The Prostate

Prostate Abscess

An abscess is a medical term used to describe an inflamed and painful collection of pus somewhere in the body. It is typically caused by a bacterial infection and can develop anywhere in or on the body.

Often the abscess is named for the part of the body it affects, as in, a toenail abscess, rectal abscess, or a prostate abscess. 

An abscess forms as the body tries to “wall off” an infection to limit the damage it might cause. The abscess typically contains a mixture of dead white blood cells, dead skin, and sometimes live bacteria. The dead white blood cells result from the body′s immune system attempting to fight off the infection. A skin infection, such as a pimple, is a typical example of a relatively harmless and minor abscess. 

An abscess inside an organ can be significantly more severe. When an abscess occurs in the male prostate, it is usually the result of a serious malfunction somewhere in the male reproduction or urinary system. It can be life-threatening if not properly treated.

Most prostate abscesses occur after several years of inattention and several bouts of prostatitis. 

What Causes a Prostate Abscess?

A prostate abscess is a relatively rare condition. It is often the result of a long-term chronic prostate infection (prostatitis) left untreated or poorly treated, sometimes for years. 1

In recent years, due to powerful antibiotics, the incidence of serious prostatic abscesses has declined significantly. However, since many men have chronic prostatitis that is not effectively treated, prostatic abscess remains a concern. Prevention is vital since there are no specific guidelines for treating this condition, and treatment is time-consuming. 

If the abscess is large, it may require surgical drainage to remove the accumulated pus. Large amounts of pus residing within the abscess area can allow the infection to continue to spread systemically. This can trigger a chain reaction throughout the body and result in sepsis. Without treatment, sepsis can rapidly lead to tissue damage, organ failure, and even death.  

Once a prostate abscess has been diagnosed, it is imperative to treat it immediately to avoid having the infection spread to other organs or other areas of the body. The presence of this type of infection alone indicates a serious failure of the patient′s immune system. Other morbidities may also be present, and ignoring a prostate abscess can result in hospitalization with a serious, life-threatening infection. 

Symptoms

Excluding groin pain, a prostate abscess may have the same symptoms as prostatitis. In many cases, the symptoms may have been apparent and ignored for several weeks or even months. 

Common symptoms include;

The following symptoms rarely occur with only prostatitis but may be common if the prostatitis has progressed to an abscess. 

  • Pus or blood in the urine

  • Pelvic pain or swelling in the area between the scrotum and anus 

  • In severe cases, fever, especially in the groin (or systemically), may be present 

The prostate itself may be seriously enlarged, either from the abscess (prostatic cyst) or pre-existing prostatic disease. In either case, a rectal examination may be necessary, but if an infection is present, the rectal exam may also be painful. 

Diagnosis

Doctors should suspect prostate abscess in men with persistent pain in the area between the scrotum and anus, especially those that have been dealing with long-term chronic prostatitis. Most men that are diagnosed with prostate abscess also suffer from benign prostate hypertrophy (BPH), an age-related enlargement of the prostate gland. 

While BPH enlarges the prostate, it is usually not accompanied by pain and tenderness like that associated with an active infection, such as a prostate abscess. Typically, sex won’t worsen prostatitis, but when a man has both prostatitis and an abscess, pain might be experienced during sexual activity, including with ejaculation. This can interfere with the enjoyment of sex. 

A recurring prostate infection is usually treated with antibiotics. Also known as chronic bacterial prostatitis, bacteria cause this infection in the prostate gland. A prostate infection may come back because antibiotics couldn’t get deep enough into the prostate tissue to destroy all of the bacteria. 

As mentioned above, an abscess can also form as the result of a chronic or under-treated prostate infection. This scenario is more common than it should be. Many urologists tend to under-diagnosed a prostate abscess and treat it in the same way as prostatitis.

While bacterial prostatitis is also deemed to be an infection, it is almost always explicitly confined to the prostate gland and rarely forms an abscess. Men that are incompletely treated for either recurring prostatitis or a urinary tract infection (UTIs) tend to develop abscesses more frequently. 

However, recurring UTI′s may simply be due to poor diet or hormonal imbalances of a man and should not be used as an indication of a prostate abscess without further testing. 

A scan via ultrasound or computed tomography can help identify a pus pocket that is distinctive for a prostate abscess. Prostate abscesses are often discovered unexpectedly during endoscopy of the urinary tract for other purposes. 

Pus, bacteria, and blood are not usually found in men with healthy urinary tracts and prostates. However, it is common to find pus and bacteria in the urine in men with a prostate abscess. Coupled with long-term chronic prostatitis,, it may also indicate an indicator for an abscess. 

Treatment Options for a Prostate Abscess

Treatment for a prostate abscess typically consists of three critical paths;

Common treatment typically uses strong antibiotics (often needed for several months) and drainage of pus from the abscess. Urologists tend to use strong antibiotics (like Cipro) for a short-term period, like 10 days or less, but this is rarely successful over the long term. The prostate contains many small capillaries and vessels that the usual antibiotics may not reach. 

If the treatment period is not long enough or the antibiotic not powerful enough, the abscess formation will surely reoccur, making the situation worse. Prostate abscesses tend to be very tenacious and often need to be treated for longer than other typical infections. Antibiotics do not always kill the entire infection, especially when they are not used long enough. 

This also poses the problem of antibiotic side effects. Strong antibiotics can carry a host of side effects, particularly when used long-term. Also, most are not specifically designed for long-term treatment. Natural health providers typically use natural antibiotics like Oregano oil and Colloidal silver for long-term treatment. I have had significant success with prostatitis using a therapeutic dose of colloidal silver over several months. 

When dealing with an active prostate abscess, it is always wise to drain as much pus as possible from it. There are several ways a doctor might do this;

  • An instrument can be threaded up the urethra with an embedded needle to puncture and drain the abscess. 

  • A hollow needle can be inserted in the perineal area (between the scrotum and anus). 

  • The practitioner can insert a gloved finger in the rectum and massage the prostate gland. This is known as transurethral draining or milking of the prostate. Pus and prostatic fluid released from the urethra can be collected for further examination. This method is used for cases where the abscess is small and its area well-defined, so the doctor can determine where to press to remove the largest amount of pus. The first two methods are more aggressive, likely more to be painful, and more likely to be successful.

  • Transurethral unroofing. This procedure is essentially the same as the surgical procedure called a TURP or transurethral resection of the prostate. It is a surgical procedure done under general anesthetic. The exception from the usual TURP is that the procedure is designed to drain pus from the abscess rather than removing tissue prostatic. It is generally more successful when the abscess is large and well defined. 2 

To make the best decision regarding drainage, it is important to predetermine the abscess’s size and shape. This is typically done using either transrectal ultrasonography (TRUS), computed tomography (CT), or other imaging. Drainage should be considered if high levels of pain are present or high concentrations of pus are evident. Large abscesses should be drained whenever possible. 3 

Drainage should be followed by a course of antibiotics as well as a follow-up examination within a couple of weeks.

The transurethral unroofing procedure is essentially a modified TURP used mostly in cases where the abscess is large and well defined. It does not eliminate the need for additional antibiotics after the procedure.

Preventing Recurrence

One of the problems with a prostate abscess is recurrence. In most cases, the chance of an abscess returning after proper treatment is minimal. Men who have had several occurrences of prostatitis are more likely to have an occurrence or a recurrence. 

Due to the high level of small vessels in the prostate, even strong antibiotics may not get far enough into the prostate gland to completely kill the infection.

One indication of this is when the abscess comes back in the same or nearby spot. This typically means the abscess was not treated effectively and was not completely eliminated. This tends to happen when all of the prescribed antibiotics are not taken or when the dosage was insufficient to eradicate the infection.  

A prostate abscess is rare in younger men but can occur when sexual release is restricted for long periods. A typical situation for younger men is typically called “blue balls.” Numerous recurrence of this condition can eventually result in prostate dysfunction and/or abscess.

Older men can sometimes have a condition where they cannot have an orgasm or ejaculation, even with extensive stimulation. The condition (known as anorgasmia) is more common in people with diabetes due to nerve deterioration at or near the penis head or in the pelvic area. 

Anorgasmia can be a significant problem for those that suffer from it. Some men that have frequent episodes become sexually aroused for an extended period of time without a release or decrease of arousal. This can cause pain or discomfort in the area around the scrotum.  

Constant arousal and its inherent engorgement can create a tension situation throughout the pelvic region that can sometimes result in an abscess if not released. 

During sexual arousal, the parasympathetic nervous system is activated. Blood flow and pressure in both the blood vessels of the penis and the testicles are increased. This high degree of tension is relieved on orgasmic release. However, for those that cannot achieve orgasmic release, the pressure remains, and excess blood may stay in the genital area.

For young men, it is usually not an issue, as the congestion ends rather quickly. But for older, especially diabetic men, the congestion may remain and, in some cases, may result in prostate and testicular swelling. A prostate abscess can be a more serious side effect of this condition.

Young men have given the slang name “blue-balls” to this condition. It can happen anytime a male remains aroused without orgasm, but for some people that have an underlying circulation problem, such as diabetics, it can become serious.

If an abscess is treated thoroughly, there’s no compelling reason another abscess will form there again. However, within the prostate, a gland with multiple small capillaries, some pockets of infected tissue may remain. If the infection is not eliminated, the abscess could become active again. 4

Conclusion

Any abscess in the body is a serious matter. A prostate abscess is no different. Unfortunately, many men try to ignore the condition until it has advanced to a serious, persistent problem. 

Any time there is an abscess or infection, be it anywhere on the body, there is the potential for the infection to spread. When the infection is inside the male prostate (an abscess), it can spread and cause significant pain. In addition, there is always the possibility of the infection spreading systemically and causing sepsis. 

Any minor infection can become severe and can even be life-threatening if allowed to proceed unchecked. An abscess in the male prostate, while serious, is unlikely to result in severe sepsis or septic shock. However, it cannot be totally ruled out.

A prostate abscess is not usually common, and, as such, many urologists tend to rule it out without actually checking for it. It is quite possible for a quick diagnosis of prostatitis to actually be a prostate abscess and go untreated or minimally treated until its severity is recognized. 

Any man that has groin pain or swelling should make this fact well known on medical examination. If treated for the condition and it does not improve within a reasonable amount of time, it should be reevaluated. 

Some urologists view any kind of prostate problem as a ticket towards removing the man′s prostate. Remove of the prostate is serious, major surgery that has severe, debilitating, and life-altering side effects. It should generally not be considered as a solution for a prostate abscess.

Sources

  1. Dr. Ahmed Zayed, Bacterial Prostatitis: Types, Symptoms, and Treatment, bensnaturalhealth.com/blog/, February 12, 2021
  2. Uday Mann, et al, Transurethral resection and drainage of prostate abscess: A case study, University of Manitoba, 15 June 2020
  3. Kazuhiko Oshinomi, et al, Treatment strategy for prostatic abscess: Eighteen cases’ report and review of literature, Department of Urology, School of Medicine, Showa University, Tokyo, Japan, Vol 29, No 4, Pps 206-209, Jan 2018
  4. Anil Kumar, et al, NCBI Education, January 16, 2021

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