Prostatitis: definition, symptoms, causes and treatment

By Cristiano Antonino On Jun 8, 2023

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Among the most common typically male problems there is certainly prostatitis, an inflammatory disease of the prostate that mainly affects men under the age of fifty

What is prostatitis

There are four types of prostatitis:

Acute bacterial prostatitis
Chronic bacterial prostatitis
Chronic abacterial prostatitis (chronic pelvic pain syndrome), which is distinguished in two forms, inflammatory non-inflammatory, based on the presence of leukocytes in prostatic secretions
Asymptomatic inflammatory prostatitis.

We speak of chronic prostatitis when the symptoms have persisted for at least three months.

The bacterial forms represent about 5-15% of prostatitis.

The prostate

The prostate is a chestnut-sized exocrine gland of the male genitourinary tract located below the bladder and anterior to the rectum.

It contributes to the production of seminal fluid as it secretes prostatic fluid.

The prostatic fluid represents about 20-40% of the ejaculate and has several tasks:

create a sperm-friendly environment
keep the sperm flowing
reduce the acidity of vaginal secretions by improving, at this level, the survival and motility of sperm

Causes of prostate inflammation

There can be many causes that determine the appearance of prostatitis: bacterial infections (in 5-15% of cases), pathologies affecting the gastrointestinal system, procedures involving the urogenital system, incorrect lifestyle, sexual habits incorrect, pathologies of the urethral canal, ejaculation disorders, urination disorders, pathologies affecting the immune system, stress.

Bacterial infections that cause prostatitis

In the abacterial forms it is often not possible to determine the cause of the inflammation of the prostate.

In the bacterial forms (acute or chronic) the inflammation is due to a contamination of the prostate by pathogenic bacteria.

Bacteria can reach the prostate and cause an infectious-inflammatory process in several ways.

Ascending contamination: at urethral departure. Bacterial contamination initially affects the urethra. The bacteria can then rise up to affect the prostate as well. It can occur, for example, due to poor hygiene, unprotected sexual intercourse, often anal;
Descending contamination: germs present in the urinary tract due to a urinary tract infection (UTI), can reach the prostate and infect it;
Direct way: since the prostate is in close contact with the rectum, in the case of disorders of the gastro-intestinal system, bacteria can pass directly from the intestine via lymphatic means;
Blood way

Among the bacterial forms, the most commonly involved microorganisms are:

gram-negative bacteria: among these the most common is Escherichia Coli. Common is the finding of other pathogens such as Proteus Mirabilis, Klebsiella and Pseudomonas Aeruginosa
Gram-positive bacteria: the detection of Gram-positive pathogens such as Enterococcus faecalis has increased in recent years
intracellular atypical germs: infections caused by Chlamydia trachomatis or Ureaplasma Urealyticum can be at the origin of prostatitis

Symptoms of prostatitis

There are several symptoms with which prostatitis manifests itself, although the most frequent, obviously, is a pain that radiates in the area between the scrotum and the anus, often also involving the lumbar region, the penis and the testicles.

Among the most common symptoms, in addition to pelvic pain, we have:

burning on urination
dysuria (painful urination, which is difficult)
high fever
premature ejaculation
incontinence
infertility
impotence

These are symptoms that most often affect urination and sexual life.

Urinating can become annoying due to the burning sensation, the impossibility of holding back or even the difficulty in emptying oneself.

Likewise, problems with erection and ejaculation can be encountered, which can also be made painful.

These symptoms are generally common to all prostatitis, although in the case of acute bacterial prostatitis chills and muscle pains in various areas of the body can be added, as well as the presence of blood in the urine.

There may also be pus, i.e. an abscess, in the prostate, or inflammation of the epididymis (a small tube that connects the efferent ducts to the vas deferens of the testicles).

When faced with abacterial prostatitis, on the other hand, it is possible that there are no common symptoms such as pain or particular discomfort, but signs of inflammation or infection can be detected in the semen or prostatic secretions.

Risk factors

There are some factors that can lead to developing prostatitis more easily, making the attack of bacteria more dangerous or causing inflammation that does not have a bacterial origin.

Some risk factors are directly related to lifestyle, such as:

the young age (less than 40 years)
risky sexual relationships and promiscuity
prolonged sexual abstinence
excessive consumption of alcohol
smoke
trauma to the pelvic area
sedentary lifestyle

Other factors are instead to be attributed to health reasons, such as:

bladder catheterization for problems of a voiding nature or following surgery
presence of a urinary tract infection
diabetes mellitus
immunosuppression
trauma to the pelvic area
prostate biopsy, transurethral cystoscopy and operations on the genitourinary system
gastrointestinal disorders, such as constipation, diarrhea, irritable colon, haemorrhoidal disease

Prostatitis diagnosis

To diagnose prostatitis, the specialist starts with a medical history.

It collects precise information on the patient’s clinical history, not only those relating to the problem for which the doctor is consulted, but also those relating to any other pathologies, previous operations or drug therapies in progress.

He then collects information on the family history, to evaluate any genetic and hereditary problems.

Information on the patient’s lifestyle is also useful: smoking, consumption of alcohol, drugs, work, sedentary lifestyle and physical activity.

We then move on to the objective examination with particular reference to the prostate and to the inspection and palpation of the genitals.

The prostate exam

By inserting a finger into the patient’s rectum, the urologist will be able to evaluate the shape, size and consistency of the prostate, any pain on prostate palpation and any suspicious areas for malignant neoplasms.

Sometimes in the patient with prostatitis there is the leakage of secretions from the penis during rectal exploration.

Microbiological tests

In the field of bacterial forms, the diagnosis is made with culture tests.

They are useful primarily because they allow you to distinguish a bacterial form from an abacterial one, but also because they give information on the type of microorganism responsible for the symptoms in order to prescribe the most appropriate therapy.

The tests most commonly prescribed and used for the diagnosis of prostatitis are

Meares-Stamey test
urinalysis and urine culture
sperm culture
urethral swab

Sometimes, to fully understand the patient’s symptoms, further investigations such as an ultrasound of the urinary tract with a full bladder, a transrectal prostate ultrasound, an ultrasound of the scrotal contents or a uroflowmetry may also be useful.

The dosage of PSA in the course of prostatitis is not indicated.

How is prostate inflammation treated?

The treatment of prostatitis varies according to the origin that triggered it, and therefore to whether it is a bacterial infection or not.

When prostatitis is caused by bacteria, antibiotics are used.

In acute bacterial prostatitis, a one-month treatment is usually chosen that is able to penetrate the prostate tissue.

It is important to complete the cycle of drugs in order not to risk making the infection chronic.

Very rarely this type of treatment requires intravenous administration, and therefore hospitalization.

In the case of abacterial prostatitis it is more difficult to completely resolve the disorder, as the treatments relieve the symptoms without ever making them disappear completely.

There are pharmacological and non-pharmacological remedies to improve the symptoms of prostate inflammation.

Among the remedies that do not involve taking medicines we find:

prostate massage, performed on a regular basis by the doctor by inserting a finger into the rectum
hot genital baths
relaxation techniques, in particular biofeedback, used to relieve pain of various kinds

Changes in diet and increased fluid intake may also improve the situation.

Prostatitis is an inflammation of the prostate gland which in most cases arises from a bacterial infection.

Other times it is inflammation resulting from external factors, but in any case it can be disabling and compromise daily life and sex life.

For this reason, it is necessary to consult a urologist if you experience pelvic pain, difficulty urinating or other discomfort associated with the urinary tract.

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