Inflammation of the Prostate

Generality

Inflammation of the prostate is an exclusively male problem and quite widespread, so that statistics in hand, affects 8.2% of men on at least one occasion in a lifetime.

It should be remembered that the prostate is the chestnut-shaped organ, located under the bladder, which contributes significantly to the formation of the sperm.

Inflammation of the prostate, better known in the medical field as prostatitis, may depend on infectious (to be precise bacterial) or non-infectious causes.

The symptomatic picture of inflammation of the prostate is typical and generally consists of: pain in the pelvic area, pain in the scrotum, pain in the lower back, urinary disorders (dysuria, stranguria, urgent need to urinate etc.), painful ejaculation, painful defecation etc.

For an accurate diagnosis of prostate inflammation, it is essential to carry out numerous patient examinations and investigations; the purpose of a highly articulated diagnostic procedure is mainly to understand the causes of the inflammatory state.

Treatment varies depending on the trigger: infectious prostate inflammation requires antibiotic therapy, while non-infectious prostate inflammation needs other forms of treatment, not always specific and with mixed results.

Types of prostatitis

The types of prostate inflammation are 4 and correspond, to be precise, to:

• acute prostatitis of bacterial origin (type I),
• chronic prostatitis of bacterial origin (types II),
• non-bacterial chronic prostatitis (type III)
• asymptomatic prostatitis (type IV).

To define this classification was a US health agency, known as the National Institute of Diabetes and Digestive and Renal Diseases or NIDDK, exactly in 1999; in reality, NIDDK reworked a classification of prostatitis dating back to 1968, which called prostatodynia chronic non-bacterial prostatic inflammation and excluded asymptomatic inflammation of the prostate (because its existence was unknown).

Current classification of various types of prostate inflammation
Type I	Acute prostatic inflammation of bacterial origin.
Type II	Chronic prostatic inflammation of bacterial origin.
Type III	Chronic non-bacterial prostatic inflammation (these prostatitis also fall under the heading of chronic pelvic pain syndrome). Subtype IIIA: chronic inflammatory pelvic pain syndrome. Subtype IIIB: non-inflammatory chronic pelvic pain syndrome.
Type IV	Asymptomatic inflammation of the prostate.

Inflammation of the acute prostate of bacterial origin

Inflammation of the acute prostate, of bacterial origin, is a form of prostatitis caused by bacteria, whose symptoms appear abruptly and suddenly.

Also known as type I prostatitis, this inflammation of the prostate may be the consequence of:

• urinary tract infection,
• sexually transmitted infection,
• an infection of the testicles (epididymitis),
• the abnormal invasion of the prostate by the bacteria that normally inhabit the rectum,
• the presence of phimosis,
• a prostate biopsy procedure,
• a traumatic injury in the perineal area
• an obstruction of the bladder neck.

The typical symptoms and signs of type I prostatitis are:

• high fever with chills,
• pelvic pain,
• scrotal pain,
• pain in the lumbar area of ​​the back,
• inguinal pain,
• various types of urinary disorders (dysuria, stranguria, urgent need to urinate, hematuria, etc.),
• hemospermia,
• painful ejaculation,
• painful defecation
• pain during sexual intercourse.

To diagnose acute inflammation of the prostate, of bacterial origin, are fundamental: physical examination, medical history, digital rectal exploration and a series of laboratory tests on urine, blood and sperm samples.

Due to a late diagnosis, or if the treatments are inadequate, type I prostatitis can be responsible for several complications, including: bacteremia, inability to urinate, formation of a prostatic abscess, spread to neighboring organs of infection and chronicization of the inflammatory state (chronic prostatitis of bacterial origin).

Risk factors of acute bacterial prostatitis:

• The presence of a bacterial infection in the urinary tract (cystitis, urethritis, etc.);
• Drink a little water. It is a risk factor for bacterial urinary tract infections;
• Unprotected sexual relations with people suffering from a sexually transmitted infection;
• Having multiple sexual partners;
• Bladder catheterization;
• A previous prostate biopsy intervention;
• The presence of lesions at the level of the rectum;
• The immunosuppression. Two major causes of immunodepression are AIDS and diabetes;
• The presence of an orchite;
• The stress.

Inflammation of the chronic prostate of bacterial origin

The inflammation of the chronic prostate of bacterial origin is the prostatitis caused by bacteria, whose symptomatology appears gradually and has a characteristic persistence (the chronic term refers precisely to the persistent character).

Also known as type II prostatitis, chronic inflammation of the prostate of bacterial origin can be: the outcome of the non-treatment of acute prostatitis of bacterial origin, the consequence of a urinary tract infection or, finally, the complication of an epididymitis (testicular infection).

The symptoms and signs of chronic prostatitis of bacterial origin are reminiscent of the characteristic disorders of acute prostatitis of bacterial origin; of different have:

• The mode of appearance, which - as stated - is gradual;
• The severity, which is lower;
• The peculiarity of "coming and going", in the sense that they alternate periods in which they seem to have disappeared totally to periods in which they recur in a striking manner;
• The duration, which is decidedly greater. The symptoms and signs of type II prostatitis may persist for several months.

The diagnostic procedure for detecting chronic prostatic inflammation of bacterial origin is the same as for acute forms of bacterial origin; therefore, it is essential to diagnosis: physical examination, medical history, digital rectal exploration and laboratory tests on urine, blood and sperm samples.

In the absence of adequate treatment, different complications can result from a type II prostatitis, including: the inability to urinate, bacteremia or sepsis, and prostate abscess.

There is not enough scientific evidence to support the thesis that inflammation of the prostate - acute or chronic - of bacterial origin would, in some way, favor the development of prostate cancer.

Risk factors for chronic bacterial prostatitis:

• The use of the bladder catheter (bladder catheterization);
• The presence of a urinary tract infection;
• The presence of urethral stricture;
• The presence of a testicular infection;
• Benign prostatic hypertrophy (or enlarged prostate);
• The presence of risk factors of urinary tract infection (eg: poor fluid intake, etc.);
• A history of prostatitis;
• Neglect in the treatment of acute bacterial prostatitis;
• The traumas to the urinary system;
• The presence of systemic infections.

Inflammation of the chronic non-bacterial prostate

Inflammation of the chronic non-bacterial prostate is the gradual and persistent appearance prostatitis, which does not depend on the presence of bacteria in the prostate gland.

Also known as type III prostatitis or chronic pelvic pain syndrome, it arises for reasons that doctors and researchers, despite numerous studies, have not yet fully clarified. Some experts suspect of nervous damage; someone else has hypothesized an autoimmune origin; someone else has blamed the appearance of the condition on: an excess of stress, trauma at the prostate, heavy work activities and the practice of high-impact sports.

Excluded fever, the symptoms and signs of non-bacterial chronic prostatic inflammation are similar to the symptoms and signs of prostatic inflammation of bacterial origin.

As a rule, to diagnose chronic type III prostatitis, doctors use (again) the same tests and laboratory tests, which they would use in the presence of a suspected bacterial prostatitis. Moreover, the only way to know if an inflammation of the prostate has a bacterial or non-bacterial origin is to look for the presence of bacteria in the blood, urine, prostatic fluid and sperm.

The chronic pain that characterizes type III prostatitis can be responsible, in some patients, for episodes of depression and anxiety.

The two subtypes of chronic pelvic pain syndrome

The most recent classification of prostatitis distinguishes type III prostatitis in two subtypes: chronic inflammatory pelvic pain syndrome (or subtype IIIA ) and non-inflammatory chronic pelvic pain syndrome (or IIIB subtype ).

This distinction derives from the curious observation of non-bacterial chronic forms of prostatitis, characterized by large quantities of white blood cells in the blood, urine and sperm (an unequivocal sign of severe inflammation), and other forms of chronic non-bacterial prostatitis, characterized by from small amounts of white blood cells in the same organic liquids.

Asymptomatic inflammation of the prostate

The so-called asymptomatic inflammation of the prostate is prostatitis which, in the men concerned, does not produce any symptoms, although it is responsible for a marked inflammatory process at the prostate level. It would seem a contradiction, yet it is so: there is inflammation at the level of the prostate gland - all the diagnostic tests clearly show it - but this inflammation is not associated with the presence of symptoms and signs, so that the affected person ignores to be affected from prostatitis and discovers it only for a chance case, perhaps during an examination carried out for other reasons.

Asymptomatic inflammation of the prostate is also called type IV prostatitis or asymptomatic inflammatory prostatitis .

Despite numerous studies on type IV prostatitis, doctors have not yet understood the triggers and reasons for the lack of symptoms.

Outline of therapy

The treatment of inflammation of the prostate depends on the triggering causes (is it bacterial? Is it not bacterial?) And on the characteristics of the inflammatory process (is it acute? Is it chronic? Is it asymptomatic?).

In principle, the therapy of prostatic inflammation with bacterial origin involves:

• Antibiotics . They are essential to fight the triggering agent, or bacteria;
• Anti-inflammatories . They reduce inflammation and consequently mitigate the painful symptoms;
• Alpha-blockers . By releasing the smooth muscles of the bladder and prostate, they can alleviate urinary disorders in many patients.

If the treatment of bacterial prostatitis is clear and definite, the treatment of non-bacterial chronic forms is not at all and, in some circumstances, raises several discussions. Currently, doctors are inclined towards a therapy that includes:

• Anti-inflammatories, especially if diagnostic tests confirm the presence of the so-called chronic inflammatory pelvic pain syndrome;
• Painkillers ;
• Alpha-blockers;
• Laxatives . Some patients seem to benefit from using these drugs.

If there are any complaints due to prostatic inflammation, especially in the presence of fever, urinary burning or the urge to urinate, it is very important to contact the urologist specialist early. In fact, curing prostatitis in its onset is much easier and more effective than in cases that have become chronic; the risk of complications is also avoided following acute infectious phenomena, such as urine retention (inability to urinate) and prostatic abscess.

Antibiotic therapy: medical recommendations

For patients with inflammation of the prostate of bacterial origin (acute or chronic does not matter), doctors scrupulously recommend to follow and complete the antibiotic therapy according to the indications that they themselves have given; therefore, for no reason, even if the symptoms disappear even after a few days of treatment, the persons in care must stop the hiring prematurely.

All this is explained by the fact that, only by respecting these recommendations, are the foundations for a good, if not optimal, cure.

Although it is true that such prolonged therapy decreases the immune defenses and tends to alter the intestinal bacterial flora in negative, the benefits obtained are far superior to the possible side effects.

Treatment of complications resulting from bacterial prostatic inflammation

The formation of a prostatic abscess requires a small surgical procedure to drain the pus.

Bacteraemia and sepsis require further antibiotic treatment, to be added to that against pathogens responsible for prostatic inflammation and to be performed in a hospital setting, under the close observation of a doctor. In fact, bacteremia and sepsis represent two medical emergencies and require the immediate intervention of specific personnel who are experts in the field.

Finally, the inability to urinate forces patients to use the bladder catheter to empty the bladder.

Medical advice in the presence of inflammation of the bacterial prostate

During the treatment of inflammation of the prostate of bacterial origin, doctors strongly recommend:

• Drink a lot of water;
• Refrain from sexual practice (NB: remember that the partner should also follow antibiotic therapy);
• Take hot baths;
• Avoid using the bicycle;
• Always use a pillow when sitting for long periods of time;
• Avoid the consumption of coffee, alcohol and spicy foods;
• Use phytotherapeutic decongestants (decoctions and infusions based on gramigna, equiseto, parsley root, artichoke leaves, sage, birch, bearberry or dandelion).

The implementation of these remedies seems to alleviate the symptoms and favor the resolution of ongoing prostate inflammation.