Overview
Prostatitis is a condition that affects the prostate gland in men and people assigned males at birth, which is associated with inflammation. Inflammation is the body’s reaction to tissue injury. It can also involve areas around the prostate gland within the pelvic area.
The National Institute of Diabetes and Digestive Kidney Diseases(NIDDK) developed a classification system for prostatitis.
This system has for categories, which are; I, II, IIIa , IIIb and IV.
- I is acute (bacterial) prostatitis. It needs urgent medical attention.
- II is chronic bacterial prostatitis. It is rare and presents as intermittent UTIs.
- IIIa is inflammatory chronic prostatitis/ chronic pelvic pain syndrome. It is not due to bacteria.
- IIIb is non-inflammatory chronic prostatitis/chronic pelvic pain syndrome, which is also non-bacterial.
- IV is asymptomatic inflammatory prostatitis
Key Facts
- It occurs exclusively in men and people assigned male at birth.
- Bacterial prostatitis (BP) occurs in bimodal distribution in younger and older men.
- Prevalence is approximated as 8%-16%.
- More than 2 million people visit urologists for prostatitis symptoms.
Causes
Different forms of prostatitis have various causes.
Causes of bacterial prostatitis;
- Sexually transmitted infections such as gonorrhea, syphilis and chlamydia
- Prostate biopsy
- UTIs
- Prostate stones
- Injury or damage to pelvic region.
- Infections of the bladder and formation of bladder stones
Causes of CPPS and non-bacterial prostatitis;
- Damage or injury to muscles of the pelvic floor
- Stress
- Irritation of the pelvic nerve
- Auto-immune diseases
Risk Factors
- Age. Being older than 50 years.
- Medical conditions such as BPH(benign prostatic hyperplasia), where the prostate becomes enlarged.
- Sexual abuse.
- History of prostatitis.
- Recent bladder infection.
- Congenital anomaly of the ureter.
- Unprotected vaginal intercourse.
- Indwelling catheter (prolonged catheterization and instrumentation)
- Trans-urethral biopsy.
- Urinary tract infections(UTIs)
Signs & Symptoms
Non-bacterial prostatitis may lack symptoms.
Acute bacterial prostatitis, chronic bacterial prostatitis and CPPS(chronic pelvic pain syndrome) share symptoms such as;
- Dysuria- Painful urination.
- Hematospermia- Blood is present in semen.
- Hematuria.-Blood in urine.
- Dyspareunia-Pain when having sex.
- Painful ejaculation.
- Erectile dysfunction.
- Lower abdominal pain and pains in the genitals.
Diagnostic Tests
Diagnosis of prostatitis involves;
- Physical examination
- Medical history and review of patient symptoms
Tests such as:
For diagnosing bacterial infections. These include;
- Prostatic specimen test
- Digital rectal exam
- Urine test
- Blood tests
Other tests include;
- Imaging of the pelvic region
- Urodynamic tests
Differential Diagnosis
For bacterial acute prostatitis, this can be;
- Prostate cancer
- UTIs
Treatment & Management
This is dependent upon the kind of diagnosis made and the presenting symptoms.
- Antibiotics are used to treat acute or chronic prostatitis.
- Pain treatment and management using non-steroidal anti-inflammatory drugs(NSAIDs) such as ibuprofen, ketorolac or analgesics such as paracetamol. Neurologic pain is treated with amitriptyline or gabapentin.
- Urinary symptoms can be managed using alpha-blockers. They relax bladder neck where prostate and bladder join. This can ease symptoms like difficulty urinating.
- Psychological symptoms such as stress, anxiety and depression due to the condition can be managed through psychotherapeutic interventions with specialized professionals.
- Quercetin relieves inflamed prostate gland.
Alternative therapeutic interventions;
- Acupuncture
- Herbal remedies.
- Prunus africana leaves
- Kegel exercises
- Staying hydrated
Complications
- Abscess.
- Epididymitis(inflammation of the vas deferens).
- Chronic pelvic pain.
- Sepsis.
- Sexual dysfunction.
Ways of Prevention
- Practice safe sex to prevent prostatitis from STIs
- Early treatment of UTIs