Prostatitis is a general name used to describe inflammation of the prostate, as well as the clinical manifestations associated with inflammation of the prostate. It is a very common disease that affects men of all ages. Prostatitis is the most common urological disease in men under 50 and the third most common in men over 50. There are different types of prostatitis:
- Acute bacterial prostatitis
- Chronic bacterial prostatitis
- Chronic nonbacterial prostatitis
- Asymptomatic inflammatory prostatitis
What are the causes and symptoms of prostatitis?
The causes and symptoms vary depending on the type of prostatitis.
Acute bacterial prostatitis
Acute bacterial prostatitis is an infectious inflammation of the prostate caused by bacteria. The most common bacteria are E. coli, Klebsiella and Proteus. Microbes can be transmitted sexually, as well as through blood, urine, lymph, or as a complication after a prostate biopsy. In acute prostatitis, intense symptoms of infection are observed - fever, tremor, weakness, fatigue, frequent and painful urination or urinary retention.
Chronic prostatitis (bacterial and non-bacterial)
Chronic bacterial prostatitis is usually caused by the same bacteria that cause acute bacterial prostatitis. In rare cases, other microorganisms such as gonococci, chlamydia, mycoplasma and fungi are also involved. Chronic prostatitis often occurs as a complication of a chronic bladder infection.
The cause of chronic nonbacterial prostatitis is unclear. Symptoms are similar in both types and include:
- Feeling of tension or heaviness in the perineum (the area between the testicles and anus)
- Frequent urination and urge to defecate
- Sensation of incomplete emptying of the bladder
- Difficulty urinating
- Burning during urination
- Pain in the testicles and groin area
- Erectile problems
- Dyspareunia (painful sexual intercourse)
- Premature or even painful ejaculation
- Frequent urination at night
- Psychological discomfort
Asymptomatic inflammatory prostatitis
This type of prostatitis is said to be asymptomatic because it does not present any clinical manifestations. It is usually diagnosed incidentally, for example during a prostate biopsy for another reason unrelated to prostatitis. The cause of this prostatitis is not yet fully understood.
How is prostatitis diagnosed?
Diagnosis is based on the patient's medical history and a thorough clinical examination. A urine culture is necessary to identify the cause and determine the type of prostatitis. During the appointment, the doctor decides whether more specialized screening tests are necessary, such as an ultrasound of the bladder, prostate, cystoscopy, MRI.
Acute bacterial prostatitis
Based on the patient's medical history and physical examination, the doctor will determine whether it is acute prostatitis. A general blood test will confirm the diagnosis, and a urine test will determine the bacterial strain of the infectious agent.
Chronic bacterial prostatitis
Diagnosis is based on the patient's medical history and clinical examination. A urine test may not identify the bacteria that causes this specific type of prostatitis. Sometimes you need to take a urine test several times or take a urine test after performing prostate massage.
Chronic nonbacterial prostatitis – chronic pelvic pain
The diagnosis of chronic nonbacterial prostatitis is made after exclusion of other types of prostatitis and if symptoms persist for more than 3 months. It is a chronic disease that significantly affects the patient's quality of life. The main difficulty is that this type of prostatitis cannot be proven by laboratory tests, because blood and ultrasound appear normal and a urologist needs a lot of experience to make a diagnosis.
How is prostatitis treated?
The treatment recommended by your doctor depends on the type of prostatitis:
For acute bacterial prostatitis
Antibiotics, antipyretics and anti-inflammatories are selected. Increased fluid intake is recommended, and hospitalization for intravenous fluids and antibiotics is often necessary.
For chronic bacterial prostatitis
Antibiotic therapy is also indicated for this type of prostatitis. Treatment lasts 3 to 8 weeks to minimize the risk of relapse. At the same time, the causes of chronic urinary tract infections are clarified. These conditions are urolithiasis, benign prostatic hyperplasia with residual urine, and various diseases affecting the bladder nerves. The urologist will advise you on how to cure these diseases or prevent urinary tract infections.
For chronic nonbacterial prostatitis (synonym - chronic pelvic pain)
Until the cause is known, there is no single treatment that fits all cases. The disease often occurs with periods of exacerbation and remission, and the triggering factors are different for each patient. Treatment is usually long-term and associated with changes in the patient's lifestyle.
This complex disease requires the experience of a doctor who must individualize and adjust treatment methods depending on the situation. Treatments are usually combined to relieve symptoms and improve quality of life. As with bacterial prostatitis, treatment includes antibiotics, anti-inflammatories, muscle relaxants, drugs that improve urinary flow and regulate urinary frequency (α-blockers, anticholinergics), drugs that improve erectile function, natural/herbal extracts, as well as antipsychotics in chronic pain patients. Sometimes collaboration with a mental health psychiatrist may also be required.
What is the prognosis for prostatitis?
Acute bacterial prostatitis is completely curable by taking antibiotics for a short period of time (usually 3 weeks). Although relapses are common, chronic bacterial prostatitis responds well to antibiotics and the patient no longer has symptoms after treatment with antibiotics. Chronic bacterial prostatitis is a problem for both the patient and the doctor. Symptoms usually do not disappear completely; There are exacerbations and remissions. The goal of treatment is to improve the patient's quality of life. Asymptomatic inflammatory prostatitis is not clinically important and does not require treatment.