Prostatitis in men is an inflammation of the male prostate gland. This is a relatively common condition in men, which is accompanied by pain when emptying the bladder (urination) and ejaculation. 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: 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 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 muscles.
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 frequency of urination, 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 about 15 percent of all men in Germany develop prostatitis once in a lifetime. The likelihood of prostate infection increases with age. Studies show that most cases are between the ages of 40 and 50.
Prostatitis syndrome
At the same time, an expanded understanding of the term prostatitis has emerged in medicine. The so-called prostatitis syndrome summarizes several complaints in the pelvic area of a person, which usually have an unknown cause. The term "prostatitis syndrome" summarizes various clinical pictures:
- Acute bacterial prostatitis
- Chronic bacterial prostatitis
- Inflammatory and non-inflammatory chronic pelvic pain syndrome ("Abacterial chronic prostatitis")
- Asymptomatic prostatitis
Acute and chronic bacterial prostatitis
Acute prostatitis is caused by bacteria (acute bacterial prostatitis). Bacteria either travel through the bloodstream to the prostate or are spread by a bacterial infection of the bladder or urethra in 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 there is inflammation of the prostate gland and recurrent microbes in the urine, the so-called prostate express (obtained by massaging the prostate fluid) or in the ejaculate, more than three months, then it ischronic inflammation. bacterial prostatitis. It is less rapid than acute prostatitis. Although chronic inflammation of the prostate gland causes pain when urinating and possibly a feeling of pressure in the perineal area, the symptoms are usually not as severe as in acute prostatitis.
Chronic pelvic pain syndrome (bacterial prostatitis)
However, in such cases, white blood cells (leukocytes) can often be found as an expression of inflammation in the prostate gland (chronic pelvic pain syndrome). To differentiate, this is another form of the disease in which neither bacteria nor leukocytes are detected (non-inflammatory chronic pelvic pain syndrome). In general, chronic pelvic pain syndrome (acaterial prostatitis) is the most common form of prostatitis.
In most cases of prostate infection, bacteria cannot be found in the urine, prostate or ejaculate as the cause of the disease. The trigger for prostatitis remains unclear. Doctors call this syndrome chronic pelvic pain (chronic catarrhal 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 detected by chance, for example, as part of a fertility test.
Prostatitis: symptoms
Inflammation of the prostate can cause various 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 everyone affected necessarily has 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 gland around the urethra also causes typical symptoms of urination. Urination causes burning pain (alguria) and urine flow is significantly reduced (dysuria) due to swelling of the prostate. Because victims can only excrete small amounts of urine, they have a constant frequency of urination and should go to the toilet frequently (pollakisuria). Other symptoms of prostatitis include bladder pain, 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 (haematuria) are characteristic 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 bacterial prostatitis (chronic pelvic pain syndrome) do not differ.
How to recognize?
The onset of prostatitis is rarely recognized unambiguously, as it is sometimes asymptomatic, and its symptoms are individual to each patient and change over time.
These features include:
- A man has little difficulty passing urine in the toilet. The gland gradually expands, the urinary tract shrinks.
- The patient loses interest in sex. Difficulties with penile arousal increase when trying to have sex. Orgasm is difficult to achieve or is weak or disappears completely.
- Burning in the urethra, itching in the perineum.
- I often want to urinate, but I get it drop by drop.
- Sperm comes out quickly during intercourse with minimal pleasure.
- General fatigue, depression, irritability, aggression, increased anxiety.
In the morning a person feels overwhelmed, loses initiative in life.
At the same time, at night, sometimes prolonged erections and painful ejaculations occur spontaneously, not related to sex.
Observing these phenomena, the patient calms down, believing that he is well with potency, the problems, according to him, are related to the partner, their relationship. He was defeated by depression, which aggravated the development of the disease.
Morbidity statistics
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 years. 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 a prostate abscess (especially in acute bacterial prostatitis). Prostate abscess is a purulent inflammation of the inflammation that usually needs to be opened and emptied with an incision. As an additional 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 various causes. The treatment and prognosis of the inflammation depend on the cause of the prostatitis
Bacterial prostatitis: causes
Only ten percent of cases of prostatitis are caused by prostate bacteria (bacterial prostatitis). Bacteria can enter the prostate through the 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 gut, 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, the bacteria in the prostate gland have escaped in a still unclear way to protect the human immune system. This allows the 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 put forward many theories, each of which sounds plausible, but all of them have not yet been clearly proven. In some cases, genetic material from hitherto unknown microorganisms has been found in the pelvis. Therefore, the cause of pelvic pain syndrome may be microorganisms that cannot yet 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 drainage, the volume of the bladder increases, which thus compresses the prostate. Eventually, this pressure damages the prostate tissue, causing inflammation.
Another possible reason is that inflammation of the bladder tissue can spread to the prostate gland. It is also possible that irritation of the nerves around the prostate causes pain that is incorrectly attributed to the prostate gland.
Finally, it is also possible for an overactive or misdirected immune system to cause chronic pelvic pain syndrome.
However, in many cases the cause of chronic pelvic pain cannot be clearly proven. Then doctors talk about idiopathic prostatitis.
Anatomical reasons
In rare cases, prostatitis is caused by 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 pelvic floor muscle dysfunction may contribute to the development of prostatitis.
Mental causes
Recently, more and more psychological causes of prostatitis are being discussed. In particular, in the syndrome of non-inflammatory chronic pelvic pain is probably a mental trigger. The exact mechanisms are not yet known.
Risk factors for prostatitis
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 drugs, immunosuppressive therapy). In addition, major diseases such as diabetes can contribute to the development of prostatitis: high blood sugar in patients with diabetes often leads to high sugar in the urine. Abundant sugar in the urine can provide the bacteria with good growing conditions, which facilitates the development of urinary tract infections. In addition, the immune system is weakened in diabetes.
Another risk factor for developing prostatitis is a bladder catheter. Insertion of 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 diagnosis
In case of prostate problems, a family doctor or urologist is the appropriate contact person. The GP may take a medical history, but if prostatitis is suspected, he or she will refer you to a urologist. This makes a physical examination. If prostatitis is suspected, this is usually the so-called digital rectal examination. However, this study does not provide clear evidence of inflammation of the prostate, but only confirms the suspicion. Laboratory tests for bacterial prostatitis may be performed. If no specific cause is found, treatment is also carried out in cases of reasonable suspicion of prostatitis.
Case history
Typical questions when recording a medical history (history) may be:
- Do you have pain when urinating?
- Where exactly are you in pain?
- Does your back hurt?
- Have you noticed a change in ejaculation?
Digital rectal examination
Because the prostate gland is 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 with his legs bent. Using a lubricant, the doctor slowly inserts a finger into the anus and scans the prostate and surrounding organs (palpation). It examines the size and sensitivity to pain in the prostate gland: the inflamed prostate gland is greatly enlarged and very sensitive to pain.
Laboratory test
Urine analysis 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 achieved by the doctor by applying gentle pressure to the prostate, for example by palpation. Ejaculate can also be checked for pathogens and signs of inflammation.
Further research
An ultrasound scan of the rectum (sonography) can be used to determine 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 (urolometry) is performed to rule out that an existing urine drainage problem is caused by a narrowing of the urethra. The patient urinates in a special funnel that measures the amount of urine per unit 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 in the blood (prostate-specific antigen) are generally considered an indicator of prostate cancer. However, even with prostatitis, the level of PSA in the blood can be significantly increased. If the reading is significantly elevated, a tissue sample (biopsy) is usually performed and tested 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. In chronic prostatitis, the drug should be taken for a longer period of time (about four to six months). Even if the symptoms have subsided, antibiotics should still be continued as prescribed by your doctor. This prevents recurrence and reduces the likelihood of recurrence (relapse).
Asymptomatic prostatitis can also be treated with antibiotics.
If you have chronic bacterial prostatitis (chronic pelvic pain syndrome), antibiotic therapy is usually ineffective. In chronic pelvic inflammatory disease, although there is no evidence of the pathogen, antibiotic testing is done because improvement can sometimes be made. However, antibiotic therapy is not recommended for non-inflammatory chronic pelvic pain syndrome.
Other therapeutic approaches in chronic acaterial prostatitis are so-called 5α-reductase inhibitors and herbal medicines. If no improvement is achieved, drug therapy will be supplemented with physiotherapy. He 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 may help relieve the acute symptoms of a prostate infection. Painkillers may be prescribed for severe pain. Also, heating pads and warm-up pads on the back or lower abdomen can help you relax your muscles. Often relieves the pain of inflammation of the prostate.
Home remedies such as processing rye or eating pumpkin seeds with soft shells can also help with symptoms of prostatitis. Other tips include regular pelvic floor workouts, no sharp bike saddles and no beer, meat, fat or sugar.
Treatment of complications
If massive urinary obstruction occurs in the context of the disease, 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 the incision. The access route is usually the rectum.