prostate inflammation

An inflammation of the prostate, i.e. the male prostate gland, is known in medicine as prostatitis (prostatitis). The prostate is located directly under the man's bladder: it is about the size of a chestnut. The prostate surrounds the first section of the urethra and extends to the so-called pelvic floor, which consists of muscles.

The man's prostate produces a fluid, a secretion, which consists of, among other things, "spermine" and the so-called "prostate-specific antigen" - PSA for short. The prostate-specific antigen ensures that the ejaculate is thinner, while spermine is very important for the mobility of the sperm.

An inflammation of the prostate is associated with severe pain in the anal and perineal area. In addition, symptoms such as frequent urination, pain during ejaculation and urination occur. The male prostate gland is quite often affected by inflammation.

As we get older, the likelihood of suffering from prostatitis increases. On average, around one in ten men will suffer from prostatitis at some point in their lives. Studies show that most cases affect men between the ages of 40 and 50.

Prostatitis syndrome

A broader understanding of the technical term "prostatitis" has now become established among medical professionals. Various complaints in the male pelvic area, which usually have an unknown cause, are summarized under the term "prostatitis syndrome". The following clinical pictures fall under prostatitis syndrome:

• Acute bacterial prostatitis

• Chronic bacterial prostatitis

• Chronic pelvic pain syndrome – CBSS for short or abacterial chronic prostatitis

• Asymptomatic inflammatory prostatitis

Acute, bacterial and chronic bacterial prostatitis

Acute prostatitis is caused by bacteria. The pathogens either reach the prostate via the bloodstream or they spread to the prostate from a bacterial infection of the urethra or bladder. The acute form of prostatitis is considered a serious general illness that is associated with severe pain when urinating, chills and fever. Around 10 percent of prostate infections are caused by bacterial pathogens.

In some patients, acute bacterial prostatitis can develop into chronic prostatitis. Chronic bacterial prostatitis is diagnosed when the following criteria are met:

• Prostatitis persists for more than three months.
• Bacterial germs can be repeatedly detected in urine and prostate secretion or ejaculate fluid.

Compared to acute bacterial prostatitis, the chronic form does not progress as quickly or as intensely. Chronic prostatitis can also cause pain when urinating and, in some cases, a feeling of pressure in the perineum area. In general, however, the symptoms of the affected patients are not as severe as in cases of acute inflammation.

Chronic pelvic pain syndrome (abacterial prostatitis)

In most cases, no bacterial pathogens can be detected in the urine, ejaculate or prostate secretion.

The exact cause of the inflammation of the prostate gland remains unclear. In such a case, doctors speak of chronic pelvic pain syndrome or abacterial chronic prostatitis.

In many cases, white blood cells (leukocytes) can be detected in those affected as an expression of the inflammatory processes in the prostate. However, there can also be a form of the disease in which neither bacterial germs nor leukocytes can be detected: In such a case, we speak of non-inflammatory, chronic pelvic pain syndrome. Chronic pelvic pain syndrome is generally the most common form of prostate inflammation.

Asymptomatic prostatitis

In such a case, no symptoms of illness such as pain or the like can be detected. Inflammatory cells are either discovered in the man's sperm or prostate secretion, or the inflammatory cells can be detected in more distant tissue under the microscope. For this reason, this type of prostatitis is also known as "histological prostatitis." In most cases, asymptomatic prostatitis is discovered by chance, for example during a fertility test.

In the ICD-10, the international classification of diseases, prostatitis can be found in the chapter “Diseases of the male genital organs” under the number N41.0

Symptoms: This is what prostatitis looks like

The classic symptoms of acute bacterial prostatitis are:

• Frequent urge to urinate
• Pain when urinating (in most cases with a small amount of urine)
• Pain during bowel movements
• Pain in the bladder and perineal region.
• nausea
• Vomit
• Fever
• Chills.

Chronic bacterial inflammation of the prostate also causes pain and problems urinating. However, these symptoms subside from time to time, only to reappear after a short while. This progression of the disease in phases and recurring signs of inflammation is characteristic of chronic prostate inflammation. The phases can sometimes last for several months.

Another typical sign of chronic prostate inflammation is male erection problems.

Abacterial inflammation of the prostate gland – which is not caused by bacterial pathogens – essentially causes similar symptoms to a chronic bacterial form.

In addition, affected men sometimes complain of pain during ejaculation.

Asymptomatic inflammation of the prostate gland – a special case

In rare cases, no symptoms may occur at all, but the doctor may detect an increased number of leukocytes (white blood cells) in the prostate secretion or male ejaculate. Such asymptomatic inflammation of the prostate is usually discovered purely by chance, for example during an infertility test or cancer screening.

Course: Does prostatitis have subsequent complications?

The acute form of prostatitis is generally easy to treat. If the patient takes the prescribed antibiotics diligently, the pain and fever generally subside within about 36 hours. After a few days, the symptoms of the disease should have significantly subsided.

Chronic prostatitis generally lasts for several months and typically progresses in phases: there are times when the patient hardly feels any symptoms and times when significant symptoms occur. The chronic form of the disease is generally more persistent than the acute bacterial form. Antibiotic treatment often takes several weeks to take effect.

Possible complications

In some cases, in addition to the acute symptoms of the disease, secondary complications can occur that complicate the course of the disease and delay healing. The most common secondary complication is a so-called prostate abscess, which occurs particularly in acute bacterial prostatitis. The abscess is a purulent encapsulation of the inflammation, which usually has to be opened and drained through a surgical incision.

Another possible complication is inflammation of neighboring structures, such as the epididymis (epididymitis) or the testicles (orchitis). Scientific research studies also indicate that chronic prostatitis is also associated with the development of prostate carcinoma (prostate cancer).

Causes and risk factors of prostatitis

Doctors know of various causes that can lead to prostate inflammation. The treatment and prognosis of the inflammatory disease are then tailored to the respective cause.

Bacterial prostatitis

In most cases, intestinal germs such as Enterococcus faecalis or Escherichia Coli cause bacterial inflammation of the prostate.

If the pathogens enter the urinary tract through the opening of the penis, they initially cause a urethral infection or a bladder infection. If the pathogens then migrate further through the urethra into the prostate, the inflammation can spread to the man's prostate gland.

In men who develop inflammation of the prostate in hospital, the cause is often bacterial pathogens of the genus “Pseudomonas aeruginosa”. They can enter the urinary tract via a bladder catheter, for example.

In rarer cases, prostatitis occurs as a result of a sexually transmitted disease. If this does happen, it is usually caused by chlamydia.

Acute inflammation of the prostate can become chronic. This is the case if the inflammation has not completely subsided after three months.

Chronic pelvic pain syndrome (abacterial prostatitis)

In the case of abacterial inflammation of the prostate, no bacterial germs can be detected. However, white blood cells (leukocytes) can be detected in the prostate fluid and in the semen. Leukocytes are defense cells that indicate that the organism is fighting an internal inflammation.

The specific causes of inflammation have not yet been fully clarified and are still controversial among medical experts. Prostatitis may be caused by a combination of different influences. However, the following factors are said to play an important role:

• Disorders of the central nervous system that affect the muscles and nerves of the urogenital tract and result in the affected men no longer being able to empty their bladder normally.
• Disturbed immune response
• Psychological factors such as trauma, depression, anxiety or excessive prolonged stress.

Some doctors also suspect that hidden infections could be the cause of chronic pelvic pain syndrome. However, this assumption is currently still controversial.

Anatomical causes

A narrowing of the urinary tract can also be the cause of prostatitis, albeit in rare cases. If the urinary tract is too narrow, urine backs up and prostatitis occurs. Such a narrowing of the urinary tract can be caused by tumors or prostate stones, for example.

In addition, doctors suspect that a functional disorder of the pelvic floor muscles can promote inflammation of the prostate.

Risk factors

Some men are particularly susceptible to developing prostatitis. These include, for example, patients with a impaired immune system or a suppressed immune system, for example as a result of immunosuppressive therapy.

Underlying diseases such as diabetes can also lead to inflammation of the prostate. The increased blood sugar level often leads to a high sugar level in the urine. The high sugar content may provide ideal conditions for bacterial germs to grow, making it easier for urinary tract infections to develop. In the case of diabetes, the immune system is also weakened.

Bladder catheters are also a risk factor. Even the insertion of a bladder catheter can cause fine tears in the urethra and thus prostate injuries. In addition, bacterial germs can settle on the bladder catheter, forming a so-called biofilm. The germs can then rise through the urethra to the bladder and cause prostatitis.