Symptoms
Types, symptoms and progression of prostatitis
Prostatitis or prostatitis syndrome is an inflammation of the prostate that can be very painful for men.
Classification of prostatitis into four categories
The National Institute of Health, NIH for short, distinguishes between four types of prostatitis:
Type | Description |
NIH I | Acute bacterial prostatitis (with the aid of bacteria, less than three months) |
NIH II | Chronic bacterial prostatitis (with the aid of bacteria, longer than three months) |
NIH IIIA oder NIH IIIB | Chronic abacterial prostatitis/chronic pelvic pain syndrome (without the aid of bacteria, longer than three months, inflammatory or non-inflammatory) |
NIH IV | Asymptomatic prostatitis (no symptoms) |
Symptoms of prostatitis
Prostatitis syndrome can be accompanied by various symptoms - depending on which type is present:
Acute bacterial prostatitis:
- Sudden onset of fever and chills
- Pain in the lower abdomen, perineum (area between the anus and scrotum) and lower back
- Pain or burning when urinating (dysuria)
- Frequent urge to urinate, often also at night (nocturia)
- Difficulty urinating, weak urine stream or complete urinary retention
- Pain when ejaculating
- General discomfort and feeling of weakness
Chronic bacterial prostatitis:
- Recurrent urinary tract infections
- Mild but persistent pain in the lower abdomen, perineum and lower back
- Dysuria
- Nocturia
- Discomfort when urinating
- Pain when ejaculating
- Occasional fever
Chronic abacterial prostatitis/chronic pelvic pain syndrome:
- Persistent or recurring pain in the pelvic area, perineum, penis or testicles
- Dysuria
- Nocturia
- Problems with urination
- Pain when ejaculating
- Sexual dysfunction, such as erectile dysfunction and reduced libido
- Psychosocial symptoms such as anxiety and depression
Asymptomatic prostatitis:
- No noticeable symptoms
- Usually discovered by chance during other medical examinations, such as prostate biopsy or infertility tests
If you are experiencing symptoms, this free and anonymous self-test can help you better assess the health of your prostate:
Important: this test does not replace a visit to the doctor as only a urologist can make a diagnosis.
How does prostatitis progress?
The progression of prostatitis can vary greatly and depends on the type of inflammation:
- Acute bacterial prostatitis: can start suddenly and lead to serious complications such as blood poisoning (sepsis) or an abscess in the prostate if not treated quickly and appropriately.
- Chronic bacterial prostatitis: often develops gradually and can last from months to years.
- Chronic abacterial prostatitis/chronic pelvic pain syndrome: this is the most common type of prostatitis, the most difficult to treat and can lead to a significant reduction in quality of life.
- Asymptomatic prostatitis: it is usually only discovered by chance and does not normally require treatment because it is asymptomatic, unless there are other health problems.
Trigger
Causes and risk factors of prostatitis
Prostatitis can have various triggers, ranging from bacterial infection to non-infectious causes. There are also various factors that increase the risk of prostatitis.
What causes prostatitis?
Depending on the type of prostatitis, there are several possible causes:
- Acute bacterial prostatitis: it is usually caused by bacteria that enter the prostate through the urinary tract. Common pathogens are Escherichia coli (E. coli), Klebsiella, Proteus and other intestinal bacteria.
- Chronic bacterial prostatitis: often caused by a partially treated acute infection or recurrent infections. The bacteria can remain in the prostate tissue and cause repeated inflammation.
- Chronic abacterial prostatitis/chronic pelvic pain syndrome: the exact cause is often unknown and may be multifactorial. Possible factors include nerve damage or nerve irritation in the pelvic area, autoimmune reactions, stress and other psychological stresses.
- Asymptomatic prostatitis: often detected incidentally during other prostate examinations or fertility problems. The cause is usually unclear.
Factors that can increase the risk of prostatitis
The risk of prostatitis may increase due to the following factors:
- Urinary tract infection: men with frequent urinary tract infections have a higher risk of developing prostatitis as the infection can spread to the prostate.
- Bladder catheters or medical interventions: the use of bladder catheters or instrumental interventions in the urogenital area can increase the risk of prostate infections.
- Sexually transmitted infection (STI): chlamydia and gonorrhoea can infect the prostate and cause prostatitis.
- Anal intercourse or rectal exams: these practices can increase the risk of a bacterial infection of the prostate.
- Age: chronic prostatitis is more common in older men, while acute bacterial prostatitis is more common in younger and middle-aged men.
- Disorders of the immune system: a weakened immune system, for example due to HIV/AIDS or other immunological diseases, can increase the risk of prostate infections.
- Stress and other psychological factors: chronic stress and other prolonged psychological stress can contribute to the development or aggravation of chronic abacterial prostatitis/chronic pelvic pain syndrome.
- Genetic predisposition: there is evidence that hereditary factors may play a role in susceptibility to prostatitis.
- Injuries to the pelvic area: trauma to the pelvic area, such as in sports or an accident, can increase the risk of prostatitis.
Knowing the risk factors for prostatitis is an important first step in preventing prostatitis.
Diagnosis
How is prostatitis diagnosed?
- Anamnesis: the doctor begins by asking about the patient's medical history. Important information includes: nature and duration of symptoms, previous urinary tract infections or episodes of prostatitis, sexual activity and sexually transmitted infections, if any, the use of urinary catheters or medical interventions in the urogenital area, medication and allergies and other relevant health problems
- Digital Rectal Exam (DRE): during the DRU, the urologist palpates the prostate through the rectum to assess its size, shape and consistency and to determine any sensitivity to pain.
- Urinalysis: a urine sample can be used to detect inflammation-causing bacteria and an increased leukocyte (white blood cell) count as evidence of inflammation.
- Blood test: a blood test provides information about inflammation markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and an increase in white blood cells. It also shows the level of prostate-specific antigen (PSA), which can also be elevated in prostatitis.
- Analysis of the prostate secretion: by massaging the prostate during the digital rectal exam (DRU), the urologist can obtain a sample of the prostate secretion, which is then analysed for bacteria and inflammatory cells in a laboratory.
- Transrectal Ultrasound (TRUS): this medical imaging procedure provides a detailed view of the prostate and can detect abscesses or other abnormalities.
- Magnetic Resonance Imaging (MRI): in complex cases, this medical imaging procedure is used to accurately assess the prostate and surrounding tissue.
As the symptoms of prostatitis can also be caused by other conditions, it is important to rule out other causes. These include benign prostate enlargement, prostate cancer, cystitis, urethral infection or neurological disorders that cause problems with urination.
Treatment
Treatment of prostatitis
In order to treat prostatitis successfully, it is important to tailor treatment to the patient’s personal medical diagnosis. On the other hand, there are some simple things that patients can do on their own in daily life to help their recovery.
Treatment with medication and co.
Treatment of prostatitis depends on the severity of the inflammation and individual symptoms:
- Acute bacterial prostatitis: requires immediate and intensive treatment with drugs that specifically target the bacteria that cause prostate inflammation. Antibiotics are suitable for this. In addition, the doctor may prescribe painkillers that also have an anti-inflammatory effect.
- Chronic bacterial prostatitis: requires prolonged antibiotic treatment for bacterial prostate inflammation. Pain-relieving and anti-inflammatory drugs can be taken additionally.
- Chronic abacterial prostatitis/chronic pelvic pain syndrome: requires a combination of different treatment approaches. As far as physical discomfort is concerned, painkillers and physiotherapy can help relax the pelvic muscles. Psychological stress can be alleviated with psychotherapy, among other things. Alternative methods such as acupuncture or heat treatments may also be helpful.
- Asymptomatic prostatitis: usually does not require treatment as it does not have any noticeable symptoms. Regular visits to the doctor for check-ups are usually sufficient.
General recommendations
In addition to the regular treatment for prostatitis, those affected can also help their condition by making some lifestyle changes. Here are a few tips:
- Drink plenty drink: sufficient fluid intake can help to flush the urinary tract and prevent infections.
- Eat a healthy diet: a well-balanced diet can boost overall health and immune system.
- Exercise regularly: light physical activity and pelvic floor exercises can improve blood circulation and relieve symptoms.
- Reduce stress: relaxation techniques such as yoga, meditation and breathing exercises can help reduce the stress that can aggravate symptoms.
Prevention
Early detection of prostatitis
Regular check-ups with a urologist can help detect and treat prostate diseases, including prostatitis, in good time. Statutory health insurance companies cover annual check-ups for men aged 45 and over free of charge. These usually include an anamnesis (discussion about the patient's medical history) and a Digital Rectal Exam (DRU), during which the doctor palpates the prostate through the rectum in order to detect any changes as early as possible.
FAQs
Answers to frequently asked questions about prostatitis
No. There are four types of prostatitis, of which only two - acute and chronic bacterial prostatitis - are caused by bacteria. The other two types, chronic abacterial prostatitis or chronic pelvic pain syndrome and asymptomatic prostatitis, are not caused by bacteria.
Symptoms such as pain in the lower abdomen, in the area between the anus and scrotum, in the lower back or in the pelvic region, pain and problems when urinating, frequent urge to urinate (at night), pain when ejaculating can be indications of prostate inflammation.
The duration of prostatitis depends on the specific type. For example, acute bacterial prostatitis lasts no longer than three months, whereas a chronic form can last for more than three months and even years.
Prostate inflammation is not usually life-threatening. However, depending on the severity of the condition, it can have a significant impact on quality of life and, if left untreated, can also lead to complications (such as sepsis or abscesses in the prostate).
Bacterial prostatitis (acute and chronic) is usually caused by bacteria such as Escherichia coli (E. coli). In the abacterial and asymptomatic form, the cause is usually less clear or even completely unknown.
Yes. Risk factors for prostatitis include: urinary tract infections, bladder catheter or medical interventions, sexually transmitted infections (STIs), anal intercourse or rectal exams, age, disorders of the immune system, stress or other psychological factors, genetic predisposition and injuries to the pelvic area.
Urologists have the following options for diagnosing prostatitis: anamnesis, Digital Rectal Exam (DRU), urinalysis, blood test, analysis of prostate secretion, Transrectal Ultrasound (TRUS) or Magnetic Resonance Imaging (MRI).
Treatment of prostatitis depends on the type of prostatitis. If bacteria are involved, the doctor will generally prescribe antibiotics. The patient can also take painkillers, which not only relieve pain but also inhibit inflammation.
Generally, antibiotics are used if prostatitis is caused by bacteria. Painkillers are typical medicines that also reduce the pain and inflammation in the prostate.
As psychological stress is a risk factor for prostatitis (as it is for other conditions), it is important to minimise it as much as possible in everyday life. An unhealthy diet, too little exercise and insufficient fluid intake should also be avoided.
Acute bacterial prostatitis can usually be treated with antibiotics. However, chronic forms can be more difficult to treat and often require prolonged therapy and regular aftercare to control symptoms.
Regular check-ups with a urologist can help detect prostatitis at an early stage. From the age of 45, men with statutory health insurance should always take advantage of the free annual check-up. Other diseases of the prostate can also be detected early enough through these check-ups.
Sources
- 1 Schaeffer AJ, Anderson, RU, Krieger JN et al.: Statement on prostatitis. The assessment and management of male pelvic pain syndrome, including prostatitis. In: Edition MLUTD, editor. 6th International Conference on New Developments in Prostate Cancer and Prostate Diseases. Paris: Health Publications 2006; 343–75.