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 form and causes of prostate inflammation. 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 about the size of a chestnut. It surrounds the first section of the urethra and extends to the so-called pelvic floor, which is composed of 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. In addition, symptoms such as urinary frequency, pain when urinating (urinating) and pain during ejaculation occur during inflammation of the prostate.
The prostate is relatively common with inflammation. It is estimated that about 15 percent of all men in Germany develop prostatitis once in a 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, an expanded understanding of the term prostatitis appeared in medicine. In the so-called prostatitis syndrome, several complaints in the pelvic area of a person are summed up, 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 ("Abacterial chronic prostatitis")
- Asymptomatic prostatitis
Acute and chronic bacterial prostatitis
Acute prostatitis is caused by bacteria (acute bacterial prostatitis). The bacteria either 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 during urination, fever, and chills. Inflammation of the prostate is caused by bacteria in about ten percent of cases.
Chronic prostatitis can develop from acute: if inflammation of the prostate gland and repeated microbes in the urine, the so-called prostate expressate (obtained by massage of the prostate fluid) or in the ejaculate, are observed for more than three months, then this is chronic inflammation. bacterial prostatitis. It is less lightning fast than 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 (abacterial prostatitis)
In most cases of prostate infection, bacteria cannot be detected in urine, prostate or ejaculate 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 neither bacteria nor leukocytes are found (non-inflammatory chronic pelvic pain syndrome). In general, chronic pelvic pain syndrome (abacterial 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 usually slightly milder. Not every affected person necessarily has 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 markedly reduced (dysuria) due to prostate swelling. Because victims can only excrete small amounts of urine, they have a constant urinary frequency and must 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 prostate. Disorders of sex drive and potency 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 unequivocally, since sometimes it is asymptomatic, and its symptoms are individual for each patient and change over time.
These features include:
- A man has a little difficulty passing urine in the toilet. The gland gradually enlarges, the urine channel contracts.
- The patient loses interest in sex. Difficulties with arousal of the penis increase when attempting to have sexual contact. Orgasm is achieved with difficulty, or weak, or completely disappears.
- Burning in urethra, itching in perineum.
- I often want to urinate, but I get it drop by drop.
- The semen comes out quickly during intercourse with minimal pleasure.
- General fatigue, depression, irritability, aggressiveness, anxiety increase.
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 well with potency, the problems, in his opinion, are connected with the partner, their relationship. He is overcome by depression, which aggravates the development of the disease.
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, over 30% of young people of reproductive 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 every tenth 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 prostate abscess (especially in acute bacterial prostatitis). An abscess of the prostate is a purulent inflammation of inflammation that usually needs to be opened and emptied with an incision.
As a further complication of prostate inflammation, inflammation can spread to nearby structures such as the epididymis or testicles (epididymitis, orchitis). It is also suspected that chronic prostatitis is 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 prostatitis.
Bacterial prostatitis: causes
Only ten percent of cases of prostatitis are caused by bacteria from the prostate (bacterial prostatitis). Bacteria can enter the prostate through the blood (hematogenous) or from nearby organs such as the bladder or urethra, where they can lead to 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 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 for bacteria to 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, each of which sounds plausible, but all of them have not yet been clearly proven. In some cases, genetic material of previously unknown microorganisms has been found in the small pelvis. 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, which thus presses 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 nerve irritation 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. Then doctors talk about idiopathic prostatitis.
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 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 non-inflammatory chronic pelvic pain syndrome, a psychic trigger is likely. The exact mechanisms are still unknown.
Prostatitis risk factors
Some men are especially at risk of developing prostate infections. These include, for example, men with a compromised immune system or a suppressed immune system (eg, with medication, immunosuppressive therapy). In addition, underlying diseases such as diabetes can contribute to the development of prostatitis: elevated blood sugar in diabetic patients often leads to elevated urinary sugar. The abundant sugar in urine can provide bacteria with good growth conditions, making it easier for urinary tract infections to develop. In addition, 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. In addition, 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 lead to prostate infections.
Prostatitis: examinations and diagnostics
In case of prostate problems, a family doctor or urologist is the right contact person. The general practitioner 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 examination. If prostatitis is suspected, this is usually a so-called digital rectal examination. 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 offered if prostatitis is suspected.
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?
- Have you noticed a change in ejaculation?
Digital rectal examination
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 and without anesthesia, usually painlessly. The patient is asked to lie 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 in the prostate gland: the inflamed prostate gland is greatly 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 accomplished by the doctor by applying gentle pressure on the prostate, such as by palpation. The ejaculate can also be checked for pathogens and signs of inflammation.
An ultrasound scan of the rectum (sonography) can be used to pinpoint 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).
Urine flow measurement (uroflowmetry) is performed to rule out that the existing urinary drainage problem is caused by a narrowing of the urethra. The patient urinates in 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 likelihood of urethral obstruction.
Prostatitis: PSA measurement
Elevated blood PSA (prostate-specific antigen) levels are generally considered an indicator of prostate cancer. However, even with prostatitis, the PSA level in the blood can be significantly increased. If the reading is significantly elevated, 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 should be taken over a longer period of time (about four to six months). Even if symptoms have already subsided, antibiotics should in any case 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.
If there is 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 testing is done because sometimes improvement can be made. However, antibiotic therapy is not recommended for noninflammatory chronic 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 physiotherapy. It recommends physical therapy, pelvic floor exercises or regular prostate massage. In addition, 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. Pain relievers can be prescribed for severe pain. Also, heating pads and heating pads on your back or lower abdomen can help relax your muscles. It often relieves pain from inflammation of the prostate.
Home remedies like processing rye or eating soft-shelled pumpkin seeds can also help with 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, in the context of the disease, massive urinary outflow obstruction occurs, prostatectomy may be helpful, as residual urine always carries a high risk of urinary tract infection.
If inflammation secretes pus in the prostate gland (abscess), it should be emptied with an incision. The access route is usually the rectum.