Overview: What is prostatitis
The prostate, i.e. the prostate gland in men, can become inflamed. Up to 15 percent of men develop prostate inflammation at least once in their lives, experts refer to this as prostatitis. The risk of this disease increases significantly from the age of 40.
Prostatitis is medically divided into two forms:
- If bacteria are the cause of the prostate inflammation, this is referred to as bacterial prostatitis. A distinction can also be made between an acute bacterial and a chronic bacterial form. Chronic bacterial prostatitis means that the disease has been present for more than three months.
- If bacteria do not play a role as a trigger, it is abacterial prostatitis. This is usually chronic pelvic pain syndrome (chronic pelvic floor pain syndrome, CPPS for short). The symptoms last for at least three months, as with chronic bacterial prostatitis, but with no evidence of bacteria in the urine and prostate cultures. However, inflammatory markers can be detected in some of those affected. Medically, this is referred to as inflammatory CPPS. If there are no signs of inflammation, it is a non-inflammatory CPPS. Asymptomatic prostatitis is known as the third form of abacterial prostatitis: Inflammation can be detected, but there are no symptoms. This is usually an incidental finding as part of a screening examination.
The prostate is one of the internal male sex organs and is a chestnut-sized gland that lies below the bladder and surrounds the urethra. The function of the prostate is to produce fluid, which the body adds to the sperm during ejaculation. The milky secretion contains various components. Spermine, an ingredient, helps the seeds to move better. Both factors are important for fertility.
Prostatitis: causes and risk factors
The causes of prostatitis vary depending on which form it is.
Bacterial prostatitis
As the name suggests, bacterial prostatitis is caused by bacteria. The most common triggers are intestinal bacteria such as Escherichia coli. Klebsiella or enterococci can also cause the infection. Sometimes pathogens from sexually transmitted diseases such as chlamydia or gonococci (gonorrhea) also play a role.
The bacteria enter from the outside via the urethra. They usually infect the bladder first and then ascend to the prostate as part of this urinary tract infection.
Accordingly, the main risk factors for bacterial prostatitis are frequent urinary tract infections and unprotected anal intercourse, as this allows intestinal bacteria to enter the penis. However, operations in the urogenital area also increase the risk of prostatitis. Other risk factors:
- Bladder catheter
- Diabetes
- Immunodeficiency
Abacterial prostatitis
The causes of abacterial prostatitis, on the other hand, are largely unclear. So far there are only hypotheses about the triggers. Chronic pelvic pain in particular appears to be related to stress and therefore tension in the pelvic floor muscles. Bladder emptying disorders could also play a role, as well as nerve irritation. Inflammations caused by pathogens that are still unknown cannot be ruled out.
Symptoms of prostatitis
The signs of prostatitis can be very different. They largely depend on the type of inflammation.
Typical symptoms of acute bacterial prostatitis are
- Urge to urinate frequently, although the amount of urine is small
- Burning pain occurs when urinating
- The flow of water may be weakened because the prostate is swollen due to the inflammation and this narrows the urethra.
- Pain during bowel evacuation
- Pain in the abdomen, sometimes also in the lower back
- Nausea and vomiting
- Fever
Chronic bacterial prostatitis causes similar, but much milder symptoms. Some men with this form of prostatitis also notice pain during and after ejaculation.
Prostatitis: Diagnosis with us
After taking your medical history and asking about your symptoms, we will palpate the prostate. We check whether it is swollen and sensitive to pain. The prostate is very close to the rectum, so we can palpate it through the bowel. The patient lies comfortably on their side and the doctor inserts their finger a little into the bowel; with lubricant this causes no problems
Blood test for prostatitis
In addition, blood is taken to determine inflammatory parameters. The PSA value can be determined at the same time. This can be increased in the case of prostatitis.
Urinalysis
A urine test provides information on possible pathogens and the white blood cell count – this is elevated in the case of inflammation.
A urine sample can be used to detect acute bacterial prostatitis, but not chronic bacterial prostatitis. The so-called 4-glass test is important here, as it reveals which pathogens occur in which sections of the urinary tract. The patient therefore passes four portions of urine:
- The first portion is the initial urine; if this sample contains pathogens from the urethra, this is an indication of urethritis.
- The second portion concerns the midstream urine, which reflects the condition of the bladder and upper urinary tract.
- The third portion is prostate secretion, which we cause to be released by gently massaging the prostate via the rectum. The secretion provides information about inflammation of the prostate.
- The fourth portion contains initial urine again, now after the prostate massage, this sample is important for a more precise clarification of the health of the prostate gland.
If pathogens and signs of inflammation are found exclusively in the third and fourth samples, this indicates prostatitis. However, if no bacteria were found, but an increased number of white blood cells, it could be an abacterial prostatitis, such as chronic pelvic floor pain syndrome.
Prostatitis: prevention, early detection, prognosis
Two main measures are recommended to prevent prostatitis:
- If possible, use condoms during sexual intercourse; they prevent you from contracting a sexually transmitted disease that could, among other things, inflame the prostate.
- Avoid urinary tract infections, prevent them by avoiding cold feet and hypothermia of the abdomen, drink plenty of fluids. And if you get a bladder infection anyway: Take it seriously and let us clarify the symptoms quickly and treat them accordingly. Early treatment can prevent germs from ascending and infecting the prostate.
Lower abdominal pain and discomfort during erection and ejaculation are also alarm signs that require an appointment with us as soon as possible. Early detection is the prerequisite for successful therapy without relapse.
Course and prognosis
Overall, the chances of recovery from acute prostatitis are very good. With the appropriate medication, the symptoms usually subside on the second day.
Chronic bacterial prostatitis, on the other hand, takes much longer to treat, often more than six months. However, some sufferers continue to have recurrent episodes of the disease. It is therefore important to have abdominal and urinary tract infections clarified quickly; early treatment prevents them from becoming chronic.
Abacterial prostatitis such as pelvic floor pain syndrome also often require lengthy treatment. This means that the disease, like chronic bacterial prostatitis, can also be a major psychological burden for those affected.