What is prostatitis?
The term prostatitis encompasses a group of diseases that affect the prostate gland. They can be acute or chronic, infectious or non- infectious, but they all share a set of symptoms that consist, above all, of pain or discomfort in the perineal region and genitourinary tract, accompanied by urinary symptoms such as dysuria, pollakiuria, or sexual dysfunction (pain during ejaculation, haematospermia).
Prostatitis is a condition with a bimodal incidence peak: men aged between 20 and 40 and those over 60 are more likely to suffer. In 10% of prostatitis cases a bacterial cause is evident, while in the remainder the cause is non-infectious or its aetiology cannot be determined.
In consideration of the fact that clinically there are various prostatic syndromes, the NIH (National Institute of Health) classifies them in four categories:
- Acute bacterial prostatitis
- Chronic bacterial prostatitis
- Chronic inflammatory or non-inflammatory pelvic pain syndrome
- Asymptomatic inflammatory prostatitis
What causes prostatitis?
Bacterial prostatitis is generally caused by typical urinary pathogens, in most cases this is Escherichia coli, but it can also be Klebsiella or Staphylococcus aureus, among others. Some sexually transmitted diseases (STDs) such as chlamydia and gonorrhoea can also cause bacterial prostatitis. Chronic bacterial prostatitis can be the result of trapped bacteria that antibiotics have not eradicated.
Nonbacterial prostatitis can be inflammatory or non-inflammatory. Its mechanism is not known, but may involve incomplete relaxation of the urinary sphincter. As a result, the subsequent high urinary pressure can cause a reflux of urine into the prostate (triggering an inflammatory response) or an increase in autonomic activity in the pelvis that causes chronic pain without inflammation.
Symptoms vary depending on the type of prostatitis, both in terms of its appearance and the degree of severity. Although it frequently involves a certain degree of irritation (dysuria, frequency, vesical tenesmus) or urinary obstruction (sensation of incomplete emptying of the bladder, nocturia), and also pain, which in addition to occurring in the perineum, may also be experienced in the lumbar region or the testicles.
With acute bacterial prostatitis, in addition to spontaneous perineal pain, systemic symptoms such as fever, chills, general malaise, nausea and vomiting, and even septic shock often occur. Urinary disorders such as dysuria or urinary retention are also common.
The chronic syndromes of prostatitis usually produce a milder clinical picture. In some cases, the symptoms are modest or non-existent and only involve alterations to semen that can cause infertility. In other cases, sexual manifestations predominate, such as total or partial erection loss, painful ejaculation, or haematospermia.
The most common is pelvic pain and obstructive and irritative urinary symptoms (difficulty commencing urination, decrease in the volume of urine, imperious urination, increased urination frequency during the day and/or night, etc.). Pain can occur in different areas: suprapubic, perineal, lumbosacral, scrotal and penile. In the case of chronic prostatitis, symptoms usually last for at least three months.
To discount underlying diseases and treat prostatitis correctly, an accurate diagnosis is required to determine which type of prostatitis is involved. Initial diagnostic tests may include a digital rectal examination, urine and blood tests, or diagnostic imaging tests. In several cases prostatic massage is often performed to evaluate the secretions.
Treatment of prostatitis
The treatment of prostatitis is based on the cause.
Acute bacterial prostatitis can be treated on an outpatient basis with antibiotics, rest, analgesics, stool-softening drugs and hydration. The treatment typically lasts between two and four weeks.
In the case of chronic prostatitis, antibiotic treatment may last for up to 12 weeks. The treatment for chronic prostatitis may occasionally include anti-inflammatories or muscle relaxants. Once completed, the doctor will perform a follow-up to ensure that the infection has completely disappeared.
Treatment of chronic pelvic pain syndrome is difficult and non-specific because in most cases the cause will not have been definitively determined. It is common for the treatment to begin with antibiotics that are effective against atypical bacteria, with the inclusion of anti-inflammatories and/or analgesics to relieve pain.