Inflammation of the prostate: symptoms & treatment for prostatitis

Most men would prefer not to have to think about having an organ like the prostate gland – as long as it works. But it is not enough that half of all men after the age of 60 have to reckon with complaints from an enlarged prostate; even at a younger age, the prostate gland can draw unpleasant attention to its existence.

Prostatitis Syndrome: definition of prostatitis

The chestnut-sized prostate is one of the internal sex organs in men. It contributes to sperm formation, the closure of the urinary bladder and seminal ducts and hormone metabolism. The disorders described below are summarized under the term prostatitis syndrome:

• Acute or chronic bacterial prostatitis: Like any other organ, the prostate can become inflamed, especially since it is directly connected to the urethra and, thus, to the outside world, through which germs can enter the body. Rarely, pathogens also migrate via the blood or lymphatic system. However, prostate inflammation caused by germs accounts for only 10% of all cases of prostatitis.
• Chronic nonbacterial prostatitis: The remaining 90% are disorders not caused by pathogens. Since pain is the main issue in these cases, it is also known as chronic pelvic pain syndrome (CPPS), which can be associated with or without signs of inflammation (abacterial inflammatory or non-inflammatory prostatitis). The term prostatopathy was also used in the past.
• Asymptomatic prostatitis: In this case, there is a detectable inflammation but no symptoms. It is diagnosed, for example, when looking for causes of infertility.

 

What causes prostate inflammation?

The underlying causes are as varied as the terms are complicated:

Acute or chronic bacterial prostatitis:  Although the body has several protective mechanisms, these can become less effective in some situations. These include narrowing of the urethra (e.g. due to scars), interventions such as cystoscopies or the insertion of a urinary catheter, but also diabetes or disorders of the immune system.

The pathogens are mainly Escherichia coli (which make up a large part of the stool bacteria) and other intestinal bacteria, and now and then Pseudomonas aeruginosa, a widespread soil and water germ that also resides in the intestines of many people and is particularly fond of a weakened immune system benefits. The various pathogens of sexually transmitted diseases, such as chlamydia, gonococci and mycoplasma, can also cause prostate infection. Tuberculosis bacteria are more likely to be washed up via the blood.

Chronic nonbacterial prostatitis: Although this form is prevalent, the exact causes are still unknown. Various triggers have been suspected in recent years, such as narrowing of the urethra with fluid backing up into the prostate, restricted release of prostate secretion (which then builds up), an autoimmune disease or even germs for which there are simply no detection methods. Functional disorders of the pelvic floor muscles and psychological influences are also discussed.

Recently, a chronic “interstitial cystitis” has been made responsible for the symptoms, an inflammation of the urinary bladder caused by a change in the permeability of the mucous membrane for harmful substances. Presumably, several factors have to come together to produce a chronic pain syndrome in the small pelvis.

Symptoms: How does prostate inflammation manifest itself?

All forms are more or less painful; there may be additional symptoms and complications:

• Acute prostate inflammation: Typical is a very painful urge to urinate and difficulty urination, pain in the perineal area and when having a bowel movement. In the beginning, there is often blood in the urine. Those affected usually have a high fever with chills and feel sick. As a complication, the infection can spread, and inflammation of the urinary bladder, epididymis, renal pelvis, abscesses and even life-threatening septic shock (colloquially known as blood poisoning ) can occur.
• Chronic prostate inflammation: We speak of chronic prostatitis – regardless of whether germs are the trigger or not – if the symptoms last longer than three months. Here, too, there are problems with urination and pulling, stabbing or even dull pain in the area of ​​the bladder, anus, perineum or pelvis, which can radiate to the back. However, the symptoms are usually less severe than in the acute clinical picture. Some patients also complain of erectile dysfunction and muscle or joint pain.

 

Inflammation of the prostate: how is the diagnosis made?

The doctor will often make the suspected diagnosis based on the symptoms described. When the rectum is palpated, the prostate often feels enlarged and is very painful, especially in the case of an acute infection.

The range of diagnostic possibilities includes the urine examination (before and after a prostate massage), the urethral swab, the search for signs of inflammation and germs in the blood, the ultrasound examination (e.g. also to exclude an abscess) and the X-ray examination using contrast media (urography). In the case of chronic pelvic pain syndrome, functional measurements of the bladder and its sphincters are also carried out (urodynamics).

Inflammation of the prostate: what therapy is there?

In the case of acute bacterial prostatitis, treatment with antibiotics is the main focus. These are initially injected into a vein or muscle, usually in the hospital, and then given as tablets (for four weeks). In addition, bed rest is necessary, and painkillers and antispasmodic substances are prescribed. If urinary retention occurs, i.e. the inability to empty the bladder, a bladder catheter must be placed temporarily through the abdominal wall. An abscess must be surgically opened.

Chronic prostatitis associated with persistent discomfort

In contrast to the acute form, chronic prostatitis is more difficult to treat, and the symptoms are often persistent. If pathogens are found, suitable antibiotics must be taken for several weeks (possibly up to a year), and in some cases, medication to relax the bladder muscles and improve the flow of urine (alpha-receptor blockers).

 

Removal of the prostate as part of treatment

If nothing helps, surgical removal of the prostate must be considered. In the case of the inflammatory, nonbacterial form, an attempt is also made with antibiotics (even if no pathogens are detectable), and anti-inflammatory agents are also given. Prostate massage three times a week or heat treatment with a microwave probe inserted through the urethra (TUMT = transurethral microwave-induced thermotherapy) is also considered helpful by some professionals.

Rye pollen extract (available as capsules at pharmacies) is effective in some studies; Medicinal plants such as pumpkin, saw palmetto, stinging nettle or bearberry may also alleviate the symptoms or prevent further inflammation.

In the non-inflammatory form, muscle-relaxing and pain-relieving drugs are particularly indicated, and psychological counselling is also recommended. If a cause for chronic prostatitis, such as a narrowing of the urethra, has been found, a particular surgical procedure can also help.

Prostatitis: home remedies & tips

Some general measures serve to prevent prostatitis and relieve the symptoms:

• Regular emptying of the bladder is essential to flush germs out, and regular emptying of the stool reduces the risk of intestinal bacteria migrating and the pressure on the prostate.
• Hypothermia should be avoided – so wear warm underwear and change your wet swimming trunks as soon as possible.
• Heat promotes blood circulation: regular warm sitz baths are recommended.
• In all chronic forms, neither physical protection nor sexual abstinence is necessary. On the contrary, regular ejaculation flushes germs to the outside; light jogging promotes relaxation of the pelvic floor muscles.
• Regular drinking of kidney and bladder tea has an anti-inflammatory and germ-inhibiting effect. The doctor should treat Urinary tract infections early to prevent the spread of germs.
• Muscle relaxation exercises and autogenic training alleviate the symptoms in some sufferers.