Prostatitis – a painful and chronic issue

The prostate is located deep inside the pelvis. The purpose of the prostate is to secrete and store the contents of semen. The weight of an adult male’s prostate is approximately 20–25 grams. Older men have a larger prostate.

Despite its high prevalence, not much is known about prostatitis. Approximately 14% of men in Finland have had prostatitis at some point in their lives. The number of patients with a disease that recurs at least once is considerably high. Young men are as likely to suffer from prostatitis as the elderly, although the disease is more common among older men.

There are at least four types of prostatitis. Only approximately 10% of cases of prostatitis can clearly be diagnosed as bacterial. The most common form of prostatitis is chronic nonbacterial prostatitis.

Acute prostatitis is a disease that involves a sudden onset and, in most cases, a fever as well as difficult urinary problems and pain in the pelvis that radiates into the genital area.

The onset mechanisms of chronic prostatitis are still unknown for the most part. Only relatively little scientific research concerning the matter has been done. Several different theories of the mechanisms have been presented. It is possible that the disease is an autoimmune reaction in which the body produces the inflammation. However, it is also possible that the flow of urine is directed from the urethra back into the prostatic ducts, causing a chemical irritation of the tissue. Structural and functional obstructions in the flow of urine can also have an effect on the onset of the disease.

Whatever the onset mechanisms of the inflammatory process might be, the condition typically causes swelling and reduced oxygen saturation of the tissue and local damage to cells caused by various inflammatory mediators.

Symptoms of prostatitis

Chronic prostatitis includes a wide range of symptoms. They develop over time, unlike in the case of acute prostatitis. The symptoms can vary between individuals and also between different incidents in a single individual. Common symptoms include urinary symptoms, such as frequent urination, burning sensation when urinating and urinary problems. Prostatitis can resemble a sexually transmitted disease by causing an itching or burning sensation in the urethra or its meatus. The most common symptom probably is a dull pain in the lower abdomen that radiates into the scrotum, perineum, inner thighs, groin and even the lower back. It is hard to determine the location of the pain.

Prostatitis can also have an effect on sexual activity by causing pain during ejaculation or erectile dysfunctions. Any traces of blood in semen can be caused by prostatitis. Chronic pain can be very unpleasant and increase the risk of depression and irritation. Prostatitis and its painful symptoms, in particular, can last for several weeks or months. Some men are likely to experience permanent recurrence of the disease.

The diagnosis of the disease is based on the typical symptoms. In a rectal examination of the prostate, the prostate is typically very sensitive to touch. There are no specific laboratory tests that would directly indicate the type of disease. The blood tests commonly used to detect the presence of an inflammation are usually within the reference range. The results of the urine sample analysis are perfectly normal. The inflammation can increase the level of PSA significantly, which may lead to a false diagnosis of prostate cancer, especially if the patient is under 50. A diagnostic prostatic massage examination is usually recommended in order to detect the presence of bacteria, but in practice, it is difficult to perform this procedure at a normal appointment. Bacteria can also be isolated from the semen. Most commonly detected bacteria include Escherichia coli, enterococci and staphylococci bacteria. The interpretation of the results is sometimes difficult. It is not always obvious which results are truly significant.

Warmth can prevent prostate issues

The treatment of prostatitis is primarily based on experience, a single specific medication is not known. Warmth and dressing warmly are known to help. Car seat warmers should be kept on. All kinds of hot packs are useful. Warm baths are also recommended. However, the homes of most patients are no longer equipped with a bath.

According to current guidelines, antibiotics should be used if the symptoms of prostatitis arise. The ideal duration of the antibiotic therapy should be several weeks. For some unknown reason, antibiotic therapy is helpful to approximately half of the patients regardless of whether the presence of bacteria has been detected or not. There has been a lot of criticism regarding the need for antibiotic therapy. It is possible that the antibiotics used have other mechanisms that prevent inflammatory processes in addition to the elimination of bacteria.

Alpha inhibitor medications decrease tension in the smooth muscle tissue. They are shown to be useful in the alleviation of urinary problems, in particular. Decreasing the tissue pressure in the prostate is also likely to help the antibiotic reach the prostate.

Treatment of prostatitis

Non-steroidal anti-inflammatory drugs (NSAIDs) are conventionally used in the treatment of prostatitis. They reduce the inflammation by preventing the generation of inflammatory mediators in the tissue. The also alleviate the pain and the swelling of the tissue. If the pain persists, however, they are not efficient enough. It is apparent that prolonged pain can damage and disturb the transmission of pain signals in the nervous system, causing the pain to persist.

Nowadays, in case of prolonged pain, painkillers used in the treatment of neuropathic pain, such as amitriptyline, are prescribed in addition to conventional painkillers. According to my experiences, pregabalin is also an efficient mode of alleviating prolonged pain. These medications belong to the groups of antidepressants and anticonvulsants.

Medications that reduce the size of the prostate can be helpful to patients who experience prostatic hyperplasia. They are effective approximately after several months of treatment, however. Emptying the prostate regularly by ejaculation or prostatic massage can alleviate the symptoms of some patients.

Other medications and modes of treatment have been applied with varying degrees of success. There is no clear indication of the effectiveness of allopurinol, a medication used in the treatment of gout. Physiotherapy may be helpful in relieving tension in the pelvic floor muscles. Bioflavonoids can also be helpful to some extent. Various modes of operative thermotherapy for the prostate can be recommended only on a case by case basis. Other surgical modes of treatment are not helpful if an obstruction of emptying the bladder cannot be detected.

Pharmacological therapy often relies on a combination of various medications and, if the condition persists, the therapy has to be customised entirely in order to ensure a proper response to treatment.

According to empirical research, exposure to cold should be avoided as a prophylactic measure. In addition, exposure to vibration or sitting for long periods may cause the onset of the symptoms. Swimming in cold water and cycling are not recommended.

Chronic prostatitis can be very stressful both physically and mentally. A link between prostatitis and prostate cancer or infertility has not been established. The condition does not place any restrictions on sexual activity, as the disease is not infectious. It is important to establish a permanent relationship with a personal doctor in order to treat persistent prostatitis ideally, as this enables determining the appropriate mode of treatment through various experiments.

Learn more:

Men’s health

Prostatitis (in Finnish)

Prostatic hyperplasia (in Finnish)

Specialists and locations

Martti Ala-Opas
LKT,DOS, kirurgian-ja urologian erikoislääkäri
Harri Backman
Kirurgian ja urologian erikoislääkäri
Andrei Dejev
Urologian erikoislääkäri
Patrik Ehnström
LL, yleislääkäri, urologian erikoislääkäri