Overview

The prostate is a walnut-sized gland situated between the bladder and the penis and in front of the rectum. It surrounds the urethra and therefore any condition that causes it to swell can cause compression of the urethra, which can lead to lower urinary tract symptoms.

The main function of the prostate gland is to produce semen, which acts as a medium to transport the sperm from the male reproductive tract to the female egg in the fallopian tube.

Prostatitis is defined as microscopic inflammation of the prostate gland tissue. The prostate gland becomes swollen and tender.

It consists of a group of conditions, which includes acute and chronic bacterial prostatitis and chronic pelvic pain syndrome (CPPS).

The inflammation of the prostate can be acute or chronic, of bacterial or nonbacterial origin. The prostate gland swells and becomes painful. It is not cancerous and also differs from benign prostatic hyperplasia (BPH).

Prostatitis usually occurs along with urinary tract infection or infection of the other parts of the male reproductive system.

Its main symptom is painful urination or difficulty in passing urine. It also causes pain in the groin, pelvic area, and fever. Depending on the cause, the symptoms may onset suddenly or gradually.

It can improve on its own or may need antibiotics and anti-inflammatory drugs for recovery. Chronic prostatitis can last for months and may keep recurring.

How common is prostatitis?

Prostatitis can affect men of all ages. Half of all men suffer from prostatitis symptoms sometime in their life. It is the most common prostate condition in men under 50 years.

After 50, benign prostatic hyperplasia (BPH) becomes the leading prostate problem with prostatitis at the third position.

About two million American men visit their health care providers for symptoms of prostatitis every year.

In the United States, 8% of all the men who visit the urologist are diagnosed with prostatitis.

Acute bacterial prostatitis is primarily seen in young men who suffer from bacterial urinary tract infections (UTIs). Chronic bacterial prostatitis is relatively rare.

Inflammatory and non-inflammatory chronic prostatitis and CPPS account for the maximum number of prostatitis diagnosed – about 90%.

Some men with inflammatory prostatitis may not show symptoms in spite of having pus cells in their semen.

Types of prostatitis

In 1999, The National Institutes of Health (NIH) has defined a system to classify prostatitis:

  • Acute bacterial prostatitis is caused by a bacterial infection, has a sudden onset, and presents with fever, chills, malaise, painful urination (dysuria), and perineal pain. It is the least common type of prostatitis.
  • Chronic bacterial prostatitis is characterized by recurring bacterial infection of the prostate with symptomatic and asymptomatic episodes. Symptoms consist of relapsing urinary tract infections (UTIs), which may be episodic or unrelenting. Examination of the prostatic fluid typically shows positive bacterial cultures. Due to its chronic nature, it is difficult to treat it completely. It typically affects men 36 to 50 years of age.
  • Chronic prostatitis or chronic pelvic pain syndrome (CPPS) is the most common type of prostatitis and the least understood. It can be inflammatory or non-inflammatory, which depends on the presence of phagocytes in urine and semen. Patient alternates between being symptomatic and asymptomatic.
  • Asymptomatic inflammatory prostatitis. As the name suggests, men with this type of prostatitis do not have any symptoms. This prostatitis is detected accidentally when the man is being investigated for infertility or prostate cancer. Semen will show the presence of phagocytes.

Etiology

Causes of acute or chronic bacterial prostatitis

Prostatitis is closely associated with UTIs. There may be infection ascending through the urethra, reflux of urine into the prostate ducts, or by direct or lymphatic spread from the rectum.

It may also be associated with sexually transmitted diseases such as gonorrhea, Chlamydia, and HIV, the use of instruments such as catheters, following sclerotherapy for rectal relapse, and by spread through blood.

The pathogens responsible for acute bacterial prostatitis are mostly E. coli followed by Pseudomonas, Proteus, and Streptococcus faecalis.

Chronic bacterial prostatitis is usually due to recurring infections caused by E. coli.

Causes of chronic prostatitis or chronic pelvic pain syndrome

The exact cause of chronic prostatitis or chronic pelvic pain syndrome is not known. It is believed that it could possibly be due to chronic exposure to chemicals in the urine, or it could be the immune system’s response to a previous urinary tract infection or due to nerve damage in the pelvic area due to surgery or trauma.

Risk factors

The following are risk factors that can make you prone to acute bacterial prostatitis

  • History of recent improperly treated infection of the urinary bladder
  • Have developed benign prostatic hyperplasia
  • Have suffered from or are suffering from sexually transmitted diseases such as gonorrhea, Chlamydia, and HIV
  • History of frequent unprotected sex with multiple partners
  • Excessive consumption of alcohol
  • Trauma to lower pelvis or gonadal region due to cycling, horse riding, etc
  • Genitourinary infections such as acute epididymitis, orchitis, urethritis, and urinary tract infections
  • Long-term use of Foley’s or condom catheter
  • Transurethral surgery
  • Phimosis
  • Have undergone recent transrectal prostate needle biopsy
  • Have undergone procedures such as Cystoscopy
  • Presence of urethral stricture

Symptoms and signs

The symptoms and signs described below are generally seen with the different types of prostatitis. Not all the symptoms may be present.

  • Pain or burning sensation when passing urine (dysuria)
  • Difficulty in passing urine, such as dribbling
  • Increased frequency of urination, particularly at night (nocturia)
  • Urgent need to urinate
  • Cloudy appearance of urine
  • Presence of blood in the urine (Hematuria)
  • Pain in the abdomen, groin, or lower back
  • Pain in the perineal area between the scrotum and rectum
  • Pain or a feeling of discomfort in the penis or testicles
  • Painful ejaculation
  • Flu-like signs and symptoms such as high fever and chills (with bacterial prostatitis)

Let us take the symptoms with each type of prostatitis.

Symptoms of acute bacterial prostatitis

Acute bacterial prostatitis is a serious condition. You should not ignore the symptoms below and you should seek medical help immediately.

  • High fever with chills
  • The urgency to pass urine but you pass very little of it.
  • Difficulty in passing urine
  • Cloudy appearance of urine
  • Pain near the base of the penis or in the perineal area
  • On digital rectal examination (DRE), the prostate gland feels soft, tender, and swollen.

Symptoms of chronic bacterial prostatitis

This is a mild bacterial infection that can linger for months and is seen more in older men. Symptoms usually keep recurring. It may be a fallout of acute bacterial prostatitis or urinary tract infection.

  • Nighttime urinary urgency
  • Painful micturition
  • Painful ejaculation
  • Lower back pain
  • Rectal pain
  • A feeling of discomfort behind the scrotum
  • Blood in the semen

Symptoms of chronic prostatitis/chronic pelvic pain syndrome

This is the most common type of prostatitis and shares many symptoms of acute bacterial prostatitis. Urinary symptoms present intermittently with no systemic symptoms.

However, on examination, no bacteria are detected in urine, semen, or prostatic fluid

  • The main symptom is the presence of pain lasting for more than three months in the penis, or the scrotum, or perineum, or the lower abdomen.
  • Painful micturition
  • Painful ejaculation
  • A weak urinary stream in spite of full bladder
  • Frequency of urine
  • On DRE, the prostate feels firm and irregular because of fibrosis.

Symptoms of asymptomatic prostatitis

As the name suggests, this type of prostatitis produces no symptoms. It may be detected accidentally on blood examination of the prostate. There is no treatment but it can lead to infertility.

The next post describes the various diagnostic procedures and the treatment options adopted for both the acute and the chronic forms of prostatitis.

Complications

Prostatitis can lead to certain complications, which can be quite serious. Prompt treatment of this condition is therefore necessary.

Complications can include:

  • Bacterial infection of the blood (bacteremia)
  • Inflammation of the epididymis
  • Formation of a prostatic abscess
  • Semen abnormalities and infertility are seen particularly with chronic prostatitis

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