Some infective causes of prostatitis would include sexually transmitted infections or diseases (STI’s/STD’s) such as Chlamydia, Gonorrhea, and other organisms such as Ureaplasma or Mycoplasma bacteria.

Non-STI type bacteria can also cause infections – these are more commonly seen in older men with Benign Prostatic Hyperplasia (BPH), Diabetes, or Inflammatory Bowel Conditions, where bacteria can translocate through the wall of the colon to the prostate tissues. This bacterial translocation can also occur after instrumentation, whether through the urethra (cystoscopy), or through the colon (colonoscopy).

Prostatitis caused by infection can be treated with courses of antibiotics, but depending on the type and severity of infection, duration of treatment can range from a few days to a few weeks.

Other causes are less well understood and can cause chronic or recurrent symptoms. These conditions are complex and may be more challenging to diagnose and treat. Some diagnoses that you may hear include:

• Chronic prostatitis
• Pelvic floor dysfunction
• Interstitial cystitis
• Chronic pelvic pain syndrome
• Levator ani syndrome
• Pelvic migraine or headache

Symptoms may be triggered by sexual intercourse, periods of stress, and even sometimes by different weather or foods!

These forms of prostatitis can often be confused or misdiagnosed as other pelvic conditions, and many patients can be left frustrated and anxious by a lack of clarity with their condition and treatment plans.

Anxiety can play a large role in both the development of symptoms as well as a consequence of the condition – people who are more anxious tend to have more severe and frequent symptoms of pelvic pain, and this can lead to anxiety about the pain itself – it really is a vicious cycle. A significant group of men may find their symptoms started after a particular sexual encounter that they later regard with guilt, shame, or regret. There may be associated anxieties about having contracted a sexually transmitted infection, despite test results showing otherwise. Chronic pain can cause people to be socially withdrawn, impair their self-esteem, and burden intimate relationships.

In addition to medications, these types of prostatitis will respond more to psychotherapy/counselling, specialized pelvic floor therapy and rehabilitation, and may also be relieved in certain cases with low intensity extracorporeal shock wave therapy (ESWT).

We will start with a consultation for your symptoms to assess the severity of the problem as well as determine if there is any underlying cause.

This discussion will include questions on your past medical history, potential sexual exposures, and other risk factors for prostatitis.

The doctor will perform a physical examination as appropriate – this may be to check for any tenderness or swelling of the prostate gland, enlarged lymph nodes, and other genital abnormalities.

We will then advise you on the appropriate testing, which may include a urine or semen sample or urethral swab, blood tests to look for signs of infection, inflammation or cancer markers, and sometimes imaging such as ultrasound or MRI scans.

If there is concern about an infective cause of prostatitis, it is best to try and hold your urine for at least 2 hours before your appointment, as this can improve testing accuracy.

Some people will notice symptoms after a few days without ejaculation – if this is the case for you, try to abstain from ejaculation for at least 3-5 days before consultation in case a semen sample is required. There is no need to be fasting for any of the tests.

There are different types of prostatitis, so treatment options and effectiveness will depend on the type and severity of the condition. Most types of prostatitis caused by infection are fully treatable with a course of antibiotics, however, this may take up to 4-6 weeks of medications in some cases.

Some types of prostatitis are chronic or recurrent and may require different a combination of therapy modalities, including medications to relax the nerves or pelvic floor muscles, targeted physiotherapy and/or ESWT.

These can take longer to resolve, and patients must be compliant and consistent with their treatment plan to improve their chances of full recovery.