Prostatitis is a general name used to describe inflammation of the prostate gland, as well as the clinical manifestations associated with prostate inflammation. This is a very common disease that affects men of all ages. Prostatitis is the most common urological disease in men under 50 years of age and the third most common in men over 50 years of age. There are different types of prostatitis:
- Acute bacterial prostatitis
- Chronic bacterial prostatitis
- Chronic non-bacterial 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. The 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, tremors, 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, mycoplasmas and fungi are also to blame. Chronic prostatitis usually 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 the anus)
- Frequent urination and urge to defecate
- Feeling of incomplete emptying of the bladder
- Difficulty urinating
- Burning when urinating
- Pain in the testicles and groin area
- Erectile disorders
- Dyspareunia (painful sexual intercourse)
- Premature or even painful ejaculation
- Frequent urination at night
- Psychological discomfort
Asymptomatic inflammatory prostatitis
This type of prostatitis is called asymptomatic because it does not present 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 complete clinical examination. Urine culture is necessary to identify the cause and determine the type of prostatitis. During the consultation, the doctor decides whether more specialized screening tests are needed, such as bladder ultrasound, prostate ultrasound, cystoscopy, MRI.
Acute bacterial prostatitis
Based on the patient's medical history and clinical examination, the doctor will determine whether the disease 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
The diagnosis is made 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 having a prostate massage.
Chronic non-bacterial prostatitis - chronic pelvic pain
The diagnosis of chronic nonbacterial prostatitis is made after excluding other types of prostatitis and if symptoms persist for more than 3 months. This 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, as the blood and ultrasound appear normal, and the urologist needs a lot of experience to make the diagnosis.
How is prostatitis treated?
The therapy recommended by your doctor depends on the type of prostatitis:
For acute bacterial prostatitis
Antibiotics, antipyretics and anti-inflammatory drugs are selected. Increased fluid intake is recommended and hospitalization is often required for administration of intravenous fluids and antibiotics.
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 being clarified. Such conditions are urolithiasis, benign prostatic hyperplasia with residual urine, and several diseases that affect the bladder nerves. The urologist will advise you on how to cure these diseases or how to prevent urinary tract infections.
For chronic non-bacterial prostatitis (synonym - chronic pelvic pain)
Until the cause is known, there is no single treatment for all cases. The disease often occurs with periods of exacerbation and remission, and the triggering factors are different for each patient. Therapy is usually long-term and combined 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 often combined to alleviate symptoms and improve quality of life. As with bacterial prostatitis, treatment includes antibiotics, anti-inflammatories, muscle relaxants, medications that improve urinary flow and regulate urinary frequency (α-blockers, anticholinergics), medications that improve erectile function, natural extracts/herbs , as well as antipsychotics in patients with chronic pain. Sometimes collaboration with a mental health psychiatrist may also be necessary.
What is the prognosis for prostatitis?
Acute bacterial prostatitis is completely curable with antibiotics taken over a short period of time (usually 3 weeks). Although relapses are common, chronic bacterial prostatitis responds well to antibiotics and the patient is symptom-free after antibiotic treatment. 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 aim of treatment is to improve the patient's quality of life. Asymptomatic inflammatory prostatitis is not clinically important and does not require treatment.