (RCPSG), FAMS (Urology)

Dr Fiona Wu is an experienced Consultant Urologist and is the Medical Director of Aare Urocare.

Prior to her private practice, she spent 15 years in public service. She was a Consultant in the Department of Urology at National University Hospital (NUH), Alexandra Hospital and Ng Teng Fong General Hospital.

She believes in treating urinary incontinence in a holistic way using minimally invasive methods – this ranges from laser treatment, neurotoxin injections, electromagnetic nerve stimulation to minimally invasive surgeries, etc. She worked closely with the gynaecology and colorectal departments to treat complex pelvic floor conditions and continues to do so in her own practice.

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