Symptoms of prostatitis
Medically Reviewed by Dr Sravya, MBBS, MS
Introduction
Inflammation of the prostate gland is called prostatitis. In men, the prostate gland is about the size of a walnut and is located below the bladder. The prostate and other sex glands generate the fluid for semen that protects, energizes, and delivers sperm as they travel to the female egg during and after ejaculation. Approximately 10% of men have symptoms of prostatitis, of which 60% of people sought medical help.
Men with these symptoms have infection, inflammation and pain. The prostate gland is a hormone dependent organ. The hormone testosterone governs the function and development of the prostate gland. This hormone is released by testicles into the bloodstream. As the testosterone enters the prostate gland, it contributes to the growth of the prostate. Without testosterone the prostate gland shrinks to a fraction of its normal size. Adult men of any age can get prostatitis.
Types of prostatitis and symptoms
- Acute Bacterial Prostatitis
- Chronic Bacterial Prostatitis
- Chronic Prostatitis
- Pelvic Pain Syndrome
- Asymptomatic Inflammatory Prostatitis
Acute bacterial prostatitis
Acute prostatitis occurs when bacteria are introduced into the prostate. These symptoms of prostatitis are drastic and occur instantly. Hence, men should seek immediate attention and medical care. In this type of bacterial prostatitis, infection occurs in the prostate gland with episodes of fever and chills, pain and burning while urinating, frequent urination with unpleasant odour, nocturia, urinary blockage and retention, blood in the urine/semen, nausea, vomiting, painful ejaculation, pain on defecation and heavy feeling behind the scrotum.
Chronic bacterial prostatitis
Symptoms of chronic prostatitis are similar to that of acute prostatitis and are not severe. Bacteria get trapped in the prostate gland and show recurrent episodes that are difficult to treat. The symptoms of prostatitis last for three months and are mild to moderate.
Chronic prostatitis / pelvic pain syndrome
This is the most common type, as the name implies this is noticed by chronic pain in the pelvis, perineum, and genitals.
Asymptomatic inflammatory prostatitis
This is an inflammation of the prostate with no symptoms. This condition is identified during the diagnosis of other conditions. It is not due to bacterial infection but might be due to stress, nerve irritation, other injuries, or previous urinary tract infections.
Causes and contributing factors of prostatitis
- Anatomical abnormalities within urogenital tract
- History of sexually transmitted diseases
- Sexual behaviors
- Gastrointestinal disturbances
- High stress level
- History of mechanical trauma
- Compromised immune system
- Dietary habits
- Excess sports- cycling, running, heavy weight lifting
- Excessive sexual activities
- Consumption of alcohol and caffeinated beverages
Risk factors
Common risk factors in the development of prostatitis includes catheter usage in a urinary tract infection, injured pelvis, HIV, infection of the reproductive system, prostate biopsy, nerve injuries and psychological stress.
Diagnosis
- Cystoscopy - doctor uses pencil sized lighted tube with camera or lens at the end, called cytoscope to view bladder and urethra
- Urine analysis - urine sample is tested for type of bacterial infection
- Urodynamic tests - a small catheter is introduced in to urethra to know about working of bladder with leaks or blockages
- Biopsy - small sample of suspicious tissue is removed to find out inflammations
- Semen analysis - positive semen culture is used to start antibiotics treatment
- Blood exam - used to measure amount of prostate specific antigen in the blood which is a protein produced by prostate
- Digital rectal exam - doctor inserts gloved, lubricated finger in to rectum to feel enlargement, tenderness or lumps
- Post prostatic massage - urine sample after prostate massage expels the prostate fluid for bacterial testing
Complications
- Bacteremia or bacterial infection in the blood
- Epididymitis or inflammation of coiled tube at the back of testicles
- Prostatic abscess or pus filled cavity in the prostate
- In chronic prostatitis - complications include semen abnormality and infertility
- Sexual dysfunction
Treatment
- Antibiotics to treat infection includes beta Lactams, cephalosporins, quinolones, macrolides, tetracycline, trimethoprim
- Alpha blockers used to treat urinary symptoms includes medications such as tamsulosin and alfuzosin, that relaxes muscles around the prostate and bladder to improve urine flow
- Non-steroidal anti-inflammatory agents - aspirin, ibuprofen, naproxen sodium are used to relieve pain. Drugs like gabapentin and amitriptyline are recommended to relieve neurogenic pain
- Psychological symptoms are mainly managed with antidepressants / anti-seizure agents
- Quercetin, a natural compound found in plants and bee pollen, are recommended to ease inflammation and swelling of the prostate gland.
- Other ways that assist are prostatic massage, acupuncture, drinking plenty of water to flush bacteria, warm sitz bath, lifestyle adjustments and surgery
Conclusion
Symptoms of prostatitis are common in men and are considered as the third most common urological disease in men. While there are different types of prostatitis chronic prostatitis / chronic pelvic pain syndrome is considered as the most challenging type as its nature and etiology are unknown.
It needs antimicrobial therapy if it is caused by infection, which is seen in minor cases. In these cases fluoroquinolones are considered as drugs of choice according to some clinical studies. Chronic prostatitis also accompanies significant impairment in quality of life and daily activities. A variety of treatments are involved to treat this prostatitis.
A meaningful conversation with a doctor is the first step to getting healthy. Finally, they come up with individual treatment plans.
Frequently Asked Questions
No, many years ago, it was said that prostatitis can lead to cancer of the prostate. But recent data shows there is no relation between prostatitis and prostate cancer.
The man must tell his sexual partner as it may affect their health.
Yes, many of them have the same symptoms of prostatitis like interstitial cystitis, urinary infections, spinal stenosis, gonorrhea, Chlamydia, and testicular infections.
Yes, there are many sexual problems. About 60 percent of men will have painful ejaculations, about 65 percent of men present premature ejaculation, and 15 – 45 percent of men say that they have erectile dysfunction.
Beyond first line agents, phytotherapy / herbal products, medication for neuropathic pain may be beneficial. Alternative therapies are usually preferred after referral to a urologist.