Prostatitis in men is an inflammation of the male prostate gland. It is a relatively common condition in men that is associated with 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 about the size of a chestnut. It surrounds the first part of the urethra and lies on the so-called pelvic floor, which is made up of musculature.
The prostate produces a secretion that includes PSA (prostate specific antigen) and sperm. PSA makes pouring 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 during urination (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 prostate once in a lifetime. The chance of prostate contracting increases with age. Research shows that most cases are between the ages of 40 and 50.
Prostatitis Syndrome
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 a person's pelvic area, which usually have an unknown cause. The term "prostatitis syndrome" encompasses various clinical pictures:
- acute bacterial prostatitis
- Chronic bacterial prostatitis
- Inflammatory and non-inflammatory syndrome of chronic pelvic pain ("Chronic abacterial 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 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 from acute: if inflammation of the prostate gland and recurrent microbes in the urine, the so-called prostate expression (obtained by massaging the prostate fluid) or in the ejaculate, is observed for more than three months, then this is chronic inflammation. bacterial prostatitis. Less is less lightning than acute prostatitis. Although chronic inflammation of the prostate gland causes pain when urinating and possibly a feeling of pressure in the perineal region, the symptoms are usually not as severe as in acute prostatitis.Chronic pelvic pain syndrome (abacterial prostatitis)
In most cases of prostate infection, bacteria cannot be detected in the urine, prostate or ejaculate as the cause of the disease. The stimulus for prostate 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 gland (chronic pelvic pain syndrome). To distinguish it is another form of the disease in which neither bacteria nor leukocytes are found (chronic chronic non-inflammatory 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. 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 various symptoms of prostatitis. Although the symptoms of acute prostatitis can be very severe and cause severe discomfort, with chronic prostatitis they are usually a little milder. Not every affected person 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 surrounding the urethra also causes typical urinary symptoms. Urination causes burning pain (algae) and urine flow is significantly reduced (dysuria) due to prostate swelling. Because victims can only secrete small amounts of urine, they have a constant urinary frequency and have to go to the toilet (Poland) often. 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 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 power 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 change.How to recognize it?
The onset of prostatitis is rarely recognized unequivocally, as it is sometimes asymptomatic, and its symptoms are individual to each patient and vary over time.
These features include:
- A man has little difficulty passing urine into the toilet. The gland gradually enlarges, the urinary tract contracts.
- The patient loses interest in sex. Difficulties with penile arousal increase when you try to have sexual intercourse. 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 get it falling.
- Sperm comes out quickly during intercourse with minimal pleasure.
- General fatigue, depression, nervousness, aggression, increased anxiety.
In the morning, a person feels overwhelmed, loses initiative in life.
At the same time, at night, sometimes prolonged ejaculation and painful ejaculation occur spontaneously, not accompanied by sex.
By observing these phenomena, the patient calms down, believing that he is well with the potential, the problems, according to him, are related to the partner, their relationship. He is overcome by depression, which exacerbates the development of the disease.
Incidence statistics
Prostatitis is one of the most prevalent 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 a 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 prostate abscess (especially in acute bacterial prostatitis). A prostate abscess is a purulent inflammation of the inflammation that usually needs to be opened and emptied with an incision.
As a further 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 different 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 bacteria from the prostate (bacterial prostatitis). Bacteria can enter the prostate through the blood (hematogenous) or 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 prostate. 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 gland have escaped a still unclear way of protecting the human immune system. This allows germs to constantly colonize the prostate. 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 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, the genetic material of previously unknown microorganisms has been found in the small pelvis. Therefore, the cause of pelvic pain syndrome may be microorganisms that can not yet be cultured in the laboratory and, consequently, are 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 thus presses 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 gland.
It is also possible that nerve irritation around the prostate is causing pain that is incorrectly attributed to the prostate gland.
Finally, it is also possible that an overactive or misdirected immune system may be causing chronic pelvic pain syndrome.
However, in many cases, the cause of chronic pelvic pain cannot be clearly indicated. 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 reasons
Recently, more and more psychological causes of prostatitis have been discussed. In particular, in chronic non-inflammatory pain syndrome, a psychic trigger is likely. The exact mechanisms are still unknown.
Risk factors for prostatitis
Some men are particularly at risk of developing prostate infections. These include, for example, men with a compromised 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 patients with diabetes often leads to high urinary sugar. Abundant sugar in the urine can provide bacteria with good growth conditions, making it easier to develop urinary tract infections. In addition, the immune system is weakened in 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 any foreign body, bacteria can settle in the bladder and form a so-called biofilm. As a result, bacteria can travel up the urethra into the bladder and lead to prostate infections.
Prostatitis: examinations and diagnoses
In case of prostate problems, a family doctor or urologist is the right contact person. The GP can get a medical history (history), but if there is a suspicion of prostate, he will refer you to a urologist. This performs a physical examination. If prostatitis is suspected, this is usually a so-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.
Case history
Typical questions when recording a medical history (anamnesis) 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 gland 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 the legs bent. Using a lubricant, the doctor then 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 examination
Urinalysis is done in most cases to identify potential pathogens. The standard method is the so-called four-cup sample. Here Ersturin, Mittelstrahlurin, Prostataexprimat and Urin are tested after prostate massage. While it is called Prostateexprimat, doctors call it prostate secretion. This is accomplished by the doctor applying gentle pressure to the prostate, such as 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 identify exactly where the inflammation is and how widespread it is. An important goal of the study is also to rule out other diseases with similar symptoms (differential diagnosis).
Uroflowmetry 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 tube, 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: Measurement of PSA
Elevated blood levels of PSA (prostate specific antigen) are commonly considered an indicator of prostate cancer. However, even with prostatitis, the level of PSA in the blood can increase significantly. If the reading is significantly elevated, tissue sampling (biopsy) is usually performed and examined in a laboratory to 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 antibiotic dose 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 in any case should continue as prescribed by the doctor. This prevents relapse and reduces the chance of 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 inflammatory disease syndrome, although there is no evidence of pathogen, antibiotic testing is done because sometimes improvement can be made. However, antibiotic therapy is not recommended for chronic noninflammatory chronic pain syndrome.
Other therapeutic approaches for chronic bacterial prostatitis are the so-called 5α-reductase inhibitors and herbal remedies (herbal medicine). If no improvement is achieved, drug therapy will be supplemented with physiotherapy. Recommends physical therapy, pelvic floor exercises or regular prostate massage. Furthermore, microwave heat therapy can stimulate tissues to increase blood flow and reduce pain.Furthermore, symptomatic therapy can help relieve the acute symptoms of prostate infection. Pain relievers can be prescribed for severe pain. Also, heating pads and heating pads on your back or lower abdomen can help relax your muscles. Often relieves pain from inflammation of the prostate.
Home remedies, such as tassel processing or eating soft pumpkin seeds, can also help with prostatitis symptoms. Other tips include regular pelvic floor exercises, no sharp bike saddle and no beer, meat, fat and sugar.
Treatment of complications
If, in the context of the disease, massive mass flow of urine is impeded, 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 an incision. The route of entry is usually the rectum.