Health News and Information

There is one male condition that can drive men to the edge of despair. It is not fatal but it can cause both them and their doctors enormous frustration. Although it may strike at any age, it most commonly begins when men are under 50 and may then plague them for years. In response, some withdraw into depression, some cope by changing jobs and some keep travelling from urologist to urologist, hoping for a cure.

The condition, which has various names, is usually known as prostatitis and arises when the prostate becomes inflamed.

This inflammation is quite different from prostate cancer and from the prostate enlargement that can burden older men.

The inflammation causes the prostate to become congested and tender and can be so difficult to treat that doctors have been known to refer to men with prostatitis as ‘heart sink patients’. Doctors’ hearts sink when they see the patient’s name on their list, because they know they can do so little to relieve the symptoms.

A small number of men do, however, escape this. Rather than dragging on, their inflammation is intense and short-lived. It develops over a few hours, causing a high fever, chills, pain behind the scrotum and urinary symptoms such as frequency or obstruction.

This may be so severe they need to be hospitalised for intravenous antibiotics. But they are the lucky ones, because after a couple of days they feel much better, and after a few weeks of oral antibiotics, their problem goes away. Such men have acute bacterial prostatitis. For unknown reasons, blood-borne bacteria land in the prostate and cause infection. Treatment is standard and relatively simple.

This contrasts starkly with chronic prostatitis, which can keep reappearing for years, eroding a man’s patience, energy and sense of wellbeing. It is rather like chronic fatigue syndrome, which wears people down by persistence. Besides causing perineal discomfort, pain in the penis and a burning sensation on ejaculation, chronic prostatitis ushers in general malaise. Understandably, such men become uninterested in sex and withdrawn. In desperation, some join self-help groups, resort to folk remedies or turn to the Internet for alternative therapies.

There are two types of chronic prostatitis. The bacterial type is usually easier to treat than the nonbacterial variety. Typically men remark that, when they are stressed, their prostatitis worsens. Although it may never totally disappear, it improves when they are on holiday.

One noted Sydney urologist who believes the condition is very much stress-related enjoys telling the story of a 28-year-old accountant who was a high-performing partner in a city linn but suffered from painful chronic prostatitis.

‘It was driving him nuts. He had it for ages, and alter I told him to change his lifestyle and get rid of the stress, he never came back to me. About 9 months later I saw him wearing a ponytail, I lawai-ian shorts and a sunlan. I le told me he had taken my advice, left the firm, sold his house and gone to Queensland with his wife. Two weeks after arriving there the pain stopped and never returned!’

Prostatitis patients of this urologist have all heard his theory about the ‘five Ss’ that may be involved in congestion of the prostate. They are sex, sport, spirits, spices and stress.

Sex This doctor believes that lack of ejaculation may cause the prostate to become swollen with fluid. If the prostate is badly inflamed, ejaculation may make it worse, but generally, clearing out fluid helps.

Sport A sedentary lifestyle can be a factor. Prostatitis is often worse after a long aeroplane trip.

Spirits and spices Alcohol and highly spiced food may affect the prostate.

Stress This may cause muscles to strain or go into spasm, which may lead to an incoordination in passing water, leading, in turn, to congestion.

One of the frustrations of chronic prostatitis is that there are no solid treatment guidelines. Sometimes doctors massage the prostate under anaesthesia to decongcst it, inject it directly with antibiotics or steroids, administer anti-inflammatories or give secretion-loosening medication.

Some studies suggest microwave hyperthermia may help. Although the precise mechanism is not understood, it is thought the microwaves sterilise the prostate, kill its sensory nerves or do both. Hyperthermia is regarded as experimental.

A recent theory is that prolonged nonbacterial prostatitis may be due to auto-immunity in some men.

Whatever the case, urologists generally lack confidence in diagnosing and treating this condition. Expressing the professions frustration, one urologist said that physicians tended to throw anything to do with the prostate that they could not identify into the category of prostatitis. He called it a wastcbaskct of clinical ignorance.

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