🩺 Prostatitis: causes, types, diagnosis and modern approaches to treatment

Prostatitis is one of the most common urological diseases in men. According to various estimates, 30 to 50% of men experience some form of this condition during their lifetime. Inflammation of the prostate gland can occur at any age, but it is most often diagnosed in men aged 25–50, the most active period of life. Despite how widespread it is, prostatitis is still surrounded by many myths and prejudices, which prevent men from seeking help in time.

The prostate gland: structure and functions

The prostate gland (prostate) is a small, unpaired organ the size of a walnut, located below the bladder and surrounding the initial section of the urinary channel (urethra). In a healthy man, the prostate weighs about 20–25 grams. The gland produces a secretion that is part of the seminal fluid (semen), providing nourishment, protection and motility for sperm cells. Prostatic secretion contains enzymes, zinc, citric acid, prostaglandins and immunoglobulins.

In addition to its secretory function, the prostate acts as a valve: during an erection it closes off the outlet of the bladder, preventing semen from flowing back into it. The prostate is also involved in regulating urination: when the gland enlarges (inflammation, adenoma), the urethra is compressed, making it harder for urine to flow out.

Types of prostatitis

Acute bacterial prostatitis (category I) is the most severe but relatively rare form (5–10% of cases). It is caused by a bacterial infection (E. coli, Klebsiella, Proteus, staphylococci). It is characterized by a sudden onset: high fever (38–40 °C), chills, severe pain in the perineum and above the pubic bone, painful and difficult urination, and sometimes acute urinary retention. This condition requires emergency medical care and antibiotic therapy.

Chronic bacterial prostatitis (category II) develops when the acute form is not completely cured, or as a primary condition with a gradual onset. It is characterized by periodic flare-ups with pain and urinary disturbances, alternating with remissions. Bacteria are found in the prostatic secretion.

Chronic non-bacterial prostatitis / chronic pelvic pain syndrome (category III) is the most common form, accounting for up to 90% of all cases of chronic prostatitis. No bacteria are found in the prostatic secretion. It is divided into inflammatory (IIIA, with white blood cells in the secretion) and non-inflammatory (IIIB, with no white blood cells) forms. The exact causes of this form have not been fully established.

Asymptomatic inflammatory prostatitis (category IV): the inflammation is discovered by chance during an examination for another reason. It usually does not require specific treatment.

Causes and risk factors

Prostatitis develops due to a combination of several factors. The bacterial forms are caused by microorganisms that enter the prostate from the urethra, bladder or rectum, or through the bloodstream from other sites of infection (chronic tonsillitis, tooth decay, inflammatory bowel diseases). Sexually transmitted infections (chlamydia, mycoplasma, trichomonas, gonococci) can also cause or sustain inflammation of the prostate.

However, bacteria are far from the only cause. The most important risk factors include:

• Blood congestion in the pelvis: a sedentary lifestyle, desk jobs (drivers, office workers, programmers), lack of regular physical activity.
• Irregular sex life: both prolonged abstinence and excessive sexual activity can disrupt blood circulation and drainage of the prostate.
• Hypothermia: especially of the perineum and pelvis, it lowers local immunity and promotes the development of inflammation.
• Chronic constipation: a full rectum puts pressure on the prostate and disrupts its blood supply.
• Alcohol abuse: causes venous congestion in the pelvis and weakens the body's defenses.
• Stress and overwork: weaken immunity and disrupt the nervous regulation of the pelvic floor muscles.
• Concomitant diseases: hemorrhoids, pelvic varicose veins, urological infections.

Symptoms of the different forms of prostatitis

The symptoms of prostatitis vary and largely depend on the form of the disease. In acute prostatitis the clinical picture is pronounced: a sharp rise in temperature, intense pain in the perineum radiating to the rectum and penis, frequent painful urges to urinate, a weak, intermittent urine stream, and sometimes a complete inability to urinate. Pus or blood may be present in the urine.

Chronic prostatitis is less pronounced, but its symptoms can significantly impair quality of life for months and years. Typical complaints include: dull, dragging pain in the perineum, above the pubic bone, in the groin, sacrum and scrotum; frequent urination, especially at night (nocturia); a feeling of incomplete bladder emptying; a weak and intermittent urine stream; discomfort or pain when urinating; discharge from the urethra (clear, mucous); painful ejaculation.

Sexual dysfunction is a frequent companion of chronic prostatitis: reduced sex drive, weaker and unstable erections, premature or painful ejaculation, and dulled orgasm. These problems often lead to anxiety, depression and withdrawal, which further worsens the course of the disease.

Diagnostic methods

Diagnosis of prostatitis begins with a detailed interview and examination by a urologist. The key examination is the digital rectal examination (DRE): the doctor palpates the prostate through the rectum, assessing its size, shape, consistency and tenderness. In acute prostatitis the gland is enlarged, extremely tender and hot; in chronic prostatitis it may be slightly enlarged, with a doughy or uneven consistency.

Analysis of prostatic secretion (obtained by massaging the gland) makes it possible to detect signs of inflammation (an increased number of white blood cells) and identify the bacterial flora. The Meares-Stamey four-glass test is the “gold standard” of diagnosis: the first portion of urine, the midstream portion, the prostatic secretion and the urine portion after massage are examined to pinpoint the location of the infection. Urinalysis and urine culture help detect a concomitant urinary tract infection.

Transrectal ultrasound (TRUS), an ultrasound scan of the prostate through the rectum, makes it possible to assess the size and structure of the gland and to detect calcifications, abscesses and cysts. Uroflowmetry, the measurement of urine flow rate, helps objectively assess the degree of urinary impairment. A blood test for prostate-specific antigen (PSA) is performed to rule out prostate cancer.

Lifestyle and prevention

Lifestyle changes are an essential part of treating and preventing prostatitis. Physical activity is the most important factor: regular exercise improves blood circulation in the pelvis and prevents congestion. Walking, jogging, swimming, squats and Kegel exercises (contracting the pelvic floor muscles) are especially beneficial. People who have to sit for long periods are advised to stand up and stretch every hour, and to use an orthopedic cushion when driving.

Diet for prostatitis should be balanced and anti-inflammatory. It is recommended to eat more vegetables, fruit, leafy greens, fish, nuts and pumpkin seeds (rich in zinc, which is essential for prostate health). Spicy, fatty and smoked foods, alcohol (especially beer, which contains phytoestrogens), strong coffee and fizzy drinks should be limited: they irritate the urinary tract and intensify inflammation.

A regular sex life (with a steady partner, using barrier contraception for casual encounters) promotes natural drainage of the prostate and prevents stagnation of the secretion. Prolonged abstinence and interrupted intercourse are undesirable. Protection from the cold: avoid sitting on cold surfaces, dress for the weather and wear warm underwear in the cold season. Regular bowel movements: consume enough fiber and fluids to prevent constipation.

When to see a urologist

You should see a urologist if you notice any urinary problems (frequency, difficulty, pain), pain in the perineum, groin or pelvis, sexual dysfunction, or abnormal discharge from the urethra. Don't wait until the symptoms become unbearable: seeking help early can prevent the disease from becoming chronic. An annual preventive visit to a urologist is recommended for all men over 40, and from an earlier age for those with risk factors.

Complications if left untreated

Untreated acute prostatitis can be complicated by a prostate abscess (a collection of pus in the gland tissue), sepsis (blood poisoning) and acute urinary retention. Untreated chronic prostatitis leads to scarring in the gland, the formation of calcifications (stones) and chronic pain syndrome. Prolonged inflammation can cause vesiculitis (inflammation of the seminal vesicles), epididymitis (inflammation of the epididymis) and, in severe cases, impaired fertility: deterioration in semen quality up to and including infertility. A chronic infection can spread to the kidneys, leading to pyelonephritis.

Common myths about prostatitis

“Prostatitis is a disease of the elderly”: false. The peak incidence is between the ages of 25 and 50, although it can occur at any age after the start of sexual activity. “Prostatitis inevitably leads to impotence”: with timely treatment, sexual dysfunction is reversible. “Prostatitis means certain infertility”: chronic inflammation can reduce semen quality, but with appropriate treatment fertility is restored in most cases. “Prostatitis is sexually transmitted”: prostatitis itself is not contagious, although the bacteria that cause it can be passed on by a partner. “Hot baths cure prostatitis”: heat treatments can relieve the symptoms of chronic non-bacterial prostatitis, but they are contraindicated in the acute bacterial form because they intensify inflammation. “If there are no symptoms, there is no prostatitis”: the asymptomatic form (category IV) is detected only during an examination.

Prostatitis is a serious disease that, if left untreated, significantly reduces a man's quality of life. However, with the right approach, combining drug therapy, physiotherapy, lifestyle changes and regular check-ups with a urologist, the prognosis is favorable in most cases. The main thing is not to put off seeing a specialist and not to self-medicate.