Prostatitis in men is an inflammation of the male prostate. It is a relatively common condition in men accompanied by pain during bladder emptying (urination) and ejaculation. Doctors distinguish between acute and chronic prostatitis. Treatment and prognosis depend on the form and causes of prostate inflammation. Read all about prostatitis here.
Prostatitis (inflammation of the prostate) is an 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 part of the urethra and extends to the so-called pelvic floor, which consists of a muscular system.The prostate produces a secretion that includes PSA (prostate-specific antigen) and spermine. 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 (urination) 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 lifetime. The chance of prostate infection increases with age. Research shows that most cases are between 40 and 50 years old.
At the same time, an expanded understanding of the term prostatitis appeared in medicine. In the so-called prostatitis syndrome, there are several complaints in the pelvic area of a person, which usually have an unknown cause. The term "prostatitis syndrome" summarizes several clinical pictures:
- Acute bacterial prostatitis
- Chronic bacterial prostatitis Inflammatory and non-inflammatory chronic pelvic pain syndrome ("Bacterial 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 spread by a bacterial infection of the bladder or urethra to the prostate. Acute prostatitis is usually a serious 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 from acute: if inflammation of the prostate gland and recurrent germs in the urine, the so-called expressive prostate (obtained by massaging the prostate fluid) or in ejaculation, is observed for more than three months, then this is chronic inflammation. bacterial prostatitis. It is less rapid 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 in acute prostatitis.
Chronic pelvic pain syndrome (bacterial 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 present (non-inflammatory chronic pelvic pain syndrome). In general, chronic pelvic pain syndrome (bacterial prostatitis) is the most common form of prostatitis.
In most cases of prostate infection, the bacteria cannot be detected in the urine, prostate or ejaculate as the cause of the disease. The cause of prostatitis remains unclear. Doctors call this chronic pelvic pain syndrome (chronic bacterial 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 by chance, for example, in 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 it is usually slightly milder. Not all affected people have all of these symptoms and the severity of the symptoms may 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 urination. Urination causes burning pain (aluria) and urine flow is significantly reduced (dysuria) due to prostate swelling. Because victims can only excrete small amounts of urine, they have a constant frequency of urination 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 pressure in the perineum or lower abdomen, dark ejaculation due to blood in the semen or blood in the urine (hematuria) are typical of chronic inflammation of the prostate. Disorders of sexual drive and power 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) are no different.
How to identify?
The onset of prostatitis is seldom categorically recognized, as it is sometimes asymptomatic and its symptoms are individual to each patient and change over time.
These functions include:
- A man has little difficulty urinating in the toilet. The gland gradually expands, the urinary tract contracts.
- The patient loses interest in sex. Difficulties in stimulating the penis increase when you try to have sex. Orgasm is achieved with difficulty, or weak, or disappears completely.
- Burning in the urethra, itching in the perineum.
- I often want to urinate, but I drop it.
- Sperm come out quickly during intercourse with minimal pleasure.
- General fatigue, depression, irritability, aggression, increased stress.
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, not related to sex.
Observing these phenomena, the patient calms down, believing that he is well with the power, the problems, in his opinion, are related to the partner, their relationship. Overcome depression, which worsens the development of the disease.
Statistical incidentsProstatitis is one of the most common diseases of the male urinary 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. About a third of cases occur 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 the 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). A prostate abscess is a purulent inflammation of the prosthesis that usually needs to be opened and emptied with an incision. 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 several causes. The treatment and prognosis of inflammation depend on the cause of prostatitis.Bacterial prostatitis: causes
Only ten percent of prostatitis cases 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 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 chlamydia or Trichomonas infections and gonorrhea.
In chronic prostatitis, bacteria in the prostate gland have escaped from another obscure way of protecting the human immune system. This allows germs to constantly 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 reasonable, but all of them have not yet been clearly proven. In some cases, genetic material of previously unknown microorganisms was found in the small pelvis. Therefore, the cause of pelvic pain syndrome may be microorganisms that cannot yet be cultured in the laboratory and are therefore not detectable.
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 puts pressure on 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 nerves around the prostate causes pain that is mistakenly attributed to the prostate gland. x / p>
Finally, an overactive or faulty immune system can also cause chronic pelvic pain syndrome.
However, in many cases, the cause of chronic pelvic pain cannot be clearly established. Then doctors talk about idiopathic prostatitis.
Anatomical reasonsIn rare cases, prostatitis is caused by a narrowing of the urinary tract. If the urinary tract shrinks, urine accumulates and if it enters the prostate, it can also cause inflammation. This stenosis 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.
Recently, more and more psychological causes of prostatitis have been discussed. In particular, in non-inflammatory chronic pelvic pain syndrome, a mental trigger is possible. The exact mechanisms remain unknown.
Risk factors for prostatitis
Some men are at particular risk for 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: high blood sugar in diabetics often leads to high blood sugar. Plenty of 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.
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. In addition, as with any foreign body, bacteria can settle in the bladder and form the so-called biofilm. As a result, bacteria can travel to the urethra in the bladder and lead to prostate infections.
Prostatitis: examinations and diagnostics
In case of prostate problems, the family doctor or urologist is the right contact person. The GP can get a medical history (history), but if prostatitis is suspected, they will refer you to a urologist. This performs a physical examination. If prostatitis is suspected, this is usually called digital rectal examination. However, this study does not provide clear evidence of prostate inflammation, but only confirms the suspicion. Laboratory tests can be done to detect bacterial prostatitis. If no specific cause is found, treatment is also given in cases of reasonable suspicion of prostatitis.
Typical questions when recording a medical history (memory) may 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
Because the prostate is right next to the rectum, it can be felt along the rectum. This digital rectal examination is performed in outpatients without anesthesia and is usually painless. The patient is asked to lie down with the legs bent. Using a lubricant, the doctor slowly inserts a finger into the anus and scans the prostate and surrounding organs (palpation). Examines the size and sensitivity of the prostate gland pain: the inflammation of the prostate gland is greatly enlarged and is very sensitive to pain.
Urination is in most cases to identify possible pathogens. The standard method is the so-called four-glass sample. Here Ersturin, Mittelstrahlurin, Prostataexprimat and Urin are controlled after prostate massage. As Prostateexprimat is called, doctors call it prostate secretion. This is achieved by the doctor by gently applying pressure to the prostate, such as palpation. Ejaculation can also be checked for pathogens and signs of inflammation.
Further researchAn ultrasound scan of the rectum (ultrasound) 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). Blood flow measurement (uroflowmetry) is performed to rule out that the existing urinary drainage problem is caused by 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 chance of urethral obstruction.
Prostatitis: PSA measurementElevated blood PSA levels (specific for prostate antigen) are generally considered a marker of prostate cancer. However, even with prostatitis, the level of PSA in the blood can increase significantly. If the reading is significantly increased, tissue sampling (biopsy) is usually performed and tested 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 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 according to the doctor's instructions. This prevents recurrence and reduces the chance of recurrence (relapse).
Asymptomatic prostatitis can also be treated with antibiotics.
If there is chronic bacterial prostatitis (chronic pelvic pain syndrome), antibiotic treatment is usually ineffective. In chronic pelvic inflammatory pain syndrome, although there is no evidence of a pathogen, antibiotics are tested because sometimes improvement can occur. However, antibiotic therapy is not recommended for non-inflammatory chronic pelvic pain syndrome.Other therapeutic approaches for chronic bacterial prostatitis are the so-called 5α-reductase inhibitors and herbal medicines (herbal medicines). If no improvement is achieved, medication will be supplemented with physiotherapy. Recommends physiotherapy, 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 treatment can help relieve acute symptoms of prostate infection. Analgesics can be prescribed for severe pain. Also, heating pads and heating pads on the back or lower abdomen can help relax your muscles. It often relieves pain from inflammation of the prostate.
Home remedies such as rye treatment 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, a huge obstruction of the outflow of urine occurs, prostatectomy may be useful, as urine residues always carry a high risk of urinary tract infection.
If the inflammation secretes pus into the prostate (abscess), it should be emptied with an incision. The access path is usually straight.