Prostatitis is a frequently painful urological condition usually associated with inflammation of the prostate gland and sometimes the parts around the prostate. The prostate gland is a walnut-sized part of the male reproductive system which is situated just below the urinary bladder of men near the base of the penis. It surrounds the upstream portion of the tube that drains urine from the urethra and aids in semen (a sperm-containing fluid) production.
Prostatitis is the most common prostate gland disorder in men aged younger than 50 years. In younger adult men, the prevalence of prostatitis is 14.2% which tends to increase with age. [1, 2, 3]
Types of Prostatitis
Depending upon its origin, prostatitis includes four categories:
- Acute Bacterial Prostatitis– It is a bacterial infection of the prostate usually with abrupt, severe onset of symptoms. It is caused when the bacteria ascend the urethra and infect the surrounding areas including the prostate gland.
- Chronic Bacterial Prostatitis– It is a recurring or ongoing bacterial infection usually with less severe symptoms. It develops if the acute bacterial prostatitis is not appropriately treated. In this condition, the bacteria may form a biofilm that helps them adhere to the prostate gland tissues. This biofilm also protects the bacteria from immune system attacks and antibiotics, which is why the infection lasts long.
- Chronic Pelvic Pain Syndrome/Chronic Prostatitis– Also referred to as sterile prostatitis, it is the most common prostatitis which has no evidence of type 1 or 2 bacterial infections. Chronic sterile inflammation is caused by blockage of the outlet of the urinary bladder or by urine reflux within the prostate gland due to enlarged prostate or urinary bladder stone obstructing the way.
- Asymptomatic Inflammatory Prostatitis– As the name suggests; this type does not have any condition indicating symptoms. However, there might be some mild inflammation within the prostate gland. [2, 3]
What Causes Prostatitis?
Most often, prostatitis is the result of bacterial infection due to the progression of urinary tract infection or procedures like prostate biopsy, catheter insertion, or other urological intervention. In some patients, the underlying cause of prostatitis could not be diagnosed and it may be because of the reflection of the inflammatory changes around the nerves that cause pain emerging from the pelvis.
Hence, the common causes of bacterial or non-bacterial prostatitis include:
- Urinary tract infections
- Sexually transmitted infections
- Autoimmune diseases
- Chronic pelvic floor tension
- Psychological Stress
- Prostate stones
- Biopsy or surgery requiring the use of a urinary catheter
- Bladder stones or infections
- Inflammation of the genitourinary system
- Muscle dysfunction
- Pelvic floor muscle spasms. 
Risk Factors of Prostatitis
Prostatitis does not have one definite cause. Following are some of the risk factors for the development of prostatitis:
- HIV infection or AIDS
- Intake of a lot of spicy, marinated food
- Earlier experience of having prostatitis
- A recent urinary bladder infection
- A pelvic trauma caused by a horseback or bike riding accident
- Infections of the urinary bladder or urethra
- Infections of the reproductive system
- Usage of urinary catheter- a tube inserted into the bladder to empty it
- Prostate enlargement
- Lower pelvis injury caused by heavy weight lifting, cycling, etc.
- Young or middle-aged adulthood
- Biopsy (a diagnostic sampling) of prostate tissue
- Nerve damage in the pelvic area due to trauma or surgery. [2, 3]
Signs/Indications of Prostatitis Based On the Types
Each type of prostatitis is associated with its own set of symptoms which varies depending upon the cause and may not be the same for every patient. Many of those symptoms are even similar to those found in other conditions. Here is the list of type-wise symptoms commonly seen in patients having prostatitis. Be careful if any of these symptoms appear and consult a urologist to get timely and appropriate treatment.
1. Indications of Acute Bacterial Prostatitis
- Fever and chills
- Muscle pain (Myalgia)
- Generalized feeling of not being well (Malaise)
- Nausea and vomiting
- Frequent urination during sleep periods (Nocturia)
- Lower urinary tract symptoms like frequency, urgency, and burning sensation while peeing (dysuria)
- Painful and frequent urination (especially at night), trouble in starting a urine stream or stopping peeing, an urgent urge to pee, and sometimes blood in the urine
- Pain on ejaculation or lower back pain
- Pain, which may be severe, in or around the testicles, penis, anus, lower abdomen, or lower back- defecation can be painful.
2. Symptoms of Chronic Bacterial Prostatitis
- Pain during and after ejaculation
- Urinary blockage- complete inability to urinate
- Urinary urgency- the inability to delay peeing
- Urinary frequency- urinating eight or more times a day. The urinary bladder starts to contract even if it is filled with a small amount of urine, hence causing more frequent urination
- Sexual dysfunction
- A weak or an interrupted urine stream
- Sexual issues such as erectile dysfunction or pelvic pain after sex
- A tender or enlarged prostate found on examination of the rectum
Symptoms of Chronic Pelvic Pain Syndrome
- Pain or discomfort lasting for more than 3 months in one or more of the body parts at the same time including the penis, scrotum, between the scrotum and anus, the central lower abdomen, and the lower back. The pain may come and go and appear gradually or suddenly
- Pain felt during or after ejaculation
- Pain spreading around the pelvic area
- Pain in the urethra after or during urination
- Pain in the penis during or after peeing
- Urinary urgency
- Urinary frequency
- An interrupted or weak urine stream. [1, 2]
Complications of Prostatitis If Left Untreated
For bacterial prostatitis-
- Prostatic abscess
- Infections spreading to the lower spine or upper pelvic bone.
For non-bacterial prostatitis-
- Depression or anxiety
- Changes in semen or sperm causing infertility
- Erectile dysfunction.
When to Seek Medical Care?
Men who have any symptoms of prostatitis should see a healthcare provider. However, they must seek immediate medical care from a urologist if they have the following symptoms:
- Blood while urinating
- Complete inability to urinate
- Intense pain or great discomfort in the urinary tract and lower abdomen
- Frequent, painful, and urgent need to urinate along with fever and chills. [2, 3]
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