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 (urination) and ejaculation. Doctors distinguish between acute and chronic prostatitis. Treatment and prognosis depend on the form and cause of the inflammation of the prostate. Read all about prostatitis here.
Prostatitis (inflammation of the prostate gland) is an inflammation of the human prostate gland. The prostate is located just below the bladder and is 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 the musculature.
The prostate produces a secretion that includes PSA (prostate specific antigen) and spermine. PSA makes the ejaculate thinner. Sperm is important for sperm motility.
Prostatitis is mainly associated with severe pain in the perineum and anal area. Also, symptoms such as urinary frequency, pain when urinating (urination) 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 lifetime. The likelihood of contracting the prostate increases with age. Research shows that most cases are between the ages of 40 and 50.
At the same time, a broader understanding of the term prostatitis has appeared in medicine. In the so-called prostatitis syndrome, several ailments in the pelvic area of a person are summarized, which usually have an unknown cause. The term "prostatitis syndrome" summarizes various 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 severe 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 from acute: if inflammations of the prostate gland and repeated microbes are observed in the urine, the so-called prostatic express (obtained from the massage of prostatic fluid) or ejaculate, are observed for more than three months, thenit is chronic inflammation. bacterial prostatitis. It is less fast than the light of acute prostatitis. Although chronic inflammation of the prostate gland causes pain when urinating and possibly a feeling of pressure in the perineal region, the symptoms are usually not as severe as in acute prostatitis.
Chronic pelvic pain syndrome (bacterial prostatitis)
In most cases of prostate infection, the bacteria cannot be detected in the urine, prostate or ejaculate as the cause of the disease. The trigger for prostatitis remains unclear. Doctors call this chronic pelvic pain syndrome (chronic bacterial prostatitis).
However, in these 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 neither bacteria nor leukocytes are found (chronic non-inflammatory pelvic pain syndrome). In general, chronic pelvic pain syndrome (bacterial prostatitis) is the most common form of 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, as part of a fertility study.
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 generally 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 pain (alguria) and urine flow is greatly reduced (dysuria) due to swelling of the prostate. Because victims can only pass small amounts of urine, they have a constant urinary frequency and have to go to the bathroom frequently (pollakiuria). 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 the presence of blood in the semen or blood in the urine (hematuria) are typical of chronic inflammation of the prostate. Disorders of sexual desire and potency are also common chronic symptoms, often due to pain during or after ejaculation. Symptoms of chronic bacterial prostatitis and chronic bacterial prostatitis (chronic pelvic pain syndrome) do not differ.
How to recognize?
The onset of prostatitis is rarely uniquely recognized, as it is sometimes asymptomatic and its symptoms are individual for each patient and change over time.
These features include:
- A man has some difficulty urinating in the toilet. The gland gradually enlarges, the urine channel contracts.
- The patient loses interest in sex. Difficulty with penile arousal increases when attempting to have sexual contact. Orgasm is achieved with difficulty, or faint, or disappears completely.
- Burning in the urethra, itching in the perineum.
- I often feel like urinating, but I get it drop by drop.
- Sperm comes out quickly during intercourse with minimal pleasure.
- General fatigue, depression, irritability, aggression, anxiety increase.
In the morning, a person feels overwhelmed, loses initiative in life.
At the same time, prolonged erections and painful ejaculation, not associated with sex, sometimes occur spontaneously at night.
By observing these phenomena, the patient calms down, believing that he is okay with potency, problems, in his opinion, are associated with the partner, with their relationship. He is overcome with depression, which aggravates the development of the disease.
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, over 30% of young people of reproductive age suffer from chronic prostatitis. In about one third of cases, it occurs in men over 20 and under 40. According to the WHO, urologists diagnose chronic prostatitis in every tenth patient.
Complications of prostatitis
In addition to acute symptoms, prostatitis can lead to complications that complicate the course of the disease and extend the healing period. The most common complication is prostate abscess (especially in acute bacterial prostatitis). A prostate abscess is purulent inflammation that usually needs to be opened and emptied with an incision.
As a further complication of prostate inflammation, the inflammation can spread to nearby structures such as the epididymis or 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. Treatment and prognosis of inflammation depend on the cause of the prostatitis.
Bacterial prostatitis: cause
Only ten percent of prostatitis cases are caused by prostate bacteria (bacterial prostatitis). Bacteria can enter the prostate through blood (hematogenous) or from nearby organs such as the bladder or urethra, where they can cause an inflammatory reaction.
Escherichia coli (E. coli), which occurs mainly 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 chlamydial or Trichomonas infections and gonorrhea.
In chronic prostatitis, bacteria in the prostate gland have escaped an as yet unclear way to protect the human immune system. This allows microbes to continually colonize the prostate. Antibiotics are relatively poor in prostate tissue, which may be another reason why bacteria survive in the prostate.
Chronic pelvic pain syndrome: causes
The exact causes of chronic pelvic pain syndrome are still not fully understood. Scientists have put forward many theories, all of which seem plausible, but all of them have not yet been clearly demonstrated. In some cases, genetic material of previously unknown microorganisms was found in the small pelvis. Therefore, the cause of pelvic pain syndrome may be microorganisms that cannot yet be grown in the laboratory and, therefore, are undetectable.
Another possible cause of chronic pelvic pain syndrome is reduced bladder emptying. Due to the violation of drainage, the volume of the bladder increases, which then presses on the prostate. This pressure eventually damages the prostate tissue, causing inflammation.
Another possible cause is that inflammation of the bladder tissue can spread to the prostate gland.
It is also possible that the irritation of the nerves around the prostate is causing pain that is mistakenly attributed to the prostate gland.
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. So doctors talk about idiopathic prostatitis.
In rare cases, prostatitis is caused by a narrowing of the urinary tract. If the urinary tract becomes narrow, urine builds up 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.
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 compromised immune systems or suppressed immune systems (eg, with drugs, immunosuppressive therapy). Additionally, underlying diseases such as diabetes can contribute to the development of prostatitis: a high blood sugar level in diabetic patients often leads to an increase in urinary sugar. The abundant sugar in the urine can provide bacteria with good growth conditions, facilitating the development of urinary tract infections. Furthermore, 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 on 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
If you have prostate problems, a family doctor or urologist is the right contact person. The primary care physician may request a medical history (anamnesis), but if there is a suspicion of prostatitis, they will refer you to a urologist. This performs a physical exam. If prostatitis is suspected, this is usually the 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 carried out in cases of reasonable suspicion of prostatitis.
Typical questions when recording a medical history (anamnesis) can be:
- Do you have pain when urinating?
- Where exactly do you feel pain?
- Does your back hurt?
- Did you notice a change in ejaculation?
Digital rectal exam
Since the prostate gland is directly adjacent to the rectum, it can be felt along the rectum. This digital rectal exam is done on an outpatient basis and without anesthesia and is usually painless. The patient is asked to lie down with his legs bent. Using a lubricant, the doctor then slowly inserts a finger into the anus and scans the prostate and surrounding organs (palpation). Examine the size and pain sensitivity in the prostate gland: The inflamed prostate gland is noticeably enlarged and very sensitive to pain.
Urinalysis is done in most cases to identify possible pathogens. The standard method is the so-called 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 done by the doctor by applying light pressure on the prostate, for example with palpation. The ejaculate can also be checked for pathogens and signs of inflammation.
You can use an ultrasound of the rectum (ultrasound) to pinpoint exactly where the inflammation is and how far it has spread. An important goal of the study is also to exclude 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 between 15 and 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 to be an indicator of prostate cancer. However, even with prostatitis, the PSA level in the blood can be significantly increased. If the reading is significantly high, tissue sampling (biopsy) is usually performed and examined in a laboratory to safely rule out prostate cancer.
As with other diseases, the treatment of prostatitis and the duration of treatment depend on the cause.
Acute bacterial prostatitis is treated with antibiotics. In mild cases, the antibiotic dose is sufficient for about ten days. For chronic prostatitis, the drug must be taken for a longer period of time (approximately four to six months). Even if symptoms have already subsided, antibiotics should still 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 the case of chronic bacterial prostatitis (chronic pelvic pain syndrome), antibiotic therapy is generally ineffective. In chronic pelvic inflammatory pain syndrome, although there is no evidence for the presence of the pathogen, antibiotic tests are performed because improvements can sometimes be achieved. However, antibiotic therapy is not recommended for chronic non-inflammatory pelvic pain syndrome.
Other therapeutic approaches for chronic bacterial prostatitis are so-called 5α-reductase inhibitors and herbal medicines (phytotherapy). If improvement is not achieved, drug therapy will be integrated with physiotherapy. 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 acute symptoms of prostate infection. Analgesics can be prescribed for severe pain. Additionally, heating pads and heating pads on the back or lower abdomen can help relax the muscles. Often relieves pain from inflammation of the prostate.
Home remedies such as processing rye or consuming soft-shelled pumpkin seeds can also help with the symptoms of prostatitis. Other suggestions include regular pelvic floor workouts, no sharp bike saddles, and no beer, meat, fat and sugar.
Treatment of complications
If, in the context of the disease, a massive obstruction of urinary outflow occurs, prostatectomy may be useful, 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 access route is usually the rectum.