Doctors generally base any diagnosis at least in part on the patient’s medical history and physical examination. But these aren’t always helpful in diagnosing prostatitis. Many men with the chronic and nonbacterial forms of this disease often have a history of problems centered around the prostate—numerous occasions of pain or spasms in the region, for example, Also, because the urethra, bladder, and prostate are so closely associated, it can be difficult to pinpoint the source of a problem in that region; the symptoms often overlap.
Clearly, the easiest form of prostatitis to diagnose is the acute bacterial form (the fever and chills are a big tip-off). But for the other kinds, and for prostatodynia, other tests are needed. Because of the prostate’s location—below the bladder, and just in front of the rectum—it can’t been seen or examined from the outside. So the first step in examining it is usually the digital rectal examination, in which a doctor’s gloved, lubricated finger is inserted into the rectum to feel for lumps or enlargement, or anything else unusual. This examination may be uncomfortable, but it doesn’t hurt and it’s generally brief, lasting less than a minute.
One important test for prostatitis is prostate massage. This is also done during a digital rectal exam, as a doctor vigorously massages or presses on the prostate to express, or force, fluid out of the prostate and into the urethra. This fluid then is collected on a glass slide and examined under a microscope in the doctor’s office. The purpose of the test is to look for such signs of infection or inflammation as abnormally high levels of white blood cells. This can be done while you wait and, like the digital rectal examination, it’s usually more uncomfortable than painful. (One exception: In acute bacterial prostatitis, the rectal examination will have found a remarkably tender prostate that is also swollen, warm and firm. In this case, a doctor should not continue with prostatic massage; it would be too painful, and could lead to the release of bacteria into the bloodstream, causing sepsis. Because a urinary tract infection often accompanies acute bacterial prostatitis, the harmful bacteria can be targeted by a simple urine test.)
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