Prostatitis

Everything about the causes, symptoms, and treatments for prostate inflammation.

Symptoms and Causes

Prostatitis is the inflammation of the prostate, the gland located below the bladder in men that produces the seminal fluid that carries sperm during ejaculation.

Depending on its origin and progression, prostatitis is classified into the following types:

Acute bacterial prostatitis: begins suddenly, causes severe symptoms, and requires immediate medical attention.
Chronic bacterial prostatitis: symptoms are less severe but persist over time (for at least three months). It develops from an acute prostatitis that has not responded properly to medication or has not been adequately treated.
Chronic nonbacterial prostatitis: also known as chronic pelvic pain syndrome, it is the most common type. The inflammation is not caused by an infection and results in persistent pain.
Prostatodynia: an asymptomatic inflammatory prostatitis that, due to the absence of symptoms, is difficult to diagnose.

The prognosis of this condition varies. While acute prostatitis usually resolves quickly with proper treatment, chronic prostatitis—particularly the abacterial type—can be very persistent and may lead to other disorders.

Symptoms

Except for prostatodynia, which is asymptomatic, the other types of prostatitis share similar symptoms that vary in intensity and duration:

Dysuria: pain or burning sensation when urinating.
Weak urine stream.
Difficulty urinating.
Increased urinary frequency.
Urinary retention.
Hematuria: blood in the urine.
Urgency: feeling of not being able to hold urine.
Decreased libido.
Partial or total erectile dysfunction.
Painful ejaculation.
Hematospermia: blood in the semen.
Pelvic pain.
Perineal pain (between the scrotum and the rectum).
Genital pain (penis and testicles).
General discomfort.
Fever.
Chills.

Causes

The causes of prostatitis vary depending on the type:

Bacterial prostatitis (acute or chronic): usually results from an infection caused by the Escherichia coli bacterium, which naturally inhabits the gastrointestinal tract. It can also be due to other bacteria such as Klebsiella, Staphylococcus aureus, Chlamydia, or Gonorrhea.
Chronic pelvic pain syndrome: the exact cause is unknown, but it is believed to be associated with:
- Urethral stricture.
- Intraductal reflux: urine flowing backward into the prostate.
- Abnormal immune response.
- Hormonal imbalances.
- Muscle dysfunction.
- Stress.
Prostatodynia: may be related to autoimmune disorders or previous infections.

Risk Factors

The main risk factors include:

Age over 35.
Benign prostatic hyperplasia.
Recurrent urinary tract infections.
Genital infection.
HIV or AIDS.
Urinary catheter use.
Pelvic nerve injury.
Stress.
Personal history of prostatitis.

Complications

Complications that may arise from prostatitis include:

Blood infection (bacteremia).
Abscess formation: pus-filled cavities in the prostate.
Epididymitis: inflammation of the epididymis, the testicular tube where sperm are stored.
Pelvic bone infection.
Infertility.
Sexual dysfunction.
Depression.

Prevention

Prostatitis cannot always be prevented. To maintain prostate and overall male reproductive health, it is recommended to:

Wash hands before and after urinating.
Maintain good general hygiene.
Use condoms during sexual intercourse, especially with multiple partners or in risky practices.
Minimize the use of urinary catheters whenever possible.
Follow a diet rich in antioxidants and red fruits.
Avoid polyunsaturated fats.
Schedule regular urological checkups.

Which doctor treats prostatitis?

Urology specialists are responsible for diagnosing and treating prostatitis.

Diagnosis

Prostatitis is diagnosed by evaluating the results of several tests. The standard diagnostic process includes:

Medical history: special attention is given to symptoms, personal background, and lifestyle.
Physical examination: the external appearance of the genitals and perineum is assessed. A digital rectal exam is also performed to check the size and sensitivity of the prostate.
Blood test: measures prostate-specific antigen (PSA) levels, a protein produced by the prostate. Elevated PSA levels indicate a prostate condition, though not necessarily its nature.
Urine analysis and culture: help detect blood in the urine and bacterial infections.
Semen culture: identifies the presence of bacteria.
Ultrasound: provides prostate imaging to identify inflammation, size changes, benign cysts, or cancerous tumors.
Biopsy: if prostate cancer is suspected, a tissue sample is collected in the operating room for laboratory analysis.

Treatment

Treatment for prostatitis varies depending on the type:

Acute bacterial prostatitis: appropriate antibiotics are administered for the specific bacteria causing the infection. Hospitalization and intravenous treatment are often required.
Chronic bacterial prostatitis: lipid-soluble antibiotics are prescribed to ensure they reach all prostate tissue, usually for a period of six to twelve weeks.
Chronic nonbacterial prostatitis: since the cause is unknown, treatment focuses on relieving symptoms. The following approaches often yield good results:
- Medication: muscle relaxants, pain relievers, anti-inflammatory drugs, alpha-blockers (to ease urination), and 5-alpha-reductase inhibitors (to block dihydrotestosterone production, which influences prostate growth).
- Physiotherapy: manual therapy and exercises help relieve pain and strengthen the pelvic floor. Shockwave therapy and neurostimulation also reduce inflammation, improve bladder control, and restore sexual function.
- Psychotherapy to manage stress.
- Dietary changes.
Prostatodynia: does not require specific treatment, but regular checkups are advised to monitor its progression.