Prostatitis is a common condition that arises when the prostate is inflamed, usually because of a bacterial infection.
Prostatitis is a broad term encompassing various conditions that occur with inflammation of the prostate. Its symptoms include fever, pain to urinate, difficulty urinating, and pain in the pelvic region.
In this text we will address the different types of prostatites, addressing their causes, symptoms and treatment options.
The prostate is a walnut-sized gland (3 to 4 cm in diameter), approximately 20 grams in weight, present only in males. It is located at the base of the bladder and surrounds the initial part of the urethra, which channels urine from the bladder.
About 70% of ejaculated fluid during orgasm is produced by the prostate. This liquid is an alkaline secretion (with high pH) that mixes and protects the spermatozoa from the acid environment of the vagina, increasing its mobility and facilitating the arrival of the same to the ovum.
Because of their anatomical location, prostate diseases often cause symptoms associated with urine and bladder, such as pain when urinating and weakness of the urinary stream.
Prostatitis is not a single disease, but a group of four diseases that have similar symptoms related to inflammation of the prostate. Currently, the prostatitis is divided into four groups:
I- Acute Prostatitis
II- Chronic Bacterial Prostatitis
III- Chronic Non-Bacterial Prostatitis or Chronic Pelvic Pain Syndrome (Inflammatory IIIa / Non-Inflammatory IIIb)
IV- Asymptomatic Inflammatory Prostatitis
Category IIIb (chronic non-bacterial prostatitis / non-inflammatory chronic pelvic pain syndrome) was formerly called prostatodynia.
Let’s talk a little bit about each one.
I. ACUTE PROSTATITIS
Acute prostatitis is an inflammatory condition usually caused by a bacterial infection of the prostate. The most common bacteria are the ones that cause urinary tract infection, such as E. coli, Klebsiella, and Proteus. Contamination of the prostate is due to the invasion of the prostate by bacteria that are in the urethra or bladder, usually due to a previously contaminated urine.
Among the main risk factors for acute prostatitis we can mention:
– Urinary tract infection.
– Use of bladder catheter.
– Local traumas due to prolonged use of bicycles or riding.
– HIV infection.
– STI Urethritis.
Symptoms of Acute Prostatitis
Acute prostatitis can occur in both young men and in the elderly and its main symptoms include:
– Dysuria (pain when urinating).
– Difficulty in urinating.
– Pelvic pain.
– Blurred urine.
– Muscle and joint pain.
The symptoms of acute prostatitis can be very intense, often leading to hospitalization. Sepsis is a possible complication of this infection.
Diagnosis of acute prostatitis
The diagnosis is made through joint evaluation of clinical signs and rectal examination, which demonstrates a painful prostate on examination. As in urinary tract infection, it serves to identify the bacteria responsible for the infection. Simple urine test (SUT) usually contains urine and microscopic bleeding.
In blood tests, dosing may help because it is usually elevated during prostate inflammation. Markers of inflammatory activity such as CRP and HSV are also elevated and the blood count usually shows leukocytes.
Treatment of acute prostatitis
Acute prostatitis is cured and treatment is given with antibiotics for an average of four weeks. Because the bacteria that cause prostatitis are usually the same as those of urinary tract infection, antibiotics are also the same, with Bacterium and quinolones being the most commonly used. The antibiotics can be changed later according to the results of the uroculture, which usually take from 48 to 72 hours to be ready.
The symptoms usually begin to disappear with 48 hours of antibiotic therapy. After seven days of treatment the culture is already negative, no longer presenting bacteria in the urine.
For pain relief common painkillers and anti-inflammatory may be used if there are no contraindications.
II. CHRONIC BACTERIAL PROSTATITIS
Chronic bacterial prostatitis is a possible complication of acute inflammation that has not been properly treated.
The picture is much milder than in acute prostatitis and the symptoms may be subtle. Most of the time the complaints are restricted to dysuria (uncomfortable when urinating), will often urinate and malaise. The fever, when present, is usually low.
As you may have noticed, many of the symptoms of chronic prostatitis are similar to those of cystitis (bladder infection), which can cause some confusion in the diagnosis. It is important to know that in adult and/or young men, cystitis is an uncommon infection, and prostatitis should always be one of the diagnostic hypotheses in male patients with symptoms similar to those of a urinary tract infection.
The diagnosis of chronic prostatitis is also made through clinical history and rectal examination. In this case, during the rectal touch, it is possible to perform the massage of the prostate to stimulate the secretion of liquids for the laboratory analysis. Prostate massage should never be done on acute prostatitis because of the risk of stimulating the release of bacteria into the bloodstream. The uroculture collected after the massage is also an option for the diagnosis of chronic prostatitis.
The bacteria that cause chronic prostatitis are, in general, the same as the acute ones. Patients who present symptoms of chronic prostatitis, with pus in the urine simple examination, but whose urocultures and cultures of prostatic secretion are persistently negative, should be investigated for chlamydial infection.
The treatment of chronic prostatitis is similar to acute treatment, lasting between 4 and 6 weeks. Patients who have recurrent infection may need longer treatment.
III. CHRONIC NON-BACTERIAL PROSTATITIS OR CHRONIC PELVIC PAIN SYNDROME
Chronic pelvic pain syndrome is a syndrome that presents with urological symptoms and discomfort in the pelvic region. The term chronic pelvic pain syndrome is more correct than chronic non-bacterial prostatitis, because there is often no involvement of the prostate in the picture, although the symptoms are suggestive of chronic prostatitis.
Chronic pelvic pain syndrome is a diagnosis of exclusion, ie it can only be given after discarding bacterial prostatitis and other causes for pelvic pain such as tumors, urinary infections, hemorrhoids and testicular diseases.
Symptoms of chronic pelvic pain syndrome include those of chronic prostatitis and others such as pelvic pain, anal discomfort and nuisance in the testicles.
There is no specific treatment for chronic pelvic pain syndrome. When a chronic bacterial prostatitis can not be ruled out, a four-week course of antibiotics is an acceptable course of action. In cases where it is not possible to determine the cause of the pain, treatment is limited to the use of analgesics.