Prostatitis is what doctors call inflammation of the prostate. It belongs to the inner male genital organs. The prostate is about the size of a chestnut. It is located directly under the bladder and includes the urethra coming out of the bladder. The most important task of the prostate: It produces the milky liquid in which the sperm swim in the ejaculate.
With prostate inflammation, the tissue of the prostate swells and constricts the urethra. Therefore, urinary discomfort (micturition discomfort) or painful ejaculation are among the most common symptoms of prostatitis. The inflammation is usually caused by bacterial infections of the urogenital tract.
Physicians traditionally distinguish between acute and chronic prostatitis. Sometimes the term is also broader. Then we talk about prostatitis syndrome. In addition to acute prostatitis and chronic prostatitis, this clinical picture also includes chronic pelvic pain syndrome (inflammatory and non-inflammatory) and asymptomatic prostatitis. In chronic pelvic pain syndrome and asymptomatic prostatitis, no cause can often be identified.
The treatment of prostatitis is simple and reliable in most cases. As a rule, outpatient drug therapy with antibiotics is sufficient. But it also happens that advanced prostate inflammation has to be treated in hospital.
Symptoms of Different Prostate Infections
Inflammation of the prostate can lead to different symptoms, depending on the form.
Acute bacterial prostatitis
It often occurs suddenly and causes a strong feeling of illness. For example, patients then suffer from:
- high fever, possibly chills
- muscle pain
- cloudy urine
Urination causes problems, which can manifest itself as follows:
- Pain (dysuria)
- too common (pollakiuria)
- strong urge to urinate
- insufficient voiding
- incontinence
- Urinary retention (no more water can be left)
Pain can also occur:
- in the pool
- at the dam
- at the tip of the penis
- during bowel movements
Chronic bacterial prostatitis
It is usually less dramatic, often only one symptom occurs. The complaints have persisted for more than three months over the past six months. The patients report about
- urination problems, similar to cystitis (more common, painful)
- light fever
- pain in the lower abdomen
- pain in the penis and / or testicles
- painful ejaculation
- sometimes blood in the sperm
- erectile Dysfunction
Chronic Pelvic Pain Syndrome (CPPS)
One speaks of chronic pelvic pain syndrome, sometimes also called abacterial chronic prostatitis, if pelvic pain persisted for more than three months in the last six months. Symptoms similar to chronic bacterial prostatitis occur in both forms of CPPS, inflammatory and non-inflammatory.
Asymptomatic prostatitis
As the name suggests, it runs without symptoms. The patients are therefore symptom-free. Inflammatory cells are found in the sperm, which is often only noticed by chance in another examination.
Causes and Risk Factors
The causes of prostate inflammation also differ depending on the type of inflammation.
Acute bacterial prostatitis
As the name suggests, bacteria are the trigger for inflammation. Most of the cases are intestinal bacteria, such as Escherichia coli. The usual way is that these bacteria first infect the urinary tract and then spread to the prostate. There they lead to a defense reaction of the tissue (inflammation). Cells from the immune system (white blood cells, leukocytes) accumulate in the prostate in order to fight the invading pathogens. Both the bacteria themselves and the immune response damage the tissue.
Other germs that are often behind acute prostate inflammation include:
- Proteus species
- Klebsiella
- Enterococci
Seldom do bacteria enter the prostate through the blood (hematogenous spread). Or are triggered by an infection of the genitals with tuberculosis.
If the urinary tract is manipulated, this can be the cause of acute inflammation. Factors that favor acute prostate inflammation include:
- a sample of the prostate
- narrowed urinary tract
- recently inserted or very long catheter in the urethra
- HIV infection
There used to be the assumption that frequent cycling or riding, drinking too little, or abstinence led to acute prostatitis. Studies have now refuted this.
Chronic bacterial prostatitis
The causes of this form of inflammation are similar to those of acute prostatitis. The germs that cause them are often the same. However, atypical pathogens such as chlamydia can also be involved in chronic inflammation, these are often transmitted during sexual contact and rise to the prostate.
Risk factors to develop chronic inflammation of the prostate are:
- A previous acute prostatitis with insufficient antibiotics
- prostate stones
- Factors that also favor acute inflammation
Chronic pelvic pain syndrome
The CPPS is the most common form of prostatitis. In many cases of chronic inflammation of the prostate without bacterial involvement, the cause cannot be proven (idiopathic prostatitis). Rarely are psychological factors suspected as a background.
Examination and Diagnosis
In order to determine exactly what the prostate is and what the cause is, a few tests are required. Not all of them may always be used, or the order may change. Here is an overview.
Anamnese
In the first place is the patient consultation, in which the complaints and accompanying symptoms - such as fever and shaking forest - are discussed. In order to determine chronic prostatitis or chronic pelvic pain syndrome, a worldwide standardized questionnaire on the clinical picture of prostatitis is also used for Germany.
Laboratory diagnosis
Blood is often taken. Here one considers in particular the inflammation values and the so-called prostate specific antigen (PSA), which is increased in the case of inflammation. If there is also a fever, so-called blood cultures may be taken at the same time. In these, the blood can be examined for germs if there is a suspicion that the inflammation has already spread to the bloodstream.
A very important part of the examinations is the analysis of the urine in order to be able to distinguish whether a bacterial infection is the cause of the inflammation or not. To find out, a special urine extraction takes place: the so-called 4-glass sample. Here, the urine before and after a massage of the prostate is compared with the extraction of prostate secretion. A single examination of the ejaculate (sperm) is not sufficient, but may also take place in addition. If bacteria are found in the sample material, a bacterial culture is created. This decides which antibiotic is suitable for the treatment of prostate inflammation.
Physical examination
The prostate also needs to be examined directly. When scanning with a finger over the rectum, the size and nature of the prostate gland are of particular interest. If there is inflammation, the prostate is slightly swollen, and the examination can be painful in some cases.
Ultrasonic
The size of the prostate gland can be seen in particular in an ultrasound examination, which is often also performed from the anus. If there are foci of fusion (abscesses), they are usually visible on ultrasound.
Further investigation methods
With inflammation of the prostate, urine flow is reduced in half of the patients. If there is suspicion of this, a measurement of the urine flow can be carried out. The urologist measures the amount of urine excreted over time and the maximum urine flow. With an ultrasound examination of the abdominal wall, one can see whether urine remains after the bladder has been completely emptied, so-called residual urine.
If a urethral constriction is suspected, the urologist injects contrast medium into the urethra. During the subsequent X-ray examination (urethrography), he can recognize the course and width of the urethra.
What is the Therapy for Prostatitis?
The treatment of prostate inflammation depends on the cause of the disease.
Acute bacterial inflammation
Antibiotics are effective in bacterial forms of prostatitis. In order to find the suitable active ingredient, a bacterial culture is first created. It can be used to check which pathogen it is and which antibiotic effectively combats the pathogen. If the inflammation is very pronounced, for example with a very high fever, or if the bacteria are detectable in the blood, the treatment may need to be carried out in a hospital. Then the antibiotic therapy begins with the administration through a vein, because the antibiotic acts faster and more concentrated.
It is important to take the antibiotics for as long as prescribed. The recommendation is currently at least four weeks of therapy. This seems very long, but is necessary to prevent chronic bacterial inflammation.
If there is urine retention, meaning that urine can no longer be left due to the swollen prostate, in this emergency situation a urine catheter must often be placed through the abdominal wall. This is temporary. Find pus - abscesses - you can wait a week in the prostate to see if they regress under antibiotic therapy. If this is not the case, there are options for puncturing or opening them in a minimally invasive manner.
Chronic bacterial inflammation
If there is chronic inflammation of the prostate, it must be clear whether it is caused by bacteria or not. In the case of bacteria, it should be evaluated exactly which antibiotic helps.
Chronic Pelvic Pain Syndrome (CPPS)
In chronic pelvic pain syndrome, it is important to accurately understand the patient's individual problems. The symptoms are varied and the treatment should therefore be tailored to the different main symptoms. Medicines for pain and inflammation and for easier urination are used. Warm clothing and warm hip baths are recommended to relieve pain caused by tension. Relaxation methods can also have a beneficial effect on pain. In almost half of the cases, pelvic pain syndrome is associated with depressive moods. In this case, psychotherapeutic support can be helpful. Sexual problems too, like
- erectile dysfunction
- Ejaculation pain
- or premature ejaculation
should be addressed and treated if necessary.
Operative procedures
Pus abscesses are opened surgically and aspirated. This intervention is sometimes done on an outpatient basis.
In the case of strong anatomical changes that are associated with severe bladder emptying disorders, the last treatment option remains the removal of the prostate (prostateectomy). Because of the far-reaching consequences, this serious intervention is only chosen if all other options have actually been exhausted.
Forecast
The healing prospects are very good, especially in acute bacterial prostate inflammation. The earlier the antibiotic treatment starts and the more consistently it is maintained, the better the chances are.
Chronic forms of prostatitis have a significantly poorer prognosis. Here it takes months or even years for the inflammation to finally resolve.
In addition, there is a very high risk of relapse in all forms of prostate inflammation. About a quarter of all men experience at least a second episode. Prostate inflammation returns four times or more in a good fifth.
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