Prostatitis in men is an inflammation of the male prostate gland. It is a relatively common condition in men that is accompanied by pain when emptying the bladder (urinating) and ejaculating. Doctors distinguish between acute and chronic prostatitis. Therapy and prognosis depend on the shape and causes of the inflammation of the prostate. Read all about prostatitis here.
Prostatitis: description
Prostatitis (inflammation of the prostate gland) is an inflammation of the human prostate gland. 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 ejaculation thinner. Sperm are important for sperm motility.
Prostatitis is primarily associated with severe pain in the perineum and anal area. In addition, symptoms such as urinary frequency, painful urination (urinate), and pain during ejaculation occur during inflammation of the prostate.
The prostate is relatively common with inflammation. It is estimated that around 15 percent of all men in Germany develop prostatitis once in their life. The probability of contracting the prostate increases with age. Research shows that most cases are between the ages of 40 and 50.
Prostatitis syndrome
At the same time, a broader understanding of the term prostatitis appeared in medicine. In the so-called prostatitis syndrome, several complaints are summarized in the pelvic area of a person, which usually have an unknown cause. The term "prostatitis syndrome" summarizes several clinical pictures:
- Acute bacterial prostatitis
- Chronic bacterial prostatitis
- Inflammatory and non-inflammatory syndrome of chronic pelvic pain ("chronic bacterial 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 of the bladder or urethra to the prostate. Acute prostatitis is usually a serious general condition with severe pain when urinating, fever, and chills. Inflammation of the prostate is caused by bacteria in about ten percent of cases.
Chronic prostatitis can develop acutely: if inflammation of the prostate gland and repeated microbes are observed in the urine, the so-called prostate expressed (obtained by massaging the prostatic fluid) or in the ejaculate, for more than three months, then it is a chronic inflammation. bacterial prostatitis. It is less lightning fast than acute prostatitis. Although chronic inflammation of the prostate causes painful urination and possibly a feeling of pressure in the perineal region, the symptoms are not usually as severe as in acute prostatitis.
Chronic pelvic pain syndrome (bacterial prostatitis)
In most cases of prostate infection, bacteria cannot be detected in urine, prostate, or ejaculation as the cause of the disease. The trigger for prostatitis remains unclear. Doctors call this 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, it is another form of the disease in which no bacteria or leukocytes are found (chronic non-inflammatory pelvic pain syndrome). In general, chronic pelvic pain syndrome (bacterial 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 are no pain or other symptoms. Asymptomatic prostatitis is usually discovered incidentally, for example, as part of a fertility study.
Prostatitis: symptoms
Inflammation of the prostate can cause various symptoms of prostatitis. Although the symptoms of acute prostatitis can be very serious and cause serious discomfort, in chronic prostatitis they are usually slightly milder. Not all affected people necessarily 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 suffer from fever and chills. Inflammation of the prostate gland surrounding the urethra also causes typical urinary symptoms. Urination causes burning (alguria) and the flow of urine is markedly reduced (dysuria) due to inflammation of the prostate. Because victims can only excrete small amounts of urine, they have a constant urinary frequency and must go to the bathroom frequently (polaquisuria). Other symptoms of prostatitis include pain in the bladder, pelvis, 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 ejaculation due to blood in the semen or blood in the urine (hematuria) are typical of chronic inflammation of the prostate. Sexual drive and potency disorders 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 unequivocally recognized as it is sometimes asymptomatic, and its symptoms are individual to each patient and change over time.
These functions include:
- A man has a little difficulty urinating in the bathroom. The gland gradually enlarges, the urinary canal contracts.
- Patient loses interest in sex. Difficulties with arousal of the penis increase when trying to have sexual contact. Orgasm is difficult to achieve, weakens, or disappears completely.
- Burning in the urethra, itching in the perineum.
- I often want to urinate, but I get it drop by drop.
- Semen comes out quickly during intercourse with minimal pleasure.
- General fatigue, depression, irritability, aggressiveness, increased anxiety.
In the morning, a person feels overwhelmed, loses initiative in life.
At the same time, at night, sometimes prolonged erection and painful ejaculation occur spontaneously, not associated with sex.
Observing these phenomena, the patient calms down, believing that he is fine with potency, the problems, in his opinion, are connected with the partner, their relationship. It is overcome by depression, which aggravates the development of the disease.
Incidence statistics
Prostatitis is one of the most widespread 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 reproductive age suffer from chronic prostatitis. In about a third of cases, it occurs in men older than 20 and younger than 40. According to the WHO, urologists diagnose chronic prostatitis in every 10th patient.
Complications of prostatitis
In addition to acute symptoms, prostatitis can lead to complications that complicate the course of the disease and prolong the healing period. The most common complication is a prostate abscess (especially in acute bacterial prostatitis). A prostate abscess is a purulent swelling of inflammation that usually needs to be opened and emptied with an incision.
As an additional complication of inflammation of the prostate, the inflammation may spread to nearby structures such as the epididymis or testicles(epididymitis, orchitis). Chronic prostatitis is also suspected of being associated with the development of prostate cancer.
Prostatitis: causes and risk factors
Prostatitis can have several causes. Treatment and prognosis of inflammation depend on the cause of the prostatitis.
Bacterial prostatitis: cause
Only ten percent of prostatitis cases are caused by bacteria in the prostate (bacterial prostatitis). Bacteria can enter the prostate through the blood (hematogenous) or 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, bacteria from the prostate gland have escaped in an as yet 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 for bacteria to survive in the prostate.
Chronic pelvic pain syndrome: causes
The exact causes of chronic pelvic pain syndrome are not yet fully understood. Scientists have come up with many theories, each of which sounds plausible, but they have yet to be clearly proven. In some cases, genetic material from previously unknown microorganisms has been found in the small pelvis. Therefore, the cause of pelvic pain syndrome may be microorganisms that cannot yet be cultured in the laboratory and therefore are not detectable.
Another possible cause of chronic pelvic pain syndrome is poor emptying of the bladder. Due to the violation of drainage, the volume of the bladder increases, which puts pressure on the prostate. This pressure eventually damages the prostate tissue, causing inflammation.
Another possible cause is that inflammation of the bladder tissue may spread to the prostate gland.
It is also possible that irritation of the nerves around the prostate is causing pain that is wrongly attributed to the glandprostate.
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 doctors talk about idiopathic prostatitis.
Anatomical reasons
In rare cases, prostatitis is caused by a narrowing of the urinary tract. If the urinary tract narrows, urine collects and if it enters the prostate, it can also cause inflammation. This narrowing can be caused by tumors or so-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 to occur. The exact mechanisms are still unknown.
Risk factors for prostatitis
Some men are at special risk of developing prostate infections. These include, for example, men with a compromised immune system or a suppressed immune system (for example, with medications, immunosuppressive therapy). Also, underlying diseases such as diabetes can contribute to the development of prostatitis: high blood sugar in diabetic patients often leads to high sugar in the urine. The abundant sugar in the urine can provide bacteria with good growth conditions, which facilitates the development of urinary tract infections. Also, the immune system is weakened in diabetes mellitus.
Another risk factor for developing prostatitis is a bladder catheter. Inserting a catheter through the urethra through the urethra can cause small tears in the urethra and damage to the prostate gland. Also, as with any foreign body, bacteria can settle in the bladder and form a so-called biofilm. As a result, bacteria can travel up the urethra to the bladder and cause prostate infections.
Prostatitis: examinations and diagnosis
In case of prostate problems, a family doctor or urologist is the appropriate contact person. The GP can take a medical history (history), but if there is a suspicion of prostatitis, he will refer you to a urologist. This performs a physical exam. If prostatitis is suspected, this is usually called a digital rectal examination. However, this study does not provide clear evidence of inflammation of the prostate, it only confirms the suspicion. Laboratory tests can be done to detect bacterial prostatitis. If no specific cause is found, treatment is also carried out in reasonably suspected cases of prostatitis.
Case history
Typical questions when taking a medical history (anamnesis) can be:
- Do you have pain when urinating?
- Where exactly do you feel pain?
- Does your back hurt?
- Have you noticed a change in ejaculation?
Digital rectal exam
Since the prostate gland is directly adjacent to the rectum, it can be palpated along the rectum. This digital rectal exam is performed on an outpatient basis without anesthesia, and is usually painless. The patient is asked to lie down with his legs bent. Then, with a lubricant, the doctor slowly inserts a finger into the anus and scans the prostate and surrounding organs (palpation). Examine the size and sensitivity to pain in the prostate gland: the swollen prostate gland is greatly enlarged and is very sensitive to pain.
Laboratory exam
Urinalysis is performed in most cases to identify potential pathogens. The standard method is the so-called four-vessel sample. Here Ersturin, Mittelstrahlurin, Prostataexprimat and Urin are tested after prostate massage. As it is called Prostateexprimat, doctors call the secretion of the prostate. This is accomplished by the physician by applying gentle pressure to the prostate, for example by palpation. Ejaculation can also be checked for pathogens and signs of inflammation.
Additional research
An ultrasound of the rectum (ultrasound) can be used to determine exactly where the swelling is and how far it has spread. An important objective of the study is also to rule out other diseases with similar symptoms (differential diagnoses).
Measurement of urine flow (uroflowmetry) is performed 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 flow is 15 to 50 milliliters per second, while urine flow is ten milliliters per second or less, there is a high probability of urethral obstruction.
Prostatitis: PSA measurement
Elevated levels of PSA (prostate specific antigen) in the blood are generally considered an indicator of prostate cancer. However, even with prostatitis, the level of PSA in the blood can increase significantly. If the reading is significantly elevated, 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 of prostatitis and the duration of treatment depend on the cause.
Medications
Acute bacterial prostatitis is treated with antibiotics. In mild cases, the antibiotic dose is sufficient for about ten days. For chronic prostatitis, the drug should be taken for a longer period of time (about four to six months). Even if the symptoms have already disappeared, the antibiotics should be continued in any case as prescribed by the doctor. This prevents relapse and reduces the chance of relapse (relapse).
Antibiotics can also treat asymptomatic prostatitis.
If chronic abacterial prostatitis (chronic pelvic pain syndrome) is present, antibiotic therapy is often ineffective. In chronic pelvic pain inflammatory syndrome, although there is no evidence of the pathogen, antibiotic tests are performed because sometimes improvement can be achieved. However, antibiotic therapy is not recommended for chronic non-inflammatory pelvic pain syndrome.
Other therapeutic approaches for chronic abacterial prostatitis are the so-called 5α-reductase inhibitors and herbal medicines (herbal medicine). If improvement is not achieved, drug therapy will be supplemented with physical therapy. Recommend physical therapy, pelvic floor exercises, or regular prostate massage. Additionally, microwave heat therapy can stimulate tissues to increase blood flow and reduce pain.
In addition, symptomatic therapy can help relieve the acute symptoms of prostate infection. Pain relievers may be prescribed for severe pain. Also, heating pads and heating pads on the back or lower abdomen can help relax muscles. Often relieves pain from inflammation of the prostate.
Home remedies like processing rye or eating soft-shelled pumpkin seeds can also help with prostatitis symptoms. Other tips include regular pelvic floor workouts, no sharp bike mounts, and no beer, meat, fat, and sugar.
Treatment of complications
If, in the context of the disease, massive urinary flow obstruction 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 gland (abscess), it should be emptied with an incision. The path is usually the rectum.