Prostatitis

Chronic Prostatitis: Causes, Symptoms, and Treatment

The prostate is part of the endocrine system and only present in the male body.

This gland is located just below the bladder and surrounds the urethra.

The prostate gland is also very small, often compared to the size of a walnut. The average prostate gland weighs about one ounce. 

Many conditions can affect the prostate gland, including benign prostatic hyperplasia (BPH) and prostate cancer.

While prostate cancer is one particular disease often discussed, it is essential not to overlook other conditions that can also affect this gland, including prostatitis. 

Types of Prostatitis

There are four main types of prostatitis, and each has its own set of causes and symptoms:

  • Acute bacterial prostatitis 

  • Chronic bacterial prostatitis

  • Chronic Non-bacterial Prostatitis (Chronic pelvic pain syndrome (CP/CPPS)

  • Asymptomatic inflammatory prostatitis

In this post, we take a look at chronic prostatitis. We will consider what chronic prostatitis is, look at the symptoms that the condition causes, and provide an overview of the potential treatment that is available.

What is Chronic Prostatitis?

Prostatitis is a condition that causes inflammation to develop in the prostate gland. In some cases, the condition can be acute and will get better in a short period of time.

Some men, however, may develop chronic prostatitis. This is when the inflammation becomes chronic and persists over a longer period of time. 

While some potential causes have been linked to prostatitis, there are many cases where no specific cause can be linked to the condition. This makes it challenging to treat effectively.

Among male patients who consult with a specialist, prostatitis is one of the most commonly diagnosed diseases.

An estimated two million men who account for outpatient visits in the United States are diagnosed with prostatitis each year. It is estimated that about 8.2% of all men will experience symptoms associated with prostatitis during their lifetime. 

Types of Chronic Prostatitis 

There is a specific range of symptoms that patients experience when they develop chronic prostatitis. It is important to note that not all of these conditions are the same. There are two different types of chronic prostatitis.

Below is an overview of the two classifications that can be made: 

● Chronic Bacterial Prostatitis: When a patient experiences prostatitis symptoms, tests will help a physician confirm if an underlying bacterial infection causes the condition. 

When the tests come back positive for the presence of an infection, then the patient will be diagnosed with bacterial prostatitis. In some cases, the inflammation and effects caused by the bacterial infection may lead to longer-term complication.

● Chronic Prostatitis: This is the more common type of chronic prostatitis. In some cases, the patient may be diagnosed with a condition called chronic pelvic pain syndrome, or CPPS. The symptoms would generally be the same.  When a patient is diagnosed with general chronic prostatitis, no specific cause has been found, even when appropriate blood tests were done. 

What are the risk factors for Prostatitis? 

Men of all ages can be affected by prostatitis, but it is more common in young and middle-aged men. Other risk factors for the development of prostatitis include the following: 

  • A prior history of prostatitis 

  • Having a recent urinary tract infection 

  • Recent use of a urinary catheter or a recent urologic procedure 

  • Engaging in rectal intercourse 

  • Having a structural or functional urinary tract abnormality 

  • Dehydration (not enough fluids) 

  • Local pelvic trauma or injury such as from bicycle riding or horseback riding

Symptoms of Chronic Prostatitis 

The development of chronic prostatitis often leads to symptoms developing gradually. Symptoms can also be confused with interstitial cystitis.

Since this condition is rather common among men, male patients need to understand what symptoms they should look for. 

Common chronic prostatitis symptoms that men are likely to experience, include: 

  • The patient may find that they constantly have an urge to urinate 

  • There may be a burning sensation while the man urinates 

  • A man may find that ejaculation is painful 

  • Urination may have an uneven flow 

  • There might be difficult when trying to start urinating

  • Urinary tract issues

  • After urinating, it may not feel like the bladder has fully emptied 

It should be noted that some men complain about pain when they develop chronic prostatitis. The pain may affect the following areas: 

  • Pelvic pain

  • Lower abdomen 

  • Lower back 

  • The area between the anus and testicles 

  • The region that sits above the patient’s pubic area

In addition to these symptoms, there are times when the patient may also experience chills or fever. This can be a sign of a bacterial infection, which may lead to the diagnosis of chronic bacterial prostatitis

Since the condition gradually worsens, patients are advised to recognize these symptoms early on and take appropriate action. When treated during an early stage, the outcome of the condition is likely to be more positive and lead to less discomfort and pain. 

Causes of Chronic Prostatitis 

In the majority of cases, when a patient is diagnosed with chronic prostatitis, the cause behind the condition cannot be identified.

Certain tests can be done, but these tests may not yield any valuable data that can help determine why the patient has developed the condition. 

This, however, is not always the case. For example, when a patient is diagnosed with chronic bacterial prostatitis, then the cause behind the condition is an infection by bacterium species.

Microorganisms can make their way toward the prostate through a tube that is connected to the bladder.

This is known as the urethra. In some cases, the infection may initially infect the bladder and then move toward the prostate, as they are located close to each other.

There have been cases before where a contaminated catheter has also caused male patients to develop an infection in their prostate, which led to bacterial prostatitis. 

When it comes to chronic prostatitis where no specific cause is found, it should be noted that certain risks and factors can contribute to the condition. 

Individuals should note the following possible  factors have been linked to chronic prostatitis: 

  • There are cases where the immune system may start to attack the prostate, which leads to inflammation.

  • A compound that forms part of urine, known as uric acid, can irritate the prostate. This can cause inflammation in the area and lead to symptoms associated with chronic prostatitis. 

  • Certain types of sexually transmitted diseases, such as chlamydia, can cause microorganisms to infect the prostate gland

  • A blockage may sometimes develop that interrupts urination. 

  • In some cases, an abnormality in muscle or nerve function may also contribute to chronic prostatitis. 

Diagnosing Chronic Prostatitis 

Before chronic prostatitis can be treated, it is important for the condition first to be diagnosed.

The first step is for the patient to consult with a physician, who will ask the individual more about the symptoms that they are experiencing. 

If the symptoms do not indicate chronic prostatitis, then the physician will likely need to conduct a digital rectal examination. This will help them detect any abnormalities with the prostate gland.

A digital rectal examination is when the physician uses a glove to insert a finger into the patient’s rectum. A lubricant will be used during the procedure. During this examination, the physician will be able to feel if the prostate of the patient is enlarged or tender.

An ultrasound of the patient’s prostate may be ordered following the digital rectum examination. The ultrasound will provide the physician with a view of the patient’s prostate, which allows them to detect inflammation and other issues with the gland. 

If symptoms do not improve following antibiotic treatment, or there are no signs of an infection, other tests might be necessary, such as urine, semen, or blood testing to look for signs of infection or other prostate issues.

In some cases, a prostate biopsy may be advised to check prostate health. This involves the Doctor using a needle to remove a small sample of tissue from the prostate for analysis.

If the physician can make a diagnosis for chronic prostatitis, then the cause of the condition needs to be identified.

A urine sample will be requested from the patient, which will be used to test for the presence of bacteria. If bacteria are present in the urine sample, then they will be diagnosed with chronic bacterial prostatitis. 

Treatment of Chronic Prostatitis 

For treatment to be initiated, a diagnosis needs to be made. The physician needs to know what caused prostatitis to develop in the first place. There are generally two routes that can be taken, depending on the findings of the tests conducted on the urine sample

If the patient is diagnosed with chronic bacterial prostatitis, then the physician overseeing the care of the patient will prescribe them a dose of antibiotics.

When diagnosed with chronic bacterial prostatitis, then long-term antibiotic treatment is often needed. With a daily dose of antibiotics over a period of 12 weeks, many patients with a chronic type of bacterial prostatitis can experience a full clear up of the condition. 

Unfortunately, as we have noted, the cause behind chronic prostatitis is often unclear. In such a case, the primary aim of providing the patient with treatment would be to reduce the severity of the symptoms that they are experiencing.

Several different medications are often used to help reduce the symptoms of chronic prostatitis, not linked to a bacterial infection. 

If prostatitis symptoms do not improve through the use of antibiotics, painkillers, and muscle relaxers may be prescribed. These can relieve the spasm of the pelvic muscles.

In the case of urinary symptoms, alpha-blockers may be prescribed. There are cases where anti-anxiety drugs may also be offered to the patient, which may assist in further alleviating pain.

Other treatment options may also be advised to the person. This may include prostatic massage. This technique assists in draining fluid that is causing the patient to experience inflammation. However, it does carry risks and as a general rule, Doctors do not advise it.

Heat therapy is also a useful option for reducing the discomfort that the patient is experiencing, such as using a heating pad. A hot bath may also bring about relief for the patient. 

Pelvic floor exercises have also been shown to benefit some men with urinary symptoms. 

Experts estimate that pelvic tension and pelvic floor muscle disorders are responsible for pain in about 50% of CP/CPPS cases. Therefore, strengthening the pelvic floor muscles could help.

Prevention of Chronic Prostatitis 

Prevention is always better compared to treating the development of a specific condition. Thus, men should be aware of specific techniques that they can use to reduce their risk of chronic prostatitis possibly.

A man can reduce the likeliness of developing bacterial prostatitis. However, there are times when preventative measures may not completely eliminate the chance of developing chronic prostatitis that is not linked to an infection. 

Good hygiene is the best way to prevent chronic bacterial prostatitis. The man should ensure their penis is always kept clean, which can help to reduce the risk of bacteria entering their urethra.

Drinking adequate amounts of fluid is also important, as this will help to ensure frequent urination. 

If a man suffers a bladder infection or an infection of their urinary tract, then these conditions should be treated as fast as possible. This way, the risk of the bacteria infecting the prostate is reduced. 

Conclusion 

Even though the prostate is an exceptionally small gland, it still plays a vital role in male sexual health.

The development of chronic prostatitis symptoms can lead to discomfort and, in some cases, even pain. While there is not always a specific cause that can be linked to the development of the condition, men need to obtain treatment to address symptoms.

Sources

  1. https://www.medscape.com/answers/785418-60722/what-is-the-prevalence-of-prostatitis-in-the-us
  2. https://www.urologyhealth.org/urologic-conditions/prostatitis-(infection-of-the-prostate)
  3. Sandhu J, Tu HYV. Recent advances in managing chronic prostatitis/chronic pelvic pain syndrome. F1000Res. 2017;6:F1000 Faculty Rev-1747. Published 2017 Sep 25. doi:10.12688/f1000research.10558.1
  4. Cohen, J, Fagin, A, Hariton , E, Niska, J, Pierce, M, et al. (2012). Therapeutic Intervention for Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): A Systematic Review and Meta-Analysis. Plos Medicine. 1 (1), p1-2.
  5. Smith CP. Male chronic pelvic pain: An update. Indian J Urol. 2016;32(1):34–39. doi:10.4103/0970-1591.173105
  6. Rees J, Abrahams M, Doble A, Cooper A; Prostatitis Expert Reference Group (PERG). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int. 2015;116(4):509–525. doi:10.1111/bju.13101

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