Prostatitis is the inflammation of the prostate gland. It is often due to an underlying prostate infection.
The disease is experienced differently in every patient and has varying clinical features. The prostate tissue is inflamed at the microscopic level, and this causes a wide range of signs and symptoms.
It can be divided into acute or chronic depending on the duration of the symptoms. Some patients have an asymptomatic disease even though their prostate gland is inflamed. And most cases are due to bacterial infection, but other causes can be reported.
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Types of prostatitis
According to the National Institutes of Health, a classification system is based on 4 main types of prostatitis. They are (1, 2):
Acute Bacterial Prostatitis
It is not a common diagnosis, but it is definitely easier to identify than chronic bacterial prostatitis. This type presents similar to a urinary tract infection. It is more common in immunosuppressed patients.
Patients with benign prostatic hyperplasia and bladder outlet obstruction have a higher risk, too. The organisms that cause acute bacterial prostatitis are usually the same as those found in urinary tract infections-for example, Escherichia coli, Enterobacter, Klebsiella, and Proteus mirabilis. The pathogenesis is generally due to urinary reflux or ascending urethral infection. However, a bacterial spread from the rectal mucosa or by hematogenous spread is also possible.
Chronic Bacterial Prostatitis
Around 5% of cases of acute bacterial prostatitis progress into chronic bacterial prostatitis. The rest of the patients do not go through an acute phase with intense urinary symptoms. Similar to acute bacterial prostatitis, this chronic type is commonly caused by E. coli infections. It is more common in men aged 36 to 50 years. They usually have a medical history of repeated urinary tract infections or a chronic persistence of the symptoms. It is difficult to diagnose, and some patients get false-negative results in the urine culture. Thus, it is commonly dismissed, and the condition is prolonged for an extended period.
Chronic Prostatitis and Chronic Pelvic Pain Syndrome
In this case, we have patients who report pelvic pain for an extended period. However, the source of this pain is often unexplained. They usually have voiding problems and pain in the genitalia, the pelvic floor, or the groin. In a urinary test, they do not have any bacteria or cells. Thus, the source of the problem is very difficult to diagnose, and the condition affects the patient’s quality of life. There is no cure for this particular condition, but many treatments can be administered to alleviate the symptoms.
Asymptomatic Inflammatory Prostatitis
In this case, inflammatory prostatitis is discovered by chance. Patients do not have any genitourinary symptoms or complaints. In many cases, asymptomatic inflammatory prostatitis is diagnosed as a part of the workup in infertility evaluations. In other cases, it is detected after an elevation in prostate-specific antigen (PSA test).
Besides this classification, we can find nonbacterial prostatitis. Before 1995, it was considered a different type. However, it is now covered in the third category listed above.
Another type of prostatitis we may find in the literature is called granulomatous prostatitis. In this case, infectious granulomas are located in the prostate. This type of prostatitis is not very common. It is mainly caused by Mycobacterium tuberculosis and certain fungi.
Patients with prostatitis have a wide variety of signs and symptoms depending on the type.
Acute bacterial prostatitis symptoms
- Fever and chills: They are universal symptoms of bacterial infection. Fever in prostatitis is due to inflammation and the immune response. Chills are part of a body temperature regulation system, usually occurring when they reach peak fever levels.
- Myalgias and arthralgias: These symptoms are somewhat common and both caused by the immune response against the infection.
- Malaise: It is a sensation of not feeling well, similar to weakness and asthenia.
- Perineal pain: Patients often feel significant pain in the groin or perineal area. This pain worsens during a digital rectal examination or a prostatic massage.
- Dysuria: It means pain or difficulty urinating. The patient often reports a burning sensation when urinating. Acute bacterial prostatitis can be diagnosed side to side with a urinary tract infection.
- Increased urinary frequency: The patient reports an increasing need to use the bathroom. The urinary volume may not be increased, but the frequency of voiding is.
- Urinary urgency: Patients often report a sensation of urgency when they need to void. When they do, it is usually in a low volume.
- Incomplete voiding: The patient often needs to push in order to keep urinating. They feel that they’re not done. An ultrasound scan would show a significant remaining urinary volume.
- Weak urinary stream: The stream velocity and thickness are compromised, and patients may also have a terminal dribble of the urine when they’re almost done voiding.
- Nocturia: It is prevalent and wakes up patients several times to urinate every night.
- Abdominal pain or low back pain: When pain is located in the abdomen, it will be close to the pubis. Back pain is less common in these cases.
- Urethral discharge: Acute bacterial prostatitis can be caused by sexually transmitted disease. Thus, this cause should be ruled out in young and sexually active patients.
Chronic bacterial prostatitis symptoms
- Intermittent dysuria: In chronic bacterial prostatitis, a burning sensation when urinating is also common. However, it is intermittent and seldom a continuous symptom.
- Intermittent obstructive symptoms: Obstructive symptoms listed above are reported every now and then. They include incomplete voiding, nocturia, weak urinary flow, and increased frequency. Patients find spontaneous relief, but the symptoms go back after a while.
- Recurrent infections in the urinary tract: Other symptoms of urinary tract infection are also found. These patients have recurrent infections and temporary relief after antibiotic therapy.
Chronic prostatitis and pelvic pain syndrome symptoms
- Pelvic pain: Pain can be located in the low abdominal area, in the perineum, or groin. Some patients report coccygeal or rectal pain instead. Other patients feel pain in the scrotal area or their testicles. The diagnosis is only made if this pain has been felt for at least 3 months during the last 6 months.
- Dysuria: Patients may have a burning sensation while urinating. However, they do not have a urinary tract infection. Their urinalysis is apparently free from pathogens.
- Increased urinary frequency: Obstructive urinary tract symptoms are common in these patients. They need to use the bathroom more frequently than usual. They may also wake up at night to urinate (nocturia).
- Incomplete voiding: Patients feel that there’s still urine in the bladder when they finish urinating. An ultrasound scan would show that there’s a remaining urinary volume after voiding.
- Pain upon ejaculation: Ejaculatory pain is common in these patients due to chronic inflammation of the prostate.
- Erectile dysfunction: These patients may display erectile problems not explained by psychological factors.
What triggers prostatitis?
Prostatitis is the inflammation of the prostate gland, and a bacterial infection often triggers it. In bacterial prostatitis cases, the origin of the bacteria can be the urinary tract or sexual intercourse. These patients have either sexually transmitted diseases or a history of recurrent urinary tract infections. They are both common triggers of prostatitis.
However, some cases do not relate to urogenital infections. In such cases, a contiguous or hematogenous spread should be considered. In any case, the majority of cases of prostatitis are triggered by bacterial species. A minority of them are caused by fungal or viral agents, as in granulomatous prostatitis. These cases are more common in patients with HIV infection (5).
In every case, what these agents do is activating inflammatory cells in the prostate. Inflammatory cells meet and stay in the prostate, releasing inflammatory cytokines. Then the prostatic tissue changes and starts swelling.
In cases of chronic pain syndrome, a bacterial infection is sometimes not present. Instead, the symptoms are triggered by a neuromuscular dysfunction. Sometimes patients have a congenital condition leading to urine reflux into the prostatic ducts.
How long does it take for antibiotics to work for prostatitis?
Antibiotics are prescribed in most cases of prostatitis. If you have prostatitis symptoms and recently started antibiotic therapy, you probably wonder when you are getting better.
The answer to what happens after being diagnosed and treated depends on the type of prostatitis. Thus, let’s consider each one separately (6,7):
Acute bacterial prostatitis
They usually receive one or two antibiotics at the same time. The duration of the antibiotics varies according to what type of bacterial infections doctors find. For example, if doctors find a gonococcal infection, you might need a single dose of two antibiotics or 7 days of doxycycline. However, the most common treatment lasts for up to 28 days.
In most cases, your symptoms will start to relieve after 1 or 2 weeks of treatment. However, you will have follow-ups with your urologist. Talk to him and refer if your symptoms are persistent or coming back. Sometimes there is antibiotic resistance. In severe prostatitis, patients look very ill (toxic appearance) and may have symptoms of sepsis. In both cases, patients may require hospital admission, and the antibiotic therapy might be extended further.
Chronic bacterial prostatitis and pelvic pain syndrome
In most chronic bacterial prostatitis cases, we can use antibiotics. It is different in patients with pelvic pain syndrome. They only benefit from antibiotics if there is any evidence of inflammation. In these cases, antibiotic therapy should be extensive. It usually takes 4 to 6 weeks until the patient is cured. Patients can alleviate their symptoms with alpha-blockers, analgesics (nonsteroidal anti-inflammatory drugs), and other medications throughout this time.
When you start feeling better is variable between one patient and the other. In some patients, chronic prostatitis becomes a recurrent problem. If your prostatitis is chronic with acute exacerbations, the time it takes for antibiotics to work depends on many factors. So, ask your doctor in these cases to have a more accurate grasp of what to expect in your case.
Does prostatitis ever go away?
Acute bacterial prostatitis is easier to handle than chronic bacterial prostatitis. But chronic bacterial prostatitis is easier to handle than chronic pelvic pain syndrome.
In acute bacterial prostatitis, there’s an excellent chance of recovery after the first round of antibiotics. Thus, prostatitis recovery time is usually 28 days. However, some cases of acute prostatitis complicate with urosepsis. In these cases, patients have a higher mortality rate and may require more extended treatment to cure. This is more common in immunocompromised, diabetes, and dialysis patients. However, even patients with risk factors can be cured of acute bacterial prostatitis.
This is not always the case in chronic bacterial prostatitis. If this is your first time with chronic prostatitis symptoms, there’s a high chance of recovery. Prostatitis can go away with due treatment course. However, you must be disciplined with your antibiotic treatment for as long as your doctor prescribes. It is usually between 4 and 6 weeks.
If you’re experiencing recurring symptoms of bacterial prostatitis, the chance of full recovery reduces. You can feel better but may experience a relapse of signs of prostatitis in the future. This only happens when chronic prostatitis is repeated, and not all men have this problem.
Something similar happens with chronic prostatitis and chronic pelvic pain syndrome. In these cases, there is not always consensus about what to do. Doctors make decisions based on each particular case. Recovery from prostatitis can take a longer or shorter time, depending on a variety of factors. Moreover, chronic pelvic pain syndrome does not have an actual cure. It is sometimes triggered by neuromuscular dysfunction or a congenital problem that leads to urine reflux. None of those can be cured by antibiotics. Thus, symptoms are relieved, and the disease becomes more bearable. However, it may not entirely go away (2).
What happens if prostatitis is left untreated?
The only type of prostatitis that does not require actual treatment is asymptomatic prostatitis.
However, some professionals recommend treating these asymptomatic cases when they are detected. According to some investigation lines, leaving asymptomatic prostatitis untreated leads to chronic inflammation of the prostate and a higher risk of prostate cancer.
But what if you have acute bacterial prostatitis, chronic bacterial prostatitis, or chronic pelvic pain syndrome? In these cases, doctors prescribe medications. Not taking your medications or not completing your treatment can result in the aggravation of your condition. One of these events may occur if you leave symptomatic prostatitis untreated (9, 10):
- Your symptoms may aggravate and force you to look for medical help once again. In some cases, untreated infections can collect in a prostatic abscess.
- If you don’t take the antibiotics as prescribed, you may contribute to antibiotic resistance. This aggravates the prognosis of prostatitis, and you may require hospitalization.
- In acute bacterial prostatitis, some patients find temporary relief of their symptoms after a while. But this doesn’t mean that prostatitis is gone without treatment. Instead, it turns into chronic bacterial prostatitis, which is harder to treat.
- If you’re immunocompromised, a severely ill or dialysis patient, there’s a high risk of complications. Sepsis of urologic origin may develop. This is a very severe and generalized inflammatory state. It requires hospitalization and intravenous antibiotics.
- In chronic prostatitis, an infected prostate left untreated can cause prostate stones (prostatic calculi). According to studies, the presence of prostate stones slightly increases the risk of prostate cancer.
- According to studies, some cases of chronic pelvic pain syndrome have a good prognosis when left untreated. However, it depends on your symptoms and other factors a doctor should look through.
Recovery time for prostatitis depends on many factors. To understand each one, it is important to know the types of prostatitis and their symptoms. We can divide them into:
- Acute bacterial prostatitis, which often features more severe symptoms. It causes fever, perineal pain, and symptoms that suggest obstruction due to an enlarged prostate.
- Chronic bacterial prostatitis, featuring intermittent symptoms. It is usually in patients with recurring urinary tract infections.
- Chronic inflammatory prostatitis and chronic pelvic pain syndrome as a chronic condition that is difficult to treat. It is also known as chronic nonbacterial prostatitis.
- Asymptomatic prostatitis
In acute bacterial prostatitis, the treatment usually lasts 28 days. However, in chronic bacterial prostatitis, it takes 4 to 6 weeks to cure the condition. In chronic pelvic pain syndrome, the condition does not have a cure, but patients can experience significant relief.
Prostatitis recovery time is longer when patients experience complications. For example, if the patient has a prostate abscess or urosepsis in acute prostatitis. If you previously had chronic bacterial prostatitis and recovered but are now diagnosed with chronic bacterial prostatitis again, the chance of recovery is lower. You may experience another episode in the future, even after following your doctor’s treatment.
The only type of prostatitis that does not require treatment is asymptomatic prostatitis. The rest requires treatment. Otherwise, the condition may worsen, or the disease may progress.
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