Prostatitis in men is an inflammation of the male prostate. 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 inflammation of the prostate. Read all about prostatitis 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 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 sperm. PSA makes ejaculation 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% of all men in Germany develop prostatitis once in their lives. 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, there are several complaints in a person's pelvic region, usually of unknown cause. The term "prostatitis syndrome" summarizes several clinical conditions:
- Acute bacterial prostatitis
- Chronic bacterial prostatitis
- Chronic pelvic pain inflammatory and non-inflammatory syndrome ("Chronic bacterial prostatitis")
- Asymptomatic prostatitis
Acute and chronic bacterial prostatitis
Acute prostatitis is caused by bacteria (acute bacterial prostatitis). The bacteria travels through the bloodstream to the prostate or spreads 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 acutely: if inflammation of the prostate and repeated microbes in the urine, the so-called expressed prostate (obtained by massaging the prostate fluid) or in ejaculation, is observed for more than three months, thenthis is a chronic inflammation. bacterial prostatitis. It is less fast than acute prostatitis. Although chronic inflammation of the prostate causes pain when urinating and possibly a feeling of pressure in the perineal region, the symptoms are generally 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 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 (chronic pelvic pain syndrome). To differentiate, it is another form of the disease in which bacteria and leukocytes are not found (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 accidentally, for example, as part of a fertility study.
Prostatitis: symptoms
Inflammation of the prostate can cause several symptoms of prostatitis. Although the symptoms of acute prostatitis can be very severe and cause severe discomfort, in chronic prostatitis they are usually slightly milder. Not all affected people necessarily have all of these symptoms, and the severity of the 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 surrounding the urethra also causes typical urinary symptoms. Urination causes burning pain (alguria) and urinary flow is markedly reduced (dysuria) due to swelling of the prostate. As victims can only excrete small amounts of urine, they have a constant urinary frequency and must go to the bathroom 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 feeling of pressure in the perineum or lower abdomen, darkening of ejaculation due to 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. The symptoms of chronic bacterial prostatitis and chronic abacterial prostatitis (chronic pelvic pain syndrome) do not differ.
How to recognize?
The appearance of prostatitis is rarely recognized unequivocally, as it is sometimes asymptomatic and its symptoms are individual to each patient and change over time.
These features include:
- A man has some difficulty urinating in the bathroom. The gland gradually increases, the urine channel contracts.
- The patient loses interest in sex. Difficulties with penis arousal increase when trying to have sexual contact. Orgasm is achieved with difficulty, or weak, or disappears completely.
- Burning in the urethra, itching in the perineum.
- I often feel like urinating, but I get it drop by drop.
- Semen comes out quickly during intercourse with minimal pleasure.
- General fatigue, depression, irritability, aggression, 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, not associated with sex.
Observing these phenomena, the patient calms down, believing that he is well with the power, the problems, in his opinion, are linked to the partner, to their relationship. He is stricken with depression, which aggravates 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 several sources, it is seen 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 over 20 and under 40. According to the WHO, urologists diagnose chronic prostatitis in every tenth patient.
Prostatitis complications
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). A prostate abscess is a purulent inflammation of the inflammation that usually needs to be opened and deflated with an incision.
As another complication of prostate inflammation, the inflammation can spread to nearby structures, such as the epididymis or testicles (epididymitis), orchitis). Chronic prostatitis is also suspected to be associated with the development of prostate cancer.
Prostatitis: causes and risk factors
Prostatitis can have several causes. The treatment and prognosis of inflammation depends on the cause of prostatitis.
Bacterial prostatitis: causes
Only ten percent of prostatitis cases are caused by prostate bacteria (bacterial prostatitis). Bacteria can enter the prostate through blood (hematogenous) or 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 chlamydia or Trichomonas infections and gonorrhea.
In chronic prostatitis, prostate bacteria have escaped in an unclear way of protecting 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 the 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 seems plausible, but all have yet to be clearly proven. In some cases, genetic material from 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 are therefore undetectable.
Another possible cause of chronic pelvic pain syndrome is insufficient emptying of the bladder. Due to the violation of drainage, the volume of the bladder increases, which presses 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.
It is also possible that irritation of the nerve around the prostate is causing pain that is erroneously 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. Next, 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 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.
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.
Prostatitis risk factors
Some men are especially at risk of developing prostate infections. This includes, for example, men with compromised immune systems or suppressed immune systems (for example, with drugs, immunosuppressive therapy). In addition, underlying diseases, such as diabetes, can contribute to the development of prostatitis: high blood sugar in diabetic patients often leads to an increase in urinary sugar. The abundant sugar in the 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 the development of prostatitis is a catheter in the bladder. Inserting a catheter through the urethra can cause small tears in the urethra and damage to the prostate. In addition, as with any foreign body, bacteria can settle in the bladder and form a so-called biofilm. As a result, bacteria can travel from the urethra to the bladder and cause infections in the prostate.
Prostatitis: tests and diagnoses
In case of prostate problems, a family doctor or urologist is the right person to contact. The general practitioner can write down the medical history (history), but if prostatitis is suspected, he will refer you to a urologist. This performs a physical exam. If prostatitis is suspected, it is usually called a digital rectal exam. However, this study does not provide clear evidence of inflammation of the prostate, but only confirms the suspicion. Laboratory tests can be done to detect bacterial prostatitis. If no specific cause is found, treatment is also performed in cases of reasonable suspicion of prostatitis.
Case history
Typical questions when recording a medical history (anamnesis) can be:
- Do you have pain when you urinate?
- Where exactly do you feel pain?
- Your back hurts?
- Did you notice a change in ejaculation?
Digital rectal examination
As 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 his legs bent. Using a lubricant, the doctor slowly inserts a finger into the anus and examines the prostate and surrounding organs (palpation). He examines the size and sensitivity to pain in the prostate: the inflamed prostate is very dilated and very sensitive to pain.
Laboratory exam
Urine testing 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 it prostate secretion. This is done by the doctor by applying light pressure on the prostate, such as 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 identify exactly where the inflammation 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).
The measurement of urinary flow (urofluxometry) 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 time. The normal flow of urine is 15 to 50 milliliters per second, while the flow of urine is 10 milliliters per second or less, there is a high probability of urethral obstruction.
Prostatitis: PSA measurement
High blood levels of PSA (prostate specific antigen) are generally considered to be an indicator of prostate cancer. However, even with prostatitis, the PSA level in the blood can increase significantly. If the reading is significantly elevated, the tissue sample (biopsy) is usually performed 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.
Medication
Acute bacterial prostatitis is treated with antibiotics. In mild cases, the dose of antibiotic 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 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 generally ineffective. In chronic pelvic pain inflammatory syndrome, although there is no evidence of the pathogen, testing with antibiotics is done because sometimes there can be improvement. However, antibiotic therapy is not recommended for chronic non-inflammatory pelvic pain syndrome.
Other therapeutic approaches for chronic bacterial 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. 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. Painkillers can be prescribed for severe pain. In addition, thermal pads and heated pads on the 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 the symptoms of prostatitis. Other tips include regular pelvic floor exercises, without a sharp bicycle saddle and without beer, meat, fat and sugar.
Treatment of complications
If, in the context of the disease, massive urinary flow obstruction occurs, prostatectomy can be useful, as residual urine always carries a high risk of urinary tract infection.
If the secret inflammation I put in the prostate (abscess), it should be emptied with an incision. The access route is usually straight.