Frequently Asked Questions
What is The Toronto Prostatitis Care Centre?
The TPCC is the only centre in Canada solely designated to the assessment and treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). The centre is run by General Practitioner Dr. Miguel Llano and Ilia Kaploun, R.N. (Urology trainee from Russia).
What is prostatitis?
Prostatitis as a term means ‘the inflammation of the prostate gland’. Prostatitis can be either Acute and, or Chronic. A majority of men suffer from Chronic Prostatitis.
This is a very common condition worldwide. It has been estimated that up to 25% of all men have experienced symptoms of prostatitis sometime in their life. At any one time, about 10-14% of men in the community are experiencing some prostatitis-like symptoms.
What are the symptoms of chronic prostatitis (CP)?
CP can present itself with many symptoms. These can be divided into systemic and local.
It is important to note, that these symptoms are not exclusively specific for prostatitis. Therefore, it is imperative during an initial assessment to determine whether men present the symptoms caused by prostatitis or some other health problem, manifesting the same symptoms.
Systemic Symptoms:
Men often complain of malaise, low energy level, fatigue, apathy, chills, night sweats, lack of motivation and, or depression. Sexual dysfunction symptoms such as low sex drive, or fear of intimate relations.
Local Symptoms:
• Pain
Patients with CP often complain of a dull, throbbing pain; a sensation of irritation; or heaviness. It can be located anywhere in the lower pelvic region (groins, pubic area, perineum, and low back), genitals (penis, scrotum). Sometimes it radiates to hips, thighs or upper abdomen. Usually the pain comes and goes, and varies in intensity. Many patients would have “good” days alternating with “bad” days. Men are often not even aware of what can trigger a “bad” day.
• Voiding
The most common symptoms are: frequency; urgency; burning on urination; weak urinary flow; feeling of an inability to empty the bladder completely; and need to get up more frequently than normal at night to void. These symptoms are usually more persistent and interfere with life’s daily activities.
• Sexual Dysfunction
Some men with prostatitis complain about difficulty getting and/or keeping an erection, with sexual activity.
There are also ejaculatory complaints such as rapid (premature) ejaculation, and pain or discomfort upon or soon after ejaculation. It has been reported that up to 50% of men with prostatitis symptoms complain about ejaculatory or post-ejaculatory pain.
CP is a very difficult condition to treat. It is imperative to treat prostatitis in the most comprehensive way possible. It is possible to cure someone from prostatitis. A key to successful treatment is to determine what caused it in the first place. Unfortunately, in many cases the underlying cause may be difficult to ascertain. Nevertheless, a proper assessment and consistent treatment can yield good / excellent results for a majority of our patients.
Can prostatitis be cured?
One of the most important tools for diagnosing prostatitis is a detailed history of your symptoms, medical history in general, sex life, life style, and dietary habits. All these aspects of life would have to be assessed, as to whether they have any relevance to, or have any effect on the condition.
A focused physical examination of external genitalia and pelvic area, may provide your physician with many clues.
How is prostatitis diagnosed?
Prostatitis is an inflammation of the prostate gland.
BPH (Benign Prostatic Hyperplasia) is a benign tumour growth inside of the prostate which leads to prostate enlargement. BPH is not normally the cause, although may result in many urinary symptoms, which are often present in Prostatitis. It is a very common finding, that men who are over 45 years of age often suffer from both conditions simultaneously.
How is prostatitis different from BPH?
What are the causes of prostatitis?
The most common cause of CP is the introduction of pathogenic bacteria into the prostate. Practically every man who has had sexual intercourse with any partner without the use of a condom ceases to be “sterile”. This means that his prostate often becomes colonized with more than one type of bacteria. Under these circumstances, the bacteria travel into the prostate via urethra. A less common pathway by which the prostate can become colonized with bacteria is via blood circulation. In this case the bacteria would lodge in the prostate by traveling from other infected parts of the body, such as the lower bowels, gallbladder, infected gums or teeth.
It is likely that other factors play a role such as:
• Anatomical deviations (tight bladder neck, urethral narrowing, and tight/inflamed foreskin (phimosis, balanitis);
• History of mechanical trauma to the lower pelvis (cycling, boating, operating heavy machinery, and horseback riding);
• Promiscuous sexual behaviour, alcohol abuse, and drugs abuse;
• Severe stress (marital discord, unemployment, demanding job, etc);
• Compromised immune system due to other chronic illnesses and/or medications;
• Gastro-intestinal disturbances (IBS, colitis, constipation and etc).
We have listed just few important factors that can play a role in supporting prostatitis, and prostatitis like symptoms. A very thorough assessment is necessary in order to determine what particular factors are relevant in an individual’s particular case.
There are a variety of available treatments, both traditional and non-traditional. The challenge is to identify the best treatment for an individual patient.
If there is an indication that bacterial infection plays a role in your symptoms, then antibiotics would be the first line of therapy. They could be combined with one of the anti-inflammatory medications, and series of prostatic massages/drainages.
If there are problems with passing urine, alpha-blockers are often prescribed. They help to relax the smooth muscles within the prostate and the bladder neck, and therefore, improve urination.
There are some patients with CP who develop pelvic floor muscular tension, which could present as a constant pain in the perineum as well as voiding dysfunction. These patients may benefit from physiotherapy, stretching exercises, yoga, biofeedback and acupuncture. Please remember, that is a very important to be thoroughly assessed before embarking on alternative therapies.
Phytotherapy is also used in the treatment of CP. Our experience indicates that it is most helpful in patients with CP, when their condition is not in an active phase of inflammation. Herbal remedies are often recommended for ‘prostate maintenance therapy’, to make the prostate healthier.
How do you treat prostatitis?
What can I do to reduce the symptoms of prostatitis?
The direct cause of the condition is not well understood, however, we do know that chronic inflammation of the prostate is caused by the introduction of bacteria into the gland. Often, the prostate becomes colonized with more than one type of bacteria — most entering the gland via the urethra.
It is possible to prevent prostatitis if you start very early in your life, by maintaining a healthy life style (i.e. good diet, regular exercise and practice safe sex).
Can prostatitis be prevented?
If you have an active infection in your prostate, it can also be present in a seminal fluid. If you engage in sexual intercourse with someone without a condom. the infection can be passed to another person. It would not necessarily cause any symptoms in your partner.
Nevertheless, your partner may become a chronic carrier of infection and pass it back to you during consecutive sexual encounters without a condom.
Is prostatitis contagious?
If you suffer from Chronic Prostatitis which is not in a very active phase of inflammation, there is no need to terminate any sexual activity. Notably, frequency of sex can have an impact on your symptoms. Whether to have more or less sex needs to be determined on an individual bases during a comprehensive assessment.