Prostatitis in men is inflammation of the male prostate. It is a relatively common condition in men that involves pain when emptying the bladder (urinating) and ejaculating. Doctors differentiate between acute and chronic prostatitis. Therapy and prognosis depend on the form and causes of the prostate inflammation. Read everything about prostatitis here.
Prostatitis: description
Prostatitis (inflammation of the prostate) is 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 what is known as the pelvic floor, which is made up of muscles.
The prostate produces a secretion that contains 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 in inflammation. It is estimated that around 15 percent of all men in Germany develop prostatitis once in their lives. The likelihood of prostate contraction increases with age. Research shows that most cases are between 40 and 50 years old.
Prostatitis Syndrome
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 combined, most of which 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 to the prostate through the bloodstream or spread to the prostate from a bacterial infection of the bladder or urethra. Acute prostatitis is usually a serious general disease 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 prostate express (obtained by massaging the prostate fluid) or in the ejaculate, are observed for more than three months, it is chronic inflammation. bacterial prostatitis. It's less lightning-fast than acute prostatitis. Although chronic inflammation of the prostate causes pain when urinating and possibly a feeling of pressure in the perineal area, the symptoms are usually not as severe as with acute prostatitis.
Chronic pelvic pain syndrome (abacterial prostatitis)
In most cases of prostate infection, bacteria in the urine, prostate or ejaculate cannot be detected as the cause of the disease. The trigger for prostatitis remains unclear. Doctors call this chronic pelvic pain syndrome (chronic abacterial prostatitis).
In such cases, however, leukocytes (leukocytes) are often found as an expression of inflammation in the prostate (chronic pelvic pain syndrome). To distinguish it, 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 (bacterial prostatitis) is the most common form of prostatitis.
Asymptomatic prostatitis
In rare cases, asymptomatic prostatitis occurs. With this form of prostatitis, there will be signs of inflammation but no pain or other symptoms. Asymptomatic prostatitis is usually discovered accidentally, for example in 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, they are usually somewhat milder in chronic prostatitis. 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 illness in which patients experience fever and chills. Inflammation of the prostate surrounding the urethra also causes typical urinary symptoms. Urination causes burning pain (alguria) and the flow of urine is significantly reduced due to prostate swelling (dysuria). Since the victims can only pass small amounts of urine, they have a constant urinary frequency and have to go to the toilet frequently (pollakiuria). Other symptoms of prostatitis include bladder, pelvic, 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, a darkening of the ejaculate due to blood in the semen or blood in the urine (hematuria) are typical of chronic inflammation of the prostate. Sex 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 do you recognize?
The onset of prostatitis is rarely clearly identified because it is sometimes asymptomatic and its symptoms are individual for each patient and change over time.
These functions include:
- A man has a little trouble getting urine down the toilet. The gland gradually enlarges, the urine duct contracts.
- The patient loses interest in sex. Difficulty with arousal of the penis increases when attempting sexual contact. Orgasm is difficult, weak, or disappears completely.
- Burning sensation in the urethra, itching in the perineum.
- I want to urinate often, but I get it drop by drop.
- The semen comes out quickly during intercourse with minimal pleasure.
- General tiredness, depression, irritability, aggressiveness, increased anxiety.
In the morning a person feels overwhelmed and loses initiative in life.
At the same time, at night, sometimes a prolonged erection and painful ejaculation occur spontaneously, unrelated to sex.
When the patient observes these phenomena, he calms down and believes that he can cope well with potency. In his opinion, the problems are related to the partner and their relationship. He becomes overwhelmed by depression, which makes the development of the disease worse.
Incidence statistics
Prostatitis is one of the most common diseases of the male genitourinary system worldwide. According to various sources, it is seen in 60-80% of sexually mature men. According to official medical statistics, over 30% of young people of childbearing age suffer from chronic prostatitis. It occurs in about a third of cases in men over 20 and under 40 years of age. 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 the prostate abscess (especially in acute bacterial prostatitis). An abscess of the prostate is a purulent inflammation of the inflammation that usually has to be opened with an incision and drained. As a further complication of prostate inflammation, the inflammation can spread to nearby structures such as the epididymis or testicles (epididymis, orchitis). Chronic prostatitis is also thought to be linked to the development of prostate cancer.
Prostatitis: causes and risk factors
Prostatitis can have various causes. Treatment and prognosis for inflammation depend on the cause of the prostatitis.
Bacterial prostatitis: causes
In only ten percent of cases, prostatitis is caused by bacteria from the prostate (bacterial prostatitis). Bacteria can enter the prostate via the blood (hematogenous) or via nearby organs such as the bladder or urethra, where they lead to an inflammatory reaction.
Escherichia coli (E. coli), which is mainly found 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 have escaped an as yet unclear way of protecting the human immune system. This allows microbes to continuously colonize the prostate. Antibiotics are relatively poor in prostate tissue, which can 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 sounds plausible, but none of them have been clearly proven. In some cases, genetic material from previously unknown microorganisms was found in the pelvis. Therefore, the cause of pelvic pain syndrome can be microorganisms that still cannot be cultured in the laboratory and therefore cannot be detected.
Another possible cause of chronic pelvic pain syndrome is impaired bladder emptying. Due to the violation of the drainage, the volume of the bladder increases, which causes pressure on the prostate. This pressure eventually damages the prostate tissue and causes inflammation.
Another possible cause is that inflammation of the bladder tissue can spread to the prostate.
It is also possible that nerve irritation around the prostate causes pain that is incorrectly attributed to the prostate.
Finally, it is also possible that an overactive or misdirected immune system causes chronic pelvic pain syndrome.
In many cases, however, the cause of chronic pelvic pain cannot be clearly established. Then doctors talk about idiopathic prostatitis.
Anatomical reasons
In rare cases, prostatitis is caused by a narrowing of the urinary tract. When the urinary tract is narrowed, urine collects and when it gets into the prostate it can also cause inflammation. This narrowing can be caused by tumors or so-called prostate stones.
Doctors also suspect that a dysfunction of the pelvic floor muscles can contribute to the development of prostatitis.
Mental reasons
Recently, there has been a growing discussion of the psychological causes of prostatitis. A psychological trigger is likely, especially in the non-inflammatory chronic pelvic pain syndrome. The exact mechanisms are still unknown.
Prostatitis Risk Factors
Some men are particularly at risk of developing prostate infections. These include, for example, men with a weakened immune system or a suppressed immune system (e. g. with medication, immunosuppressive therapy). In addition, underlying diseases such as diabetes can contribute to the development of prostatitis: high blood sugar in diabetics often leads to increased urinary sugar. The abundant sugar in sugar can provide good growth conditions for bacteria and facilitate the development of urinary tract infections. In addition, the immune system is weakened in diabetes mellitus.
Another risk factor for developing prostatitis is a urinary catheter. Inserting a catheter through 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 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 diagnoses
A family doctor or urologist is the right contact for prostate problems. The general practitioner can take a medical history (medical history), but if prostatitis is suspected, they will refer you to a urologist. This will do a physical exam. If prostatitis is suspected, it is usually a so-called digital rectal examination. However, this study does not provide any clear evidence of prostate inflammation, but only confirms the suspicion. Laboratory tests can be done to check for bacterial prostatitis. If no specific cause is found, treatment is carried out even if there is justified suspicion of prostatitis.
case history
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 is right next to the rectum, it can be palpated along the rectum. This digital rectal examination is performed on an outpatient basis without anesthesia and is usually painless. The patient is asked to lie with their 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 of the prostate to pain: the inflamed prostate is greatly enlarged and very sensitive to pain.
Laboratory examination
In most cases, a urinalysis is done to identify possible pathogens. The standard method is the so-called four-glass test. Here primary urine, midstream urine, prostate expression and urine after prostate massage are tested. As prostate expression is called, doctors call the secretion of the prostate. The doctor does this by applying slight pressure to the prostate, for example by palpation. The ejaculate can also be checked for pathogens and signs of inflammation.
Further research
An ultrasound of the rectum (sonography) can determine exactly where the inflammation is and how far it has spread. Another important aim of the study is to rule out other diseases with similar symptoms (differential diagnoses).
A urine flow measurement (uroflowmetry) is carried out to rule out that the existing problem of urinary drainage is caused by a narrowing of the urethra. The patient urinates in a special funnel that measures the amount of urine per unit of time. The normal urine flow is 15 to 50 milliliters per second, while the urine flow is 10 milliliters per second or less, there is a high possibility of urethral obstruction.
Prostatitis: PSA measurement
Elevated blood PSA (prostate-specific antigen) levels are generally seen as an indicator of prostate cancer. However, even with prostatitis, the level of PSA in the blood can increase significantly. If the reading is significantly increased, a tissue sample (biopsy) is usually done and examined in a laboratory to be sure to rule out prostate cancer.
prostatitis: treatment
As with other diseases, the treatment for prostatitis and the duration of treatment depend on the cause.
Medicines
Acute bacterial prostatitis is treated with antibiotics. In mild cases, the antibiotic dose is sufficient for about ten days. In chronic prostatitis, the drug should be used for a long time (about four to six months). Even if the symptoms have subsided, antibiotics should definitely be continued as prescribed by the doctor. This prevents relapse and reduces the chance of a relapse (relapse).
Asymptomatic prostatitis can also be treated with antibiotics.
In the case of chronic abacterial prostatitis (chronic pelvic pain syndrome), antibiotic therapy is usually ineffective. For chronic pelvic inflammatory pain syndrome, antibiotic tests are done although there is no evidence of the causative agent, as improvements can sometimes be made. However, antibiotic therapy is not recommended for non-inflammatory chronic pelvic pain syndromes.
Other therapeutic approaches for the treatment of chronic abacterial prostatitis are so-called 5α-reductase inhibitors and herbal medicines (herbal medicine). If no improvement is achieved, drug therapy is supplemented with physiotherapy. It recommends physical therapy, pelvic floor exercises, or regular prostate massage. In addition, microwave heat therapy can stimulate tissue to increase blood flow and relieve pain.
In addition, symptomatic therapy can help alleviate acute symptoms of a prostate infection. Painkillers can be prescribed for severe pain. Heating pads and heating pads on your back or lower abdomen can also help relax your muscles. It often relieves pain associated with inflammation of the prostate.
Home remedies such as processing rye or eating pumpkin seeds with soft skins can also help with symptoms of prostatitis. Further tips are regular pelvic floor exercises, no sharp bicycle saddles and no beer, meat, fat and sugar.
Treatment of complications
If there is massive obstruction of the urine flow in connection with the disease, a prostatectomy can be helpful, as the residual urine always carries a high risk of urinary tract infection.
If inflammation secretes pus in the prostate (abscess), it should be emptied with an incision. The access route is usually the rectum.