- Prostatitis: description
- Prostatitis: symptoms
- Prostatitis: causes and risk factors
- Prostatitis: examinations and diagnosis
- Prostatitis: treatment
- Prostatitis: disease course and prognosis
The prostatitis is an inflammation of the male prostate gland. It is a relatively common disease in men, accompanied by pain in bladder emptying (micturition) and ejaculation. Physicians distinguish between acute and chronic prostatitis. Therapy and prognosis depend on the form and causes of prostate infection. Read all about prostatitis here.
ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. N41A54
Causes and risk factors
Examinations and diagnosis
Disease course and prognosis
Prostatitis (prostate inflammation) is an inflammation of the prostate gland of the man. The prostate is located just below the bladder and is about the size of a chestnut. It encloses the first section of the urethra and extends up to the so-called pelvic floor, which is built up of musculature.
The prostate produces secretions that include PSA (Prostate Specific Antigen) and spermine. The PSA makes the ejaculate thinner. Spermine is important for sperm motility.
Prostatitis is mainly associated with severe pain in the perineum and anal area. In addition, symptoms such as frequent urination, pain during urination (micturition) and pain during ejaculation occur during prostate inflammation.
The prostate is relatively often affected by inflammation. It is estimated that around 15 percent of all men in Germany fall ill with prostatitis once in their lives. The chance of getting a prostate infection increases with age. Studies indicate that most cases are between 40 and 50 years old.
In the meantime, an expanded understanding of the term prostatitis has become established in medicine. Under the so-called prostatitis syndrome various complaints in the pelvic area of the man are summarized, which usually have an unknown cause. The term prostatitis syndrome is used to sum up various clinical pictures:
- Acute bacterial prostatitis
- Chronic bacterial prostatitis
- Inflammatory and non-inflammatory chronic pelvic pain syndrome ("Abacterial chronic prostatitis")
- Asymptomatic prostatitis
Acute and chronic bacterial prostatitis
A acute prostatitis is caused by bacteria (acute bacterial prostatitis). The bacteria either pass to the prostate via the blood or spread from a bacterial infection of the bladder or urethra to the prostate. An acute prostatitis is usually a severe general condition with severe pain during urination, fever and chills. Prostate inflammation is caused by bacteria in about ten percent of cases.
From an acute one can chronic prostatitis develop: If a prostate inflammation over a period of more than three months and repeatedly germs in the urine, the so-called prostate exprimate (obtained by massage of the prostate fluid) or in the ejaculate, it is a chronic bacterial prostatitis. It is less fulminant than the acute prostatitis. Although a chronic prostate inflammation triggers pain in urination and possibly a feeling of pressure in the perineal area, but the complaints are usually not as pronounced as in acute prostatitis.
Chronic pelvic pain syndrome (abacterial prostatitis)
In most cases of prostate infection, no bacteria can be detected in urine, prostate exprimate or ejaculate as the cause of the disease. The trigger for prostatitis remains unclear. Physicians call this a chronic pelvic pain syndrome (abacterial chronic prostatitis).
Often, however, white blood cells (leukocytes) can be detected in such cases as an expression of inflammation in the prostate (inflammatory chronic pelvic pain syndrome). To delineate this is another form of the disease in which neither bacteria nor leukocytes are detectable (non-inflammatory chronic pelvic pain syndrome). Overall, chronic pelvic pain syndrome (abacterial prostatitis) is the most common form of prostatitis.
In rare cases, asymptomatic prostatitis occurs. In this form of prostatitis, although there are signs of inflammation, but there is no pain or other symptoms. Asymptomatic prostatitis is usually discovered by chance, for example as part of an infertility study.
Prostate inflammation can trigger a variety of symptoms.While the symptoms of acute prostatitis can be very severe and involve a strong sense of malaise, they are usually somewhat milder in chronic prostatitis. Not every affected man necessarily has all the symptoms listed, and the severity of the symptoms can vary from man to man.
Acute prostatitis: symptoms
Acute prostatitis is often an acute condition in which sufferers suffer from fever and chills. The inflammation of the prostate surrounding the urethra also causes typical urinary symptoms. Urinating causes burning pain (alguria) and the urinary stream is markedly reduced (dysuria) due to swelling of the prostate gland. Because those affected can only excrete small amounts of urine, they have a constant urge to urinate and often need to go to the toilet (pollakisuria). Other prostatitis symptoms include pain in the bladder, in the perineal and back area. Pain can also occur during or after ejaculation.
Chronic prostatitis: symptoms
Prostatitis with a chronic course generally causes less severe symptoms than acute prostate inflammation. Symptoms such as fever and chills are usually completely absent. Symptoms of chronic prostatitis include pressure in the perineal or lower abdomen, browning of the ejaculate by blood in the semen or blood in the urine (hematuria). Libido and potency disorders are also common symptoms in the chronic form, often due to pain during or after ejaculation. The symptoms of chronic bacterial and chronic abacterial prostatitis (chronic pelvic pain syndrome) are not different.
Complications of prostatitis
In prostatitis, in addition to the acute symptoms, it can also lead to complications that complicate the course of the disease and prolong the healing period. The most common complication is a prostate abscess (especially in acute bacterial prostatitis). A prostate abscess is a purulent digestion of the inflammation, which usually has to be opened and emptied by a cut.
As a further complication of prostate inflammation, the inflammation can spread to nearby structures such as the epididymis or testes (epididymitis, orchitis). There are also suspicions that chronic prostatitis is associated with the development of prostate cancer.
Prostatitis: causes and risk factors
Prostatitis can have various causes. On the cause of prostatitis treatment and the forecast of an inflammation depend.
Bacterial prostatitis: causes
In just about ten percent of cases, prostatitis is caused by infection of the prostate with bacteria (bacterial prostatitis). Bacteria can either enter the prostate via the blood (hematogenous) or from neighboring organs such as the urinary bladder or urethra, where they can lead to an inflammatory reaction.
The Escherichia coli bacterium (E. coli), which occurs mainly in the human intestine, is the most common cause of prostatitis. Klebsiella, enterococci or mycobacteria can also cause prostatitis. Bacterial prostatitis can also be caused by sexually transmitted diseases such as chlamydial or trichomonas infections as well as gonorrhea.
In chronic prostatitis, the bacteria in the prostate escaped in a way not yet clarified way of defense by the human immune system. This allows the germs to colonize the prostate permanently. Antibiotics are relatively poor in prostate tissue, which could be another cause of bacterial survival in the prostate.
Chronic pelvic pain syndrome: causes
The exact causes of the chronic pelvic pain syndrome are still not fully understood. Scientists have come up with a variety of theories, each of which sounds plausible, but none of which has been clearly proven. In some cases, genetic material of hitherto unknown microorganisms has been detected in the pelvis. Cause of the pelvic pain syndrome could therefore be microorganisms that are still not cultivable in the laboratory and therefore not detectable.
Another possible cause of chronic pelvic pain syndrome is bladder emptying disorders. Due to the drainage disturbance, the volume of the bladder increases, which thereby presses on the prostate. This pressure eventually damages the prostate tissue, causing inflammation.
As another possible cause, it is believed that inflammation of the bladder tissue can spread to the prostate.
It is also conceivable that a nerve irritation in the vicinity of the prostate leads to pain, which are falsely attributed to the prostate.
Finally, it is also conceivable that an overactive or misdirected immune system causes a chronic pelvic pain syndrome.
However, in many cases, the cause of chronic pelvic pain can not be clearly demonstrated. Physicians then speak of idiopathic prostatitis.
In rare cases, prostatitis is caused by a narrowing of the urinary tract.If the urinary tract is narrowed, the urine builds up and, if it enters the prostate, can also cause inflammation. Such a narrowing can be caused by tumors or so-called prostate stones.
Physicians also suspect that a dysfunction of the pelvic floor muscles may favor the development of prostatitis.
Recently, more and more psychological causes of prostatitis have been discussed. In particular, in the non-inflammatory chronic pelvic pain syndrome a psychological trigger is likely. The exact mechanisms are still unknown.
Risk factors for prostatitis
Some men are particularly at risk of developing prostate infection. These include, for example, men with a disorder of the immune system or a suppressed immune system (for example, by a drug, immunosuppressive therapy). Also, underlying diseases such as diabetes mellitus can promote prostatitis: The elevated blood sugar level in diabetic patients often also leads to increased sugar levels in the urine. The abundant sugar in the urine may provide the bacteria with good growth conditions, making it easier to develop urinary tract infections. In addition, the immune system is weakened in diabetes mellitus.
Another risk factor for prostatitis is a bladder catheter. Introducing the bladder catheter through the urethra into the bladder can result in small tears in the urethra and prostate damage. In addition, as on any other foreign body can settle on a bladder catheter bacteria and form a so-called biofilm. As a result, bacteria can rise along the urethra to the bladder and also lead to a prostate infection.
Prostatitis: examinations and diagnosis
In case of problems with the prostate, the family doctor or a urologist is the right contact person. The general practitioner can take the medical history (anamnesis), but in case of suspected prostatitis he will refer you to a urologist. This performs a physical examination. This is usually the so-called digital-rectal examination in case of suspected prostatitis. However, this study does not provide any clear evidence of prostate inflammation, but only substantiates the suspicion. To detect a bacterial prostatitis, a laboratory examination can follow. If no specific cause is detectable, treatment will be given in case of reasonable suspicion of prostatitis.
Typical questions in the recording of the medical history (anamnesis) can be:
- Do you have pain when urinating?
- Where exactly do you feel the pain?
- Do you have pain in the back?
- Have you noticed any changes in ejaculation?
Digital rectal examination
Because the prostate borders directly on the rectum, it can be palpated over the rectum with your finger. This digital rectal exam is done on an outpatient basis and without anesthesia; it is usually painless. The patient is asked to lie down with his legs bent. Using lube, the doctor then slowly inserts a finger into the anus and scans the prostate and adjacent organs (palpation). He examines the size and sensitivity to pain of the prostate: An inflamed prostate gland is greatly enlarged and very sensitive to pain.
In order to detect possible pathogens, the urine is tested in most cases. The standard method is the so-called four-glass sample. Here the Ersturin, the Mittelstrahlurin, a Prostataexprimat and the Urin are tested after a massage of the Prostata. As Prostataexprimat doctors refer to the secretion of the prostate. The doctor receives this by applying light pressure to the prostate, for example during palpation. The ejaculate can also be examined for pathogens and signs of inflammation.
Using a rectal ultrasound examination (sonography) It can be determined exactly where the inflammation is located and how far it has spread. An important goal of the investigation is also to rule out other diseases with similar symptoms (differential diagnoses).
To rule out that an existing urinary drainage disorder is caused by a narrowing of the urethra, a Urine flow measurement (uroflowmetry) carried out. The patient urinates in a special funnel, which measures the amount of urine per unit of time. A normal urine flow is between 15 and 50 milliliters per second, with a urine flow of ten milliliters per second or less, there is a high probability of an obstruction in the urethra.
Prostatitis: PSA measurement
An elevated blood PSA level (prostate specific antigen) is generally considered to be an indicator of prostate cancer. However, even with prostatitis, PSA levels in the blood can be greatly increased. If the reading is significantly higher, tissue sampling (biopsy) is usually performed and examined in a laboratory to safely exclude prostate cancer.
As with other diseases, prostatitis therapy and duration of treatment depend on the triggering cause.
A acute bacterial prostatitis is treated with antibiotics. In mild cases, an antibiotic dose is sufficient for about ten days. In chronic prostatitis, the medication must be taken over a longer period of time (about four to six months). Depending on the pathogens, the active substances ofloxacin, ciprofloxacin, azithromycin, erythromycin or doxycyclin are suitable. Even if the symptoms are already subsiding, the antibiotics should in any case continue to be taken as prescribed by the doctor. This prevents relapse and reduces the likelihood of recurrence (relapse).
Also one asymptomatic prostatitis is treated with antibiotics.
Is one chronic abacterial prostatitis (chronic pelvic pain syndrome) before, antibiotic therapy is usually ineffective. In inflammatory chronic pelvic pain syndrome, despite the lack of evidence of a pathogen, a trial with antibiotics is worthwhile because sometimes an improvement can be achieved. In non-inflammatory chronic pelvic pain syndrome, however, antibiotic therapy is not recommended.
Further therapeutic approaches of chronic abacterial prostatitis are so-called 5α-reductase inhibitors such as finasteride or dutasteride, pentosan polysulphate and herbal medicines (phytotherapeutics) such as quercetin or pollen extract. If no improvement is achieved, the drug therapy will be supplemented with a physical therapy. Here, exercise therapy, pelvic floor exercises or a regular prostate massage are recommended. In addition, microwave heat therapy can stimulate tissues to increase blood flow and reduce pain.
Symptomatic therapy can also help relieve acute symptoms of prostate inflammation. Painkilling medications can be prescribed for severe pain. Also heat pads and hot water bottles on the back or lower abdomen help to relax the muscles. This often relieves the pain of prostate inflammation.
Home remedies such as a rye treatment or eating soft-shelled pumpkin seeds can also help with the symptoms of prostatitis. Other tips include a regular pelvic floor training, the absence of a sharp bicycle saddle and beer, meat, fat and sugar.
Treatment of complications
If there is a massive obstruction of the urinary outflow as part of the disease, taking a prostate (prostatectomy) may make sense, as residual urine always carries a high risk of infection in the urinary tract.
If the inflammation secrates pus in the prostate (abscess), it must be emptied by a cut. The access route is usually the rectum.
The rate of recurrence in prostatitis is very high overall. About 23 percent of those affected undergo a second episode of illness after a single illness, 14 percent suffer three and 20 percent even four or more cases of illness. To reduce the risk of relapse, avoid wearing wet clothing during or after prostatitis, over-cooling (such as during exercise), or drinking bubbles such as black tea or coffee. This reduces the risk of cystitis and therefore also of prostatitis. However, you can not reliably prevent bacterial prostatitis with these methods.
Prostatitis: disease course and prognosis
The prognosis of prostatitis depends on the one hand on the cause of the inflammation and on the other hand on how quickly the right therapy is started.
In acute bacterial prostatitis, which is treated as soon as possible with antibiotic therapy, the prognosis is usually good. By taking antibiotics, the pathogens are killed, which usually prevents the transition to chronic prostatitis.
Scientists suspect that pain during ejaculation increases the risk of chronic prostatitis. Such pain is a sign of a change in the positional relationships of the structures in the pelvic area, for example, for a blistering of the prostate through the bladder. If this compression persists for an extended period of time, chronic prostatitis may develop.
About 60 percent of all patients with acute prostatitis no longer have symptoms after six months, and around 20 percent develop chronic prostatitis. Treatment and prognosis are more difficult here. In many cases, intermittent episodes of the disease occur, which can accompany those affected for many years.
Chronic prostatitis usually requires enormous patience from those affected. The very often lengthy course can be a major psychological burden. Patients who are affected should seek professional help (for example, psychotherapeutic support) as the mental health situation has a tremendous impact on the prognosis prostatitis Has.
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