Prostatitis and pelvic pain syndrome

The male prostate – also known as the prostate gland – is roughly the size of a chestnut and located below the bladder. The gland produces some of a man’s seminal fluid. Its muscles also act as a kind of control gate, enabling either urine to flow through the penis or ejaculation to occur.

In medical terms, an inflamed prostate is known as prostatitis. The condition is rather common. As the prostate surrounds part of the urethra, the inflammation often causes pain when urinating. A weak flow of urine and the need to frequently urinate (urinary urgency) are also typical symptoms.

One possible cause of prostatitis is a bacterial infection. Known as bacterial prostatitis, this can be either acute or chronic (persistent). If no bacteria can be detected, the condition is referred to as abacterial prostatitis or pelvic pain syndrome. The precise causes of this are still largely unclear.

The way in which the condition is treated and how long it lasts depend on the type of prostatitis.

Pain when urinating is a typical symptom of prostatitis (inflammation of the prostate). Specifically, this often means a burning sensation. Furthermore, the urine stream is often weak and the bladder does not fully empty itself. As a result, some men have to go to the toilet with great frequency.

Pain can also be experienced in the anal and perineal region as well as after ejaculation.

In the case of acute bacterial prostatitis, patients also frequently feel extremely unwell with a high temperature, chills and malaise.

Chronic prostatitis and pelvic pain syndrome usually cause milder symptoms without a high temperature and chills. However, in addition to the problems when urinating, typical symptoms also include persistent pain in the perineal region, testicles and penis. A persistent need to urinate is also a possible indication of chronic prostatitis.

A loss of sexual drive (libido) and erectile dysfunction may also occur.

Prostatitis is usually caused by the bacterium Escherichia coli, which normally lives in the intestines. However, it can also be caused by sexually transmitted pathogens such as chlamydia or gonococci, the cause of gonorrhea (colloquially known as the clap). The pathogens can enter the prostate via the urethra or, in rarer cases, the bladder or blood, and cause inflammation.

With chronic bacterial prostatitis, the immune system fails to sufficiently combat the pathogens, so the condition persists for longer. It can sometimes also take a while for doctors to find the right type of antibiotics to combat the bacteria that are causing the condition.

The cause of pelvic pain syndrome is still unknown. Doctors suspect that inflammation that has affected other organs spreads to the prostate. A misguided immune system, persistent bladder-emptying disorders and nerve irritation are also possible causes.

Men with weakened immune defenses – for example due to chemotherapy that suppresses the immune system – tend to be more susceptible to prostatitis.

In some cases, people who drink a lot of alcohol or have diabetes mellitus also have a weak immune system. This explains why men with diabetes are more likely to get bacterial infections such as prostatitis. An enlarged prostate may also cause a propensity to prostatitis.

Bladder and urethra surgery, such as the insertion of a bladder catheter, increases the likelihood of prostatitis: Bacteria can settle on the catheter and get into the bladder – and ultimately cause inflammation in the prostate.

Prostatitis is relatively common: Up to 16 percent of men have prostatitis at some point in life. Bacteria can be definitively proven to have caused the condition in about 5 to 10 percent of cases.

Sixty to eighty percent of all men with acute prostatitis no longer have any symptoms 6 months after treatment.

In the case of chronic prostatitis or pelvic pain syndrome, the symptoms persist for more than 6 months or permanently. The symptoms can also recur in episodes. The pain can sometimes be so severe that it affects everyday life and reduces quality of life. Research has yet to conclusively determine exactly why prostatitis becomes a chronic condition in some men but not others.

People with suspected prostatitis should consult a family doctor or specialist urology practice. First, patients will be asked about their medical history and symptoms. A physical examination usually follows. For example, a doctor may perform a digital rectal examination by inserting a finger into the rectum to feel whether the prostate is enlarged.

A urine sample is tested in a laboratory to determine whether bacteria or other pathogens are triggering the symptoms. Midstream urine, i.e. the middle part of the urine stream when emptying the bladder, is usually used to this end. A more complex method is the “four-glass test” where the first urine of the day, the midstream urine and the urine following a prostate massage are examined. The prostatic exprimate – a secretion produced by the prostate – is also analyzed.

The urine samples are used to create a bacterial culture in order to precisely identify the pathogens and select an appropriate antibiotic.

In some cases, a blood test may also follow: Increased levels of both inflammation and the prostate-specific antigen (PSA) indicate prostatitis. PSA is a protein that only prostate cells produce. It is also a component of prostate fluid. If the prostate changes or the tissue is irritated – for example due to inflammation – more PSA enters the blood.

Depending on the nature and severity of the symptoms, an ultrasound examination of the prostate is sometimes also performed. This is known as a transrectal ultrasound and is carried out from the anus. It makes it possible to determine if the prostate is greatly enlarged and whether any abscesses have formed.

If prostatitis has been caused by bacteria, antibiotics that combat the specific type of bacteria can help.

If the inflammation is very pronounced, the patient has a high temperature or bacteria have already spread through the body in the bloodstream, hospital treatment may be necessary. Here, the antibiotic is injected into the body via a vein so that it takes effect faster and can be administered in a higher dose. This aims to prevent life-threatening blood poisoning (sepsis).

Pelvic pain syndrome is often treated with a combination of alpha blockers and anti-inflammatory medication. Alpha blockers relax the muscles, allow urine to flow more easily and alleviate discomfort when urinating.

In the case of erectile dysfunction, vasodilators can help.