What is chronic prostatitis?
Health is a priority issue for each person and therefore must be reviewed by professionals periodically and without hesitation. A medical check-in time can make the difference regarding the evolution of a disease that may become more serious than it already is.
It is the case of chronic prostatitis. Today, in this article, we want to give you information about this disease, its characteristics, and what treatments you should follow to reduce the condition.
There are two main types of chronic prostatitis.
- “Chronic bacterial prostatitis” is caused by a persistent (chronic) infection with a germ (a bacterial infection).
- And “Chronic prostatitis / chronic pelvic pain syndrome has a not fully understood cause.
Chronic prostatitis usually causes pain in the lower pelvic region of men. Urinary symptoms such as the abnormal frequency of urine may also be present.
Treatment can be complex and may include antibiotics and other medications. The symptoms can last long, although they may “come and go” or have varying severity.
What is the prostate gland?
It is the cross-section of the prostate and nearby organs. The prostate gland is only found in men. It is located just below the bladder. It is usually the size of a chestnut.
The urethra is the tube that passes urine from the bladder and runs through the middle of the prostate. The prostate helps to produce semen, but most semen is made by another gland (the seminal vesicle).
And at what point does chronic prostatitis occur?
Prostatitis means that you have inflammation in your prostate gland. Prostatitis can occur suddenly (acute) or persistently (chronic). However, it can also be caused by an infection (infectious) or, on the contrary, not contagious.
At the diagnosis of chronic prostatitis, symptoms must have been present for at least three months. In the case of acute prostatitis, symptoms usually appear and disappear much more quickly, almost without warning.
It should be kept in mind that there are two main types of chronic prostatitis, namely:
- Chronic bacterial prostatitis.
- Chronic prostatitis / chronic pelvic pain syndrome (CPPS).
Who is more likely to get chronic prostatitis?
Unlike what is usually believed, chronic prostatitis is quite common, more than we imagine. According to figures from public and private health institutions, approximately two men for every ten will have chronic prostatitis at some point during their lives.
It should be noted that chronic prostatitis most commonly affects men between the ages of 30-50, but men of any age can be affected.
Approximately 9 out of 10 men with chronic prostatitis have chronic prostatitis / chronic pelvic pain syndrome (CPPS). About 1 in 10 men with chronic prostatitis have chronic bacterial prostatitis, which is rare compared to chronic prostatitis / CPPS.
We have already said that chronic bacterial prostatitis is infectious prostatitis. And that is caused by a persistent (chronic) infection with a germ (a bacterial infection) of the prostate gland.
We can say that a man with chronic bacterial prostatitis will usually have recurrent urinary tract infections. Chronic bacterial prostatitis is usually caused by the same germs (bacteria) that cause urinary tract infections.
The prostate gland can harbor the infection so that recurrent infections may occur. However, we should not mistakenly think that, for this reason, chronic bacterial prostatitis may be a sexually transmitted infection.
Men with chronic bacterial prostatitis tend to have symptoms that diminish gradually.
During an outbreak, you may have or feel pain and discomfort. You may feel these pains locally at the base of your penis and even around your anus or just above your pubic bone and on your lower back.
However, the pain can spread to your penis and testicles. And even at the moment of excreting the stool, the evacuation may become painful. You may also have symptoms of a urine infection, as long as there is frequent urination or urination or an urgent desire that you can not control effectively.
These symptoms are similar to the symptoms of acute bacterial prostatitis. However, men with an outbreak of chronic bacterial prostatitis tend to be less sick than those with acute prostatitis.
For example, a high temperature (fever) is less likely to have general pain.
If you have chronic bacterial prostatitis, your symptoms are usually relieved when treated with antibiotics, so you should not worry much. However, unless the antibiotics completely cleanse the infection from the prostate gland, you are at risk of contracting the symptoms of the disease again.
Between the outbreaks, it can have a slight residual pain and, aside from some urinary symptoms of minor intensity, for example, how to urinate frequently or the urgency to do it.
What causes chronic prostatitis?
Now that we know that chronic prostatitis is a persistent discomfort or intense pain that you feel in your lower pelvic region; Mainly at the base of your penis and around your anus, and it is usually diagnosed if you have had pain for at least three months within the previous six months; we can move on to its causes.
First of all, it must be said that the causes of this type of chronic prostatitis have not been fully defined. Many theories have been presented to explain the reasons.
The most basic and general ones include:
- Infection of the prostate with a germ that has not yet been identified.
- Nervous problems that affect the prostate.
- An autoimmune problem of the prostate gland (antibodies that we usually produce to fight the infection may be attacking the cells of the prostate gland for some reason).
- Inflammation resulting from the presence of urine
However, the scientific community continues to study the possible causes of this type of prostatitis.
Antibiotics are the most common therapy used to treat chronic prostatitis. The eradication of bacteria is associated with short and long-term clinical success caused by traditional and non-traditional bacteria.
Studies have shown that patients with a recent diagnosis of prostatitis who have no experience with antibiotics have an excellent symptomatic response, regardless of the condition of the culture.
In contrast, men with chronic prostatitis or long-standing chronic pelvic pain syndrome (CPPS) who have been previously treated do not improve symptoms with antibiotic treatment and, therefore, should not be given antibiotics.
Antibiotic therapy can cure chronic prostatitis caused by bacteria, but relapses are common. Chronic prostatitis in men with prostate stones is harder to fix.
Fluoroquinolones are the mainstay in the treatment of chronic prostatitis. Fosfomycin has been shown to have good activity against organisms that produce extended-spectrum beta-lactamases.
Azithromycin may be more effective for Chlamydia infections. Most other antimicrobial agents are unlikely to eradicate the disease.
Although bacteria are cultured in only 5% -10% of prostatitis cases, bacteria may still be the cause of chronic prostatitis in many patients with this syndrome.
Studies using extensive research methods (e.g., reverse transcriptase-polymerase chain reaction assay) show bacterial infection in some patients despite negative urine cultures.
The negative culture results are produced for various reasons, including insufficient sample volume, the initiation of antibiotics before obtaining a sample of expressed prostatic secretion, and the presence of demanding organisms.
In such cases, patients often improve symptoms with antibiotic treatment. Therefore, if clinical evidence suggests chronic prostatitis in patients with negative cultures, it is worth a 2-week antibiotic test. If symptoms improve, prescribe a complete course of antibiotics.
In most cases, symptomatic treatment with analgesics and alpha-blockers can be used to help relieve symptoms.
Surgery is usually not indicated for chronic prostatitis. However, in selected situations when a patient has episodes of chronic prostatitis that improve with antibiotics but then reappear, transurethral resection of the prostate (TURP).
As well as, transurethral vaporization of the prostate (transurethral suppression of the prostate, its acronym in English is TUVP) can eliminate a nest of infection. This nest can be in the form of prostate stones. These stones are usually visible on transrectal ultrasonograms.
Other therapies used to treat CPPS may provide symptomatic improvement for chronic prostatitis but have not been extensively studied in the regular prostatitis population. These other therapies include the following:
- Physiotherapy with myofascial release and paradoxical relaxation.
- Biofeedback, transcutaneous electrical nerve stimulation (TENS), acupuncture.
- Medications for neuropathic pain (gabapentinoids, antidepressants).
- Neuromodulation procedures (stimulation of the spinal cord or sacral nerve root).
- Reentrenamiento vesical.
- Therapeutic ejaculation