Prostatitis in men is an inflammation of the male prostate gland. This is a fairly common condition in men accompanied by pain when emptying the bladder (urinating) and ejaculation. Doctors distinguish between acute and chronic prostatitis. Therapy and prognosis depend on the form and cause 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 about the size of a chestnut. It surrounds the first part of the urethra and extends to the so-called pelvic floor, which is made up of muscles.
The prostate produces secretions that include PSA (prostate-specific antigen) and sperm. PSA makes ejaculation thinner. Sperm are important for sperm movement.
Prostatitis is mainly associated with severe pain in the perineum and anal area. In addition, symptoms such as frequent urination, pain during urination (urination) and pain during ejaculation occur during prostate inflammation.
Prostate is quite common with inflammation. It is estimated that about 15 percent of all men in Germany suffer from prostatitis once in a lifetime. The likelihood of prostate infection increases with age. Research shows that most cases are between 40 and 50 years old.
Prostatitis Syndrome
At the same time, a broad understanding of the term prostatitis emerged in medicine. In the so-called prostatitis syndrome, some complaints in a person’s pelvic area are summed up, which usually has an unknown cause. The term "prostatitis syndrome" encompasses various clinical pictures:
- Acute bacterial prostatitis
- Chronic bacterial prostatitis
- Inflammatory and non-inflammatory pelvic pain syndrome ("Abacterial chronic prostatitis")
- Prostatitis without symptoms
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 bacterial infections of the bladder or urethra to the prostate. Acute prostatitis is usually a severe general condition with severe pain during urination, fever, and chills. Prostate inflammation is caused by bacteria in about ten percent of cases.
Chronic prostatitis can develop from acute: if inflammation of the prostate gland and recurrent microbes in the urine, called prostate express (obtained by prostate fluid sequence) or in ejaculation, is 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 during urination and may be a feeling of pressure in the perineal area, the symptoms are usually not as severe as in acute prostatitis.
Chronic pelvic pain syndrome (abacterial prostatitis)
In most cases prostate infection, bacteria cannot be detected in urine, prostate or ejaculation as a cause of disease. The cause of prostatitis is still unclear. Doctors call this chronic pelvic pain syndrome (chronic abacterial prostatitis).
However, in such cases, white blood cells (leukocytes) are often found as an expression of inflammation in the prostate gland (chronic pelvic pain syndrome). To differentiate it, it is another form of disease in which bacteria or leukocytes are not found (chronic pelvic pain syndrome not inflammation). In general, chronic pelvic pain syndrome (abacterial prostatitis) is the most common form of prostatitis.
Symptomatic 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 found inadvertently, for example, as part of fertility studies.
Prostatitis: symptoms of
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 it is usually mild. Not all people affected 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 the patient has a fever and chills. Inflammation of the prostate gland surrounding the urethra also causes common urinary symptoms. Urination causes burning pain (alguria) and decreased urine flow (disuria) due to swelling of the prostate. Because victims can only urinate in small amounts, they have a regular frequency of urination and must go to the toilet (pollakisuria) frequently. 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 prostate inflammation. Symptoms such as fever and chills are usually absent. Symptoms such as emotional stress in the perineum or lower abdomen, ejaculatory darkness caused by blood in the semen or blood in the urine (hematuria) are characteristic of chronic prostate inflammation. Disorders of sexual drive and potential are also common chronic symptoms, often caused by pain during or after ejaculation. The symptoms of chronic bacterial and abacterial bacterial prostatitis (chronic pelvic pain syndrome) are not different.
How to recognize?
The onset of prostatitis is rarely clearly identified, as it is sometimes asymptomatic, and the symptoms are individual to each patient and change over time.
These features include:
- A man has some difficulty urinating in the toilet. The glands gradually enlarge, the urinary tract contracting.
- Patients lose interest in sex. Difficulty in raising the penis increases when trying to have sexual intercourse. Orgasm is achieved with difficulty, or weakness, or complete disappearance.
- Burning in the urethra, itching in the perineum.
- I often want to urinate, but I get it in stages.
- Semen comes out quickly during intercourse with a little 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 ejaculation occur spontaneously, unrelated to sex.
Observing this phenomenon, the patient is calm, believing that he is good with his potential, his problems, in his opinion, are related to the couple, their relationship. He was overcome with depression, which worsened the progression of the disease.
Incident statistics
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, 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 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 cause 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). Prostate abscess is a purulent 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 a variety of causes. Treatment and prognosis of inflammation depend on the cause of prostatitis.
Bacterial prostatitis: the cause of
Only ten percent of prostatitis cases are caused by bacteria from the prostate (bacterial prostatitis). Bacteria can enter the prostate through the blood (hematogen) or from nearby organs such as the bladder or urethra, where it 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 infections or Trichomonas, and gonorrhea.In chronic prostatitis, bacteria in the prostate gland have escaped unexplained ways to protect the human immune system. This allows microbes to colonize the prostate continuously. Antibiotics are relatively weak in prostate tissue, which may be another reason for bacteria to survive in the prostate.
Chronic Pelvic Pain Syndrome: Causes
The exact cause of chronic pelvic pain syndrome is 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 are still uncultivated in the laboratory and, therefore, undetectable.
Another possible cause of chronic pelvic pain syndrome is bladder emptying. Due to the violation of drainage, the number of bladder increases, thus pressing on the prostate. This pressure eventually damages the prostate tissue, causing inflammation.
Another possible cause is inflammation of the bladder tissue which can spread to the prostate gland.
Finally, there may be an overactive or misdiagnosed immune system causing chronic pelvic pain syndrome.
However, in many cases, the cause of chronic pelvic pain cannot be clearly identified. Then the doctor talked about idiopathic prostatitis.
Reason for anatomy
In rare cases, prostatitis is caused by narrowing of the urinary tract. If the urinary tract is narrow, urine accumulates and if it enters the prostate, it can also cause inflammation. This narrowing can be caused by a tumor or so-called prostate stone
Doctors also suspect that dysfunction of the pelvic floor muscles may contribute to the development of prostatitis.
Mental reason
Recently, more and more causes of psychological prostatitis have been discussed. In particular, in chronic non-inflammatory pelvic pain syndrome, psychiatric triggers may occur. The exact mechanism is still unknown.
Risk factors for prostatitis
Some men are at risk for prostate infection. This includes, for example, men with compromised immune systems or depressed immune systems (for example, with medications, immunosuppressive therapy). In addition, underlying diseases such as diabetes can contribute to the development of prostatitis: increased blood sugar in diabetics often leads to an increase in urine sugar. A lot of sugar in the urine can give bacteria a good growth condition, making urinary tract infections easier to develop. In addition, the immune system is weakened by 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 foreign objects, bacteria can settle in the bladder and form so-called biofilms. As a result, bacteria can flow into the urethra into the bladder and lead to prostate infections.
Prostatitis: examination and diagnostics
If there is a prostate problem, the family doctor or urologist is the right person to contact. A general practitioner may take a medical history (history), but if there is a suspicion of prostatitis, he or she will refer you to a urologist. This performs a physical examination. If prostatitis is suspected, this is usually called a digital rectal examination. However, this study does not provide clear evidence of prostate inflammation, but only confirms the suspicion. Laboratory tests can be performed to detect bacterial prostatitis. If no specific cause is found, treatment is also performed if there is a reasonable suspicion of prostatitis.
Case history
Common questions when writing a medical history (anamnesis) can be:- Do you experience pain while urinating?
- Where exactly do you feel sick?
- Is your back sore?
- Do you see ejaculation changes?
Digital rectal examination
Because the prostate gland is close to the rectum, it can throb along the rectum. These digital rectal examinations are performed outpatiently and without anesthesia, and are usually painless. The patient is asked to lie down 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 examined the size and sensitivity to pain in the prostate gland: the inflamed prostate gland is very large and very sensitive to pain.
Laboratory examination
Urinalysis is performed in most cases to identify possible pathogens. The standard method is what is called a four-glass sample. Here Ersturin, Mittelstrahlurin, Prostataexprimat and Urine are tested after prostate massage. As Prostateexprimat is called, doctors call prostate secretions. This can be achieved by the doctor by putting gentle pressure on the prostate, as with palpation. Ejaculation can also be checked for pathogens and signs of inflammation.
Further Research
Ultrasound scans of the rectum (sonography) can be used to determine exactly where the inflammation is and how far it has spread. The important goal of this study is to rule out other diseases with similar symptoms (differential diagnosis).
Urine flow measurement (uroflowmetry) is performed to rule out that the urinary incontinence problem is due to narrowing of the urethra. The patient urinates in a special funnel, which 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
Increased levels of blood PSA (prostate-specific antigen) are generally considered to be an indicator of prostate cancer. However, even with prostatitis, PSA levels in the blood can increase significantly. If the readings increase significantly, tissue sampling (biopsy) is usually performed and examined in the laboratory to rule out prostate cancer safely.
Prostatitis: Treatment
Like other diseases, the treatment of prostatitis and the duration of treatment depend on the cause.
Medicine
Acute bacterial prostatitis is treated with antibiotics. In mild cases, the dose of antibiotics 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 the symptoms have subsided, antibiotics should 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 syndrome, although there is no evidence of pathogens, antibiotic testing is performed because sometimes an improvement can be made. However, antibiotic therapy is not recommended for chronic non-inflammatory pelvic pain syndrome.
Another therapeutic approach to chronic abacterial prostatitis is the so-called 5α-reductase inhibitors and herbal remedies (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 the acute symptoms of prostate infection. Painkillers can be prescribed for severe pain. Also, heating pads and heating pads on the back or lower part of your stomach can help relax your muscles. Often relieves pain due to inflammation of the prostate.
Treatments at home such as processing rye or eating pumpkin seeds with soft skin can also help overcome the symptoms of prostatitis. Other tips include regular pelvic floor exercises, no sharp bicycle saddle and no beer, meat, fat and sugar.
Complications treatment
If, in the context of this disease, there is a large blockage of urine outflow, prostatectomy may be beneficial, as urinary waste is always at high risk of developing urinary tract infections.
If the inflammation removes pus in the prostate gland (abscess), it should be emptied with an incision. The access path is usually the rectum.