What Are The Different Types Of Prostatitis?

What is prostatitis?

The prostate is a gland in the male reproductive system which has the main function of making a fluid to nourish and transport sperm. Prostatitis is the inflammation and swelling of the prostate. It is not cancerous nor is it the same as Benign Prostate Hyperplasia (BPH) which is the enlargement of the prostate. There are 4 types of prostatitis.

1. Acute bacterial prostatitis
   1. The symptoms are severe and occur suddenly. This is rare but is extremely dangerous and requires immediate medical attention.
2. Chronic bacterial prostatitis
   1. This is caused by a bacterial infection and can often be treated with the use of antibiotics. The symptoms tend to be less severe but appear to be recurring.
3. Chronic prostatitis or chronic pelvic pain syndrome
   1. The symptoms for this type of prostatitis come and go over several months and is the more common one. The cause is often not known.
4. Asymptomatic inflammatory prostatitis
   1. This does not show any symptoms and does not cause complications nor does it need treatment.

What are the causes?

Acute bacterial prostatitis is usually caused when bacteria in the urinary tract which consists of the bladder, kidneys, ureters, and urethra enter the prostate. Chronic bacterial prostatitis is usually caused by bacteria from sexually transmitted infections (STIs) such as gonorrhea and chlamydia or bacteria from the urinary tract.

The cause of chronic prostatitis or chronic pelvic pain syndrome is still not clear. However, potential contributors include autoimmune diseases, stress, and nerve inflammation or irritation.

Who is at a higher risk?

There are a few causes that result in one having a higher risk of being affected by prostatitis. A few of the reasons are listed below:

• having a recent urinary tract infection (UTI)
• having used a urinary catheter
• had a prostate biopsy
• a sexually transmitted infection (STI)
• had anal sex
• having injured your pelvis
• aged between 50 and 59
• have had prostatitis before
• have been sexually abused
• having an infection in the bladder or the (urethra)
• having pelvic trauma from cycling or horseback riding

Symptoms?

Symptoms vary for each individual depending on the type of prostatitis they have.

Symptoms of acute bacterial prostatitis include:

• Severe pain in or around your penis, testicles, anus, lower abdomen, or lower back and upon ejaculation
• Problems with urinating such as:
  • Pain or a burning sensation while urinating, needing to urinate frequently, problems starting or “stop-start” urinating, an urgent need to pee, blood in your urine, not being able to urinate leading to acute urinary retention which requires immediate medical attention
• High fever and chills
• Cloudy or foul-smelling urine
• Nausea and vomiting
• In extreme cases, urinary blockage where one is completely unable to urinate

The symptoms of chronic bacterial prostatitis are similar to those of acute bacterial prostatitis but less severe. Symptoms of chronic bacterial prostatitis include:

• Severe pain in or around your penis, testicles, anus, lower abdomen, or lower back and upon ejaculation
• Problems with urinating such as:
  • Pain or a burning sensation while urinating, needing to urinate frequently, problems starting or “stop-start” urinating, an urgent need to pee, blood in your urine, not being able to urinate leading to acute urinary retention which requires immediate medical attention, nocturia (needing to wake up often at night to urinate)
• Problems relating to sexual intercourse such as:
  • erectile dysfunction, pain during ejaculation, pelvic pain after sexual intercourse
• In extreme cases, urinary blockage where one is completely unable to urinate
• Blood in your semen

Chronic prostatitis or chronic pelvic pain syndrome is the most common type of prostatitis and shares many of the same signs as bacterial prostatitis. Symptoms of chronic prostatitis or chronic pelvic pain syndrome include:

• The main symptom is pain that lasts more than 3 months in at least one of these body parts:
  • Penis (often at the tip), scrotum, between your scrotum and rectum (the perineum), lower abdomen, lower back
• Pain when urinating (in the urethra or penis) or during ejaculation.
• Not being able to hold your urine, or you have to pee excessively.
• A weak urine stream, having trouble passing urine, pain in the bladder, testicles and penis, and the anus

If you have asymptomatic inflammatory prostatitis, symptoms will not be observed and this condition may be found during a routine physical exam or while checking for other conditions.

Diagnosis and tests

Your doctor may perform a few examinations and tests to check the prostate.

• Taking one’s personal and family medical history
• A physical exam
• Medical tests

Taking one’s personal and family medical history

This is one of the first things used to observe if there is a possibility of prostatitis. Questions asked may include:

• What symptoms are observed?
• When did the symptoms begin and how often do they occur?
• Do you have a history of recurrent Urinary Tract Infections?
• What medications do you take (both prescription and over-the-counter)?
• How much water do you drink a day?
• Do you consume caffeine and alcohol?
• Questions regarding his general medical history, including any significant illnesses or surgeries.

Physical Exam

The healthcare provider would examine the patient’s body, which can include checking for:

• enlarged or tender prostate
• examine how much pain is felt during this test

A digital rectal exam is often performed as well. During this examination, you lie on your side or bend over. The doctor inserts a finger into your rectum to feel the prostate gland to look for growth, tenderness, lumps, or hard spots.

Medical Tests

Cystoscopy

Cystoscopy is a procedure that uses a cystoscope to look inside the urethra and bladder. The cystoscope is inserted through the opening at the tip of the penis and into the lower urinary tract. Patients are usually given local anesthesia but in some cases, the patient may require sedation and regional or general anesthesia.

Transrectal ultrasound

Transrectal ultrasound uses a device, called a transducer, to bounce sound waves off organs to create an image of their structure. The transducer is inserted into the man’s rectum, next to the prostate as seen in the image. The ultrasound image will then show the size of the prostate and any abnormalities.

Urinalysis

This procedure involves testing a urine sample. A strip of chemically treated paper is placed into the urine sample. Patches on the dipstick would change color to indicate signs of infection in the urine. This would also help to determine the type of prostatitis one has.

Prostate-Specific Antigen (PSA) blood test.

Blood will be drawn for a PSA test by a healthcare provider. Prostate cells create a protein called PSA and prostatitis often causes high PSA levels.

Urodynamic tests

Urodynamic tests observe how well urine is stored and released by the bladder and the urethra. Urodynamic tests may include the following:

• uroflowmetry → measures the strength of urine flow
• post-void residual measurement → surveys how much urine remains in the bladder after urination

Semen analysis

This is a test to measure the amount and quality of a man’s semen and sperm and by analyzing the sample, blood and signs of infection can be observed.

Biopsy

A biopsy is a procedure that involves taking a sample of prostate tissue for examination. Light sedation and local anesthesia are given to the patient but in some cases, some patients will require general anesthesia. The urologist uses imaging techniques to guide the biopsy needle into the prostate. The prostate tissue is then examined in a lab.

References:

• https://www.nhs.uk/conditions/prostatitis/
• https://www.mayoclinic.org/diseases-conditions/prostatitis/symptoms-causes/syc-20355766
• https://www.webmd.com/men/guide/prostatitis
• https://www.urologyhealth.org/urology-a-z/p/prostatitis-(infection-of-the-prostate)
• https://my.clevelandclinic.org/health/diseases/15319-prostatitis
• https://www.healthline.com/health/prostatitis
• https://www.rafflesmedicalgroup.com/services/specialist-centres/urology/services/prostatitis/
• https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostatitis-inflammation-prostate