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Prostatitis

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The Health Index

Prostatitis is inflammation of the prostate gland, the prostate. It can cause men considerable harm. Pain - especially around the perineum and when urinating - is an indication the prostate may be inflamed. More recently, prostatitis has been referred to as “prostatitis syndrome”. Doctors have summarised several clinical pictures under this term, according to categories defined by the US National Institute of Health.

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With a prevalence of 2.2-9.7%, prostatitis is more common than you might think. Approximately 15% of men will experience symptoms of prostatitis at some point in their lives. On average, men who contract prostatitis are between 40 to 50 years of age. In about 30% of men, prostatitis lasts longer than a year. In about half of them, the prostatitis turns into a chronic form. Many experience several relapses; prostatitis can be persistent. Chronic prostatitis is much more common than acute prostatitis.

What are the causes?

In 5-10% of men with acute prostatitis, infection with bacteria is the cause of the inflammation. The bacteria spread either through the blood or the urinary tract (bladder, urethra) to the prostate gland. Bacteria that cause sexually transmitted diseases (STD) can also play a role: Chlamydia, trichomonads or Neisseria gonorrhoeae (gonorrhoeae). Acute prostatitis can turn into chronic bacterial prostatitis. This is the case if the inflammation has subsided after three months.

 

However, the chronic form causes less severe symptoms, such as painful urination. In chronic pelvic pain syndrome, doctors cannot detect bacteria in the urine or ejaculate. That is why this condition is called “abacterial chronic prostatitis”. However, germs that cannot be detected in the laboratory might also play a role here. Doctors often find an increased number of white blood cells (leukocytes), which means that there is inflammation in the body.

 

Doctors call this form of prostate inflammation an inflammatory, chronic pelvic pain syndrome. If neither bacteria nor elevated white blood cells are detectable, the condition is called non-inflammatory, chronic pelvic pain syndrome. The cause of this form of prostate inflammation can be hard to find. In asymptomatic prostatitis, doctors find signs of inflammation in the blood, but the man does not experience any symptoms, such as pain. Doctors often discover this form of prostate inflammation by chance during an examination.

There are some factors known to increase the risk of prostatitis. These include, but are not limited to:

  • Chronic disease, such as diabetes mellitus. Elevated sugar levels in urine provide an ideal environment for bacteria to multiply. HIV/AIDS also increases the risk of prostatitis.   

  • An earlier inflammation of the prostate gland.

  • Cystitis or urethritis.   

  • Pelvic injuries, for example from cycling or riding.   

  • Bladder catheter: This is where bacteria can settle and enter the prostate via the urinary tract. Even tiny injuries caused by the catheter make it easier for bacteria to enter the prostate.  

  • Suppressed immune system, for example by immunosuppressants after an organ transplant a previous prostate biopsy.

What are the symptoms?

An acute inflammation of the prostate, which usually sets in without much warning, can be very painful. Men with prostatitis will also feel very ill overall. The main symptoms are:

  • Painful, burning, stinging urination  

  • Difficulty urinating: Dribbling, delayed onset  

  • Weak, thin stream of urine: the reason is that the prostate gland surrounding the urethra is swollen and constricts the urethra  

  • Constant need to urinate because the bladder does not empty completely