Prostatitis in men is inflammation of the male prostate. It is a relatively common condition in men that is accompanied by pain when emptying the bladder (urination) and ejaculation. Doctors distinguish between acute and chronic prostatitis. Treatment and prognosis depend on the form and causes of the inflammation of the prostate. To learn all about prostatitis, click here.
Prostatitis: description
Prostatitis (inflammation of the prostate) is an inflammation of the human prostate. The prostate is located just below the bladder and is about the size of a chestnut. It surrounds the first section of the urethra and extends to the so-called pelvic floor, which is made up of musculature.
The prostate produces a secretion that includes PSA (prostate specific antigen) and spermine. PSA makes the ejaculate thinner. Semen is important for sperm motility.
Prostatitisis mainly associated with severe pain in the perineum and anal area. In addition, symptoms such as frequent urination, pain when urinating (urinating), and pain during ejaculation occur with inflammation of the prostate.
The prostate is relatively common with inflammation. It is estimated that around 15% of all men in Germany develop prostatitis once in their lifetime. The likelihood of contracting the prostate increases with age. Research shows that most cases are between 40 and 50 years old.
Prostatitis syndrome
At the same time, a broader understanding of the term prostatitis has emerged in medicine. In the so-called prostatitis syndrome, several complaints in the pelvic area of a person are summarized, which usually have an unknown cause. The term "prostatitis syndrome" sums up various clinical pictures:
- Acute bacterial prostatitis
- Chronic bacterial prostatitis
- Inflammatory and non-inflammatory syndrome of chronic pelvic pain ("chronic abacterial prostatitis")
- Asymptomatic prostatitis
Acute and chronic bacterial prostatitis
Acute prostatitis is caused by bacteria (acute bacterial prostatitis). Bacteria travel through the bloodstream to the prostate or spread from a bacterial infection from the bladder or urethra to the prostate. Acute prostatitis is usually a severe general condition with severe pain during urination, fever, and chills. Inflammation of the prostate is caused by bacteria in about ten percent of cases.
Chronic prostatitis can develop from an acute phase: if inflammation of the prostate and repeated microbes in the urine, the so-called expressed prostate (obtained by massage of the prostatic fluid) or in theejaculate, are observed for more than three months, it is a chronic inflammation. bacterial prostatitis. It is slower as lightning than acute prostatitis. Although chronic inflammation of the prostate causes pain during urination and possibly a feeling of pressure in the perineal area, the symptoms are usually not as severe as in acute prostatitis.
Chronic pelvic pain syndrome (abacterial prostatitis)
In most cases of prostate infection, bacteria cannot be detected in the urine, prostate, or ejaculation as the cause of the disease. The trigger for prostatitis remains unclear. Doctors call it chronic pelvic pain syndrome (chronic abacterial prostatitis).
However, in such cases, leukocytes (leukocytes) are often found as an expression of inflammation in the prostate gland (chronic pelvic pain syndrome). To differentiate itself, it is another form of the disease in which we do not find bacteria or leukocytes (chronic non-inflammatory pelvic pain syndrome). In general, chronic pelvic pain syndrome (abacterial prostatitis) is the most common form of prostatitis.
Asymptomatic prostatitis
In rare cases, asymptomatic prostatitis occurs. In this form of prostatitis, although there are signs of inflammation, there is no pain or other symptoms. Asymptomatic prostatitis is usually discovered incidentally, for example in a fertility study.
Prostatitis: symptoms
Inflammation of the prostate can cause various symptoms of prostatitis. Although the symptoms of acute prostatitis can be very severe and cause severe discomfort, with chronic prostatitis they are usually slightly milder. Not all affected people have all of these symptoms, and the severity of symptoms can vary from person to person.
Acute prostatitis: symptoms
Acute prostatitis is often an acute condition in which patients experience fever and chills. Inflammation of the prostate surrounding the urethra also causes typical urinary symptoms. Urination causes burning (alguria) and urine output is markedly reduced (dysuria) due to the swelling of the prostate. Because victims can only excrete small amounts of urine, they have a constant urinary frequency and have to go to the toilet frequently (pollakisuria). Other symptoms of prostatitis include bladder, pelvic pain, and back pain. Pain can also occur during or after ejaculation.
Chronic prostatitis: symptoms
Chronic prostatitis usually causes less severe symptoms than acute inflammation of the prostate. Symptoms such as fever and chills are usually completely absent. Symptoms such as a feeling of pressure in the perineum or lower abdomen, darkening of the ejaculate due to blood in the semen or blood in the urine (hematuria) are typical of chronic inflammation of the stomach. prostate. Libido and potency disturbances are also common chronic symptoms, often due to pain during or after ejaculation. The symptoms of chronic bacterial and chronic abacterial prostatitis (chronic pelvic pain syndrome) do not differ.
How to recognize?
The onset of prostatitis is rarely recognized without ambiguity, as it is sometimes asymptomatic and its symptoms are individual for each patient and change over time.
These features include:
- A man is having a little trouble urinating in the toilet. The gland gradually enlarges, the urinary canal contracts.
- The patient loses interest in sex. Difficulties in arousing the penis increase when attempting sexual contact. Orgasm is reached with difficulty, or weak, or disappears completely.
- Burning in urethra, itching in perineum.
- I often want to urinate, but I get it drip.
- Semen comes out quickly during sex with minimal pleasure.
- General fatigue, depression, irritability, aggressiveness, increased anxiety.
In the morning, a person feels overwhelmed, loses the initiative in life.
At the same time at night, sometimes prolonged erection and painful ejaculation occur spontaneously, unrelated to sex.
Observing these phenomena, the patient calms down, believing that he is well with the potency, the problems, in his opinion, are related to the partner, to their relationship. He is overcome by depression, which worsens the development of the disease.
Incidence statistics
Prostatitis is one of the most common diseases of the male genitourinary system in the world. According to various sources, it is observed in 60-80% of sexually mature men. According to official medical statistics, more than 30% of young people of childbearing age suffer from chronic prostatitis. In about a third of cases, it occurs in men over 20 and under 40. According to the WHO, urologists diagnose chronic prostatitis in one in ten patients.
Complications of prostatitis
In addition to the acute symptoms, prostatitis can cause complications that complicate the course of the disease and prolong the healing period. The most common complication is prostate abscess (especially in acute bacterial prostatitis). A prostate abscess is a purulent inflammation of the inflammation that usually needs to be opened and emptied through an incision.
As an additional complication of inflammation of the prostate, the inflammation can spread to structuresneighbors such as the epididymis or the testes (epididymitis, orchitis). Chronic prostatitis is also suspected to be associated with the development of prostate cancer.
Prostatitis: causes and risk factors
Prostatitis can have various causes. The treatment and prognosis for inflammation depends on the cause of the prostatitis.
Bacterial prostatitis: causes
Only ten percent of prostatitis cases are caused by bacteria in the prostate (bacterial prostatitis). Bacteria can enter the prostate through blood (hematogenous) or through nearby organs such as the bladder or urethra, where they can cause an inflammatory reaction.
Escherichia coli (E. coli), which occurs primarily in the human intestine, is the most common cause of prostatitis. Klebsiella, enterococci or mycobacteria can also cause prostatitis. Bacterial prostatitis can also be caused by sexually transmitted diseases such as chlamydia or Trichomonas infections and gonorrhea.
In chronic prostatitis, prostate bacteria have escaped a still unclear way to protect the human immune system. This allows microbes to continuously colonize the prostate. Antibiotics are relatively poor in prostate tissue, which may be another reason bacteria survive in the prostate.
Chronic pelvic pain syndrome: causes
The exact causes of chronic pelvic pain syndrome are not yet fully understood. Scientists have put forward many theories, each of which seems plausible, but not all of them have yet been clearly proven. In some cases, genetic material from previously unknown microorganisms has been found in the small pond. Therefore, the cause of pelvic pain syndrome may be microorganisms that still cannot be cultured in the laboratory and, therefore, are not detectable.
Another possible cause of chronic pelvic pain syndrome is impaired emptying of the bladder. Due to the violation of drainage, the volume of the bladder increases, thereby pressing on the prostate. This pressure ultimately damages prostate tissue, causing inflammation.
Another possible cause is that the inflammation of the bladder tissue can spread to the prostate.
It is also possible that irritation of the nerves around the prostate is causing pain wrongly attributed tothe prostate.
Finally, it is also possible that an overactive or misdirected immune system is causing chronic pelvic pain syndrome.
However, in many cases, the cause of chronic pelvic pain cannot be clearly demonstrated. Then the doctors talk about idiopathic prostatitis.
Anatomical reasons
In rare cases, prostatitis is caused by a narrowing of the urinary tract. If the urinary tract is narrowed, urine accumulates, and if it enters the prostate, it can also cause inflammation. This narrowing can be caused by tumors or something called prostate stones.
Doctors also suspect that dysfunction of the pelvic floor muscles may contribute to the development of prostatitis.
Mental reasons
Recently, more and more psychological causes of prostatitis have been discussed. In particular, in chronic non-inflammatory pelvic pain syndrome, a psychic trigger is likely. The exact mechanisms are still unknown.
Risk factors for prostatitis
Some men are particularly at risk of developing prostate infections. These include, for example, men with weakened immune systems or weakened immune systems (for example, with medications, immunosuppressive therapy). Additionally, underlying diseases such as diabetes can contribute to the development of prostatitis: high blood sugar in diabetic patients often leads to high blood sugar. The abundant sugar in urine can provide good conditions for bacteria to grow, making it easier to develop urinary tract infections. In addition, the immune system is weakened in diabetes mellitus.
A bladder catheter is another risk factor for developing prostatitis. Inserting a catheter into the urethra through the urethra can cause small tears in the urethra and damage the prostate. In addition, as with any foreign body, bacteria can deposit on the bladder and form a so-called biofilm. As a result, bacteria can travel up the urethra to the bladder and lead to infections of the prostate.
Prostatitis: examinations and diagnoses
In case of prostate problems, a family doctor or urologist is the right point of contact. The GP may take a medical history (history), but if prostatitis is suspected, they will refer you to a urologist. This performs a physical exam. If prostatitis is suspected, it is usually a so-called digital rectal exam. However, this study does not provide clear evidence of prostate inflammation, but only confirms the suspicion. Laboratory tests may be done to detect bacterial prostatitis. If no specific cause is found, treatment is also given if there is a reasonable suspicion of prostatitis.
Case history
Typical questions when recording medical history (anamnesis) might be:
- Do you have pain when urinating?
- Where exactly do you feel the pain?
- Do you have back pain?
- Have you noticed a change in ejaculation?
Digital rectal exam
Since the prostate is directly adjacent to the rectum, it can be palpated along the rectum. This digital rectal exam is performed on an outpatient basis and without anesthesia, and is usually painless. The patient is asked to lie down with the legs bent. Using a lubricant, the doctor then slowly inserts a finger into the anus and scans the prostate and surrounding organs (palpation). He examines the size and sensitivity to pain of the prostate: the inflamed prostate is very enlarged and very sensitive to pain.
Laboratory examination
Urinalysis is done in most cases to identify possible pathogens. The standard method is what is called the four-glass sample. Here Ersturin, Mittelstrahlurin, Prostataexprimat and Urin are tested after prostate massage. As Prostateexprimat is called, doctors call the secretion of the prostate. This is accomplished by the doctor by applying gentle pressure to the prostate, for example by palpation. The ejaculate can also be checked for pathogens and signs of inflammation.
Additional research
An ultrasound scan of the rectum (ultrasound) can be used to determine exactly where the inflammation is and how far it has spread. An important goal of the study is also to rule out other diseases with similar symptoms (differential diagnoses).
Urinary flow measurement (urinary flowmetry) is done to rule out that the existing urinary drainage problem is caused by a narrowing of the urethra. The patient urinates into a special funnel, which measures the amount of urine per unit of time. Normal urine output is 15-50 milliliters per second, while urine output is ten milliliters per second or less, there is a high probability of urethral obstruction.
Prostatitis: measurement of PSA
Elevated levels of PSA (prostate specific antigen) in the blood are generally considered to be an indicator of prostate cancer. However, even with prostatitis, the level of PSA in the blood can be significantly increased. If the reading is significantly high, a tissue sample (biopsy) is usually taken and examined in a laboratory to safely rule out prostate cancer.
Prostatitis: treatment
As with other diseases, the treatment for prostatitis and the duration of treatment depends on the cause.
Drugs
Acute bacterial prostatitis is treated with antibiotics. In mild cases, the dose of antibiotic is sufficient for ten days. For chronic prostatitis, the drug should be taken over a longer period (about four to six months). Even if the symptoms have already disappeared, the antibiotics should in all cases be continued as prescribed by the doctor. This prevents relapse and reduces the likelihood of relapse (relapse).
Asymptomatic prostatitis can also be treated with antibiotics.
In chronic abacterial prostatitis (chronic pelvic pain syndrome), antibiotic therapy is usually ineffective. In chronic pelvic pain inflammatory syndrome, although there is no evidence of the pathogen, antibiotic tests are done because sometimes improvement can be made. However, antibiotic therapy is not recommended for chronic non-inflammatory pelvic pain syndrome.
Other therapeutic approaches for chronic abacterial prostatitis are 5α-reductase inhibitors and herbal remedies (herbal medicine). If improvement is not obtained, pharmacotherapy will be supplemented by physiotherapy. He recommends physical therapy, pelvic floor exercises, or regular prostate massage. Additionally, microwave heat therapy can stimulate tissue to increase blood flow and reduce pain.
In addition, symptomatic treatment can help relieve the acute symptoms of prostate infection. Pain relievers may be prescribed for severe pain. Additionally, heating pads and heating pads on the back or lower abdomen can help relax your muscles. It often relieves pain caused by inflammation of the prostate.
Home remedies like treating rye or consuming soft-shelled pumpkin seeds can also help relieve symptoms of prostatitis. Other tips include regular pelvic floor workouts, no sharp bike saddle, and no beer, meat, fat, and sugar.
Treatment of complications
If, against the background of the disease, massive obstruction of the urinary outflow occurs, prostatectomy may be helpful, as residual urine always carries a high risk of urinary tract infection.
If the inflammation secretes pus into the prostate (abscess), it should be emptied through an incision. The access route is usually the rectum.