Doctor Answers: What Causes Prostatitis in Young Men?

If you’re a young man experiencing pelvic discomfort, painful urination, or sexual dysfunction, you might not immediately think of prostate issues. Prostate enlargement and cancer are more commonly associated with older men, but there’s one prostate condition that disproportionately affects younger males: prostatitis.

We spoke with Dr. David Letsa, a leading urologist specializing in male reproductive health, to explore the causes, symptoms, and treatment options for prostatitis in young men. Dr. Letsa shares his clinical insights and backs them up with medical studies and authentic patient experiences. 

His comprehensive responses offer clarity and direction for young men navigating the often-confusing world of prostate health. Dr. Letsa has reviewed all medical information shared here to ensure its accuracy and relevance.

Q: What is Prostatitis?

Dr. Letsa answers: Prostatitis describes the inflammation of the prostate. Indeed, it is an inflammatory process triggered by bacterial infections or an aberrant immune system response.

Prostatitis is different from benign prostatic hyperplasia (BPH) and prostate cancer. It causes swelling in the prostate gland and similar symptoms, but it is not always a chronic condition. It breaks down into acute and chronic prostatitis, depending on the extent of the symptoms.

There’s also an entity known as chronic prostatitis/chronic pelvic pain syndrome, which is usually more challenging to treat.

Q: Can Prostatitis Affect Young Men?

Dr. Letsa answers: According to the National Institute of Diabetes and Digestive and Kidney Diseases, prostatitis is the most common urinary tract condition in males under 50. It can happen in men of any age group.

However, if you have prostate symptoms as a young man, it is more likely due to prostatitis.

It is still essential to visit your doctor in such cases because prostate cancer in young men is hazardous, and it is critical to rule out that possibility.

Why is prostatitis a relatively common ailment in young men? Prostatic lithiasis (prostate stones) can form at any age. They are common in young men and cause prostatitis.

Cystitis, an inflammatory process in the urinary tract, develops regardless of the patient’s age. The prostate is contiguous and may become inflamed as well.

Young males are more commonly affected by sexually transmitted diseases. If they engage in anal sex without protection, they are at a higher risk of prostatitis, epididymitis, and similar conditions.

Q: What Causes Prostatitis in Young Men?

Dr. Letsa answers: 

The causes of prostatitis vary depending on its type, which includes acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis, and chronic pelvic pain syndrome. In young adults, the underlying causes of prostatitis are not always clear. When identifiable causes are found, they are typically linked to bacterial infections. Prostatitis is categorized into infectious and non-infectious types. Non-bacterial prostatitis is triggered by an abnormal immune response, and its exact cause is often difficult to pinpoint.

The microbes that infect the prostate are usually the same as those found in urinary tract infections. These include Escherichia coli, Enterobacter species, Klebsiella species, Proteus mirabilis, and Pseudomonas aeruginosa, with E. coli (2) being the most common trigger of the inflammatory process. Various mechanisms have been proposed to explain how these microbes reach the prostate, including:

Prostate Stones

According to some authors, it is due to prostate stones and urinary reflux. Instead of being eliminated, a minimal volume of urine refluxes to the prostate. The prostatic duct has stones, and the flow of prostatic secretions is stagnant. Under these conditions, bacteria colonize the prostate (3).

Prostate Infection

We can also have an ascending prostate infection from the urethra.

For example, in patients with a sexually transmitted disease, the bacteria travel upwards and reach the prostate gland (4).

Rectum Bacteria

Many bacteria live in the rectum, right behind the prostate. Some authors suggest that these bacteria spread by lymphatic vessels (5).

Blood Transmission

Another type of spread is through the blood. Bacteria traveling in the blood reach the prostate and colonize the organ. This is more common in HIV and immunocompromised patients (5).

Bacteria from a Prostate Biopsy

After a transrectal prostate biopsy, inoculation of bacteria is always a possibility.

Doctors always try to prevent this problem by cleaning the fields and prescribing antibiotics. However, resistant bacteria may still colonize the prostate gland (5).

It is more likely that you get prostatitis as a young adult if you have these risk factors:

• A recurrent urinary tract infection 
• Abnormalities in your urinary tract
• Diagnosed prostatic calculi or intraprostatic ductal reflux
• If you constantly engage in anal sex
• Phimosis and excessive foreskin
• Epididymitis and similar inflammatory processes
• Abnormal prostatic fluid or calculi in the prostate
• Patients with a urinary catheter or after a prostate biopsy

Q: What are the Main Prostatitis Symptoms?

Dr. Letsa answers: Prostatitis symptoms vary depending on the type. Acute bacterial prostatitis usually has more disturbing features, and patients are more likely to seek urgent medical help. Chronic bacterial prostatitis is usually not as severe, but the symptoms linger long and may cause disability.

Q: What are the Acute Prostatitis Symptoms?

Dr. Letsa answers: Symptoms of acute prostatitis include:

Fever

This inflammatory problem in the prostate releases cytokines into the blood. Upon reaching the brain temperature centers, cytokines trigger fever. This symptom can be found in almost every case of acute prostatitis.

Pelvic pain

These patients often report dull aches in the lower abdomen. Severe pain should be evaluated to rule out a pelvic abscess in these cases.

Perineal tenderness

The pelvic floor and the rectum may feel tender. If you have this symptom, you may find it uncomfortable to sit for a long time. The digital rectal examination could also trigger a distinct type of pain.

Painful Urination 

Patients often experience a burning or stinging sensation during urination, which can lead to significant discomfort. This pain occurs because the prostate gland, which encircles the urethra, becomes swollen or inflamed, irritating the urethra and mimicking the symptoms of a urinary tract infection (UTI). This irritation can also lead to an increase in urinary frequency, urgency, and the sensation of incomplete bladder emptying. 

Painful Ejaculation 

During orgasm, men may experience a sharp or throbbing pain, typically felt in the pelvic region or lower abdomen. Although the volume of semen may remain unchanged, the discomfort can be alarming and may be accompanied by the presence of blood in the semen, a condition known as hematospermia. This could indicate underlying issues with the prostate or other reproductive organs and should always be evaluated by a healthcare professional.

Weak Urine Flow 

Reduced urine flow is a common symptom associated with various prostate conditions, such as benign prostatic hyperplasia (BPH) or prostatitis. Patients may notice that the stream of urine is intermittent, weak, or takes longer to start, often leading to feelings of incomplete bladder evacuation. In more severe cases, this can result in urinary retention, where the bladder does not fully empty, posing risks for bladder damage or infections.

Increased urinary frequency

Urination frequency increases. This also happens in BPH (enlarged prostate) and prostate cancer. Prostatitis patients usually feel a significant urgency to urinate, too. Symptoms of chronic prostatitis are similar, but these patients typically don’t have a fever. The inflammatory response is not as severe, and pain is generally mild or moderate. But having long-term pain causes significant disability and a reduction in the quality of life.

Q: What are the Symptoms of Chronic Prostatitis?

Dr. Letsa answers: Chronic prostatitis features many symptoms, and patients’ complaints vary. They include:

Genitourinary pain

It is usually located in the perineum but can also affect the testicles, the penile tip, or the lower abdomen. It is triggered or worsened by ejaculation or urination. Patients with chronic pelvic pain syndrome have this as the main symptom.

Lower urinary tract symptoms (LUTS)

Similar to acute bacterial prostatitis, this type also features LUTS, such as urinary urgency, a burning sensation while urinating, nocturia, a weak urinary stream, and frequent urination.

Psychological issues

When prostatitis becomes chronic, it starts causing psychological problems. These patients are at a higher risk of anxiety, stress, depression, or behavioral issues: severe symptoms or a very long-term problem cause an overall decrease in quality of life.

Sexual dysfunction

Ejaculatory pain is more common in chronic prostatitis. The condition is held for a longer time and causes significant sexual dysfunction. These patients may develop decreased libido or erectile dysfunction. Or, the opposite can also happen, and they could experience premature ejaculation.

Q: When Should Young Men See a Doctor?

Dr. Letsa answers: Prostatitis by itself is not always an emergency, and plenty of patients live with asymptomatic inflammatory prostatitis without knowing it. But when you start experiencing symptoms, seeing a doctor and evaluating your condition is essential. Both acute and chronic bacterial prostatitis have complications. Acute bacterial prostatitis can trigger a prostatic abscess when not adequately treated. Chronic prostatitis causes sexual dysfunction, depression, and a decrease in quality of life. 

Thus, talk to your doctor whenever you feel pain in your pelvic floor, testicles, or urinary tract, and it does not go away. If your pain frequently returns, you should look for medical help. 

Key FAQs on Prostatitis in Young Men

Q: Can prostatitis in young men affect fertility?

Dr. Letsa answers: While not always the case, prostatitis can indeed affect fertility in young men. The inflammation associated with prostatitis can impact the function of the prostate gland, which plays a crucial role in producing seminal fluid, which is essential for the motility and viability of sperm.

In some instances, prostatitis can lead to changes in semen quality, including a decrease in sperm count, motility, and morphology. Furthermore, the inflammatory environment can potentially damage sperm directly. Pain and discomfort associated with prostatitis might also affect sexual function, indirectly impacting the ability to conceive.

It’s important to emphasize that not every case of prostatitis will result in fertility issues. The severity and duration of the inflammation and the specific type of prostatitis can all play a role. Suppose a young man experiencing prostatitis is also concerned about his fertility. In that case, he must consult with a healthcare professional for a thorough evaluation, including semen analysis, to determine any impact and to explore appropriate management strategies.

Q: How can lifestyle changes help prevent recurring prostatitis in young men?

Dr. Letsa answers: Lifestyle plays a significant role in overall health and can undoubtedly influence the likelihood of recurring prostatitis in young men. Several modifications can be beneficial:

• Hydration: Adequate fluid intake helps flush the urinary tract and may prevent the buildup of irritants contributing to inflammation.
• Diet: A balanced diet rich in fruits, vegetables, and whole grains can support overall immune function and reduce inflammation. Limiting processed foods, caffeine, and alcohol may also be helpful for some individuals, as these can sometimes irritate the bladder and prostate.
• Regular Bowel Movements: Constipation can pressure the prostate gland. Maintaining regular bowel habits through a high-fiber diet and adequate hydration is important.
• Avoid Prolonged Sitting: Sitting for extended periods can put pressure on the perineum and prostate. Young men with sedentary jobs should take regular breaks to stand up and move around. Using a cushion designed to reduce pressure on the perineum might also be beneficial.
• Stress Management: Chronic stress can impact prostate health and the immune system and potentially contribute to inflammation. Relaxation or stress-reducing techniques like yoga, meditation, or deep breathing exercises can be helpful.
• Safe Sexual Practices: While not the primary cause of all types of prostatitis, practicing safe sex can help prevent sexually transmitted infections that might lead to prostate inflammation.
• Avoid Irritants: Certain activities or substances can irritate the prostate in some individuals. This might include cycling for long durations on a hard seat or exposure to certain chemicals. Identifying and avoiding personal triggers can be important.

Young men must understand that these lifestyle changes are not a guaranteed cure or preventative measures for all prostatitis cases. Still, they can certainly contribute to overall prostate health and potentially reduce the frequency of recurring episodes.

Q: Are there specific exercises that support prostate health in younger men?

Dr. Letsa answers: While there aren’t specific exercises that directly ‘cure’ or prevent prostatitis, certain types of physical activity can contribute to overall pelvic health and may help alleviate symptoms or improve comfort:

• Pelvic Floor Exercises (Kegels): These exercises strengthen the muscles of the pelvic floor, which support the bladder, bowel, and prostate. Strengthening these muscles can improve urinary control and potentially reduce discomfort associated with prostatitis.
• Regular Aerobic Exercise: Activities like walking, jogging, swimming, or cycling (with a prostate-friendly seat) can improve circulation throughout the body, including the pelvic region. This can help reduce inflammation and promote overall well-being.
• Stretching: Gentle stretching exercises, particularly those targeting the hips and lower back, can help relieve tension in the pelvic area, which may indirectly benefit prostate health. Examples include yoga poses like the pigeon pose or the child’s pose.

Young men experiencing prostatitis must listen to their bodies and avoid exercises that exacerbate their symptoms. High-impact activities or prolonged sitting on hard surfaces during exercise might be uncomfortable for some. Consulting with a physical therapist specializing in pelvic floor health can be beneficial for learning proper techniques and identifying safe and effective exercises for their individual needs.

Conclusion

Prostatitis is the most common prostate issue in younger men. Unlike BPH or prostate cancer, which are typical in older males, prostatitis can happen at any age. The causes are often bacterial, with E. coli being the most frequent offender. 

The symptoms and treatments vary depending on whether it’s acute or chronic. There’s also a form known as chronic pelvic pain syndrome, which presents persistent pain and is harder to treat. Regardless of type, early diagnosis and management of prostatitis in young men are essential.

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