Prostatitis: What is it?

Pelvic Pain

Prostatitis is inflammation of the prostate gland, a small organ of the male genital system located near the bladder and placed in close contact with the urethra.

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Prostatitis: What is it?

Introduction

Prostatitis: What is it?

Prostatitis is inflammation of the prostate gland, a small organ of the male genital tract located near the bladder and placed in close contact with the urethra.

The Types of Prostatitis

In addition to acute prostatitis of bacterial origin there are also:

Chronic prostatitis of bacterial origin;
Chronic prostatitis of non-bacterial origin;
Asymptomatic prostatitis.

It is worth reminding readers that the most recent classification of prostatitis distinguishes chronic non-bacterial prostatitis into two pathological subtypes: chronic inflammatory pelvic pain syndrome (type IIIA prostatitis) and chronic non-inflammatory pelvic pain syndrome (type IIIB prostatitis). ).

The subject of this article will be chronic prostatitis and the asymptomatic variant.

What is Chronic Non-Bacterial Prostatitis / Chronic pelvic pain ?

Chronic prostatitis of non-bacterial origin - otherwise known as chronic pelvic pain syndrome, type III prostatitis or even chronic abacterial prostatitis - is a gradual onset and persistent inflammation of the prostate that is not associated with the presence of bacterial infections local to the prostate gland ("non-bacterial" means the absence of ongoing bacterial infection).

Known and classified in the 1960s as prostatodynia ("prostat-" stands for "prostate" and "-odynia" for "pain"), chronic prostatitis of non-bacterial origin is the most common type of prostatitis in the male population: statistics, in fact, report that it constitutes 90-95% of the diagnoses of inflammation of the prostate gland.

As reported in the introduction, since 1999, doctors have distinguished two subtypes of chronic non-bacterial prostatitis: chronic inflammatory pelvic pain syndrome (or type IIIA prostatitis) and chronic non-inflammatory pelvic pain syndrome (or type IIIB prostatitis) .

Chronic Inflammatory Pelvic Pain Syndrome
Chronic non-bacterial prostatitis is called chronic inflammatory pelvic pain syndrome, as a result of which large quantities of white blood cells are present in the prostate fluid, sperm and urine; the presence of large quantities of white blood cells indicates an ongoing inflammatory state.

Chronic Non-Inflammatory Pelvic Pain Syndrome
Chronic non-bacterial prostatitis is called chronic non-inflammatory pelvic pain syndrome, as a result of which traces of white blood cells are present in the prostate fluid, sperm and urine; the small presence of white blood cells denotes a mild inflammation in progress.

Pelvic pain syndrome 
Chronic Non-Bacterial Prostatitis: A Muscular problem

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Pelvic Pain Syndrome - Chronic Non-Bacterial Prostatitis: the Causes?


For the time being, the precise causes of type III prostatitis are unclear; however, there is no lack of theories in this regard:

According to some experts, the cause of chronic prostatitis of non-bacterial origin, pelvic pain syndrome,  would be a problem in the perineal Muscle spams;


The skeletal muscles of the pelvic floor support and surround the bladder, prostate and rectum. Much as spasm of neck and shoulder muscles can lead to tension headaches, spasm of the pelvic floor can lead to genital pain and lower urinary tract symptoms (LUTS).

Pain can be felt in the penis, testicles, perineum (sensation of “sitting on a golf ball”), lower abdomen and lower back. Men may have post-ejaculatory pain and erectile dysfunction.1 Indeed, more than 50 percent of men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and patients with interstitial cystitis have pelvic floor spasm on exam, which can be an independent driver of their ongoing symptoms.

The diagnosis is not difficult but does require a slight modification of the usual digital rectal exam. In men, the muscles of the pelvic floor can be palpated anteriorly to either side of the prostate and laterally during the rectal exam. 

Pelvic floor spasm is felt as bands of tight muscle, and trigger points are felt as knots of muscle that are often painful on palpation and usually re-create the patient’s symptoms. Indeed, we believe a common cause of misdiagnosis of prostatitis comes from pain experienced during the rectal exam that is assumed to be due to the prostate but is actually caused by palpation of extraprostatic muscles.



According to other researchers, chronic type III prostatitis has an autoimmune nature. In other words, it would depend on a malfunction of the immune system, which recognizes the prostate gland as foreign and attacks it;
According to other doctors still, to cause chronic pelvic pain syndrome would be particular circumstances, such as trauma to the prostate, excess stress, daily heavy lifting and intensive practice of high impact sports (eg: running, high jump, volleyball, basketball etc,).
Since the underlying causes are unknown, any possible conclusion on the risk factors is impossible.

dr. Fabio Castiglione urologist London

When to go to an urologist in London?


A man should go to his urologist in London and rely on his directions if he complains:

Episodes of unusual pain in the pelvis, groin, scrotum, etc.
Painful ejaculation episodes;
Urinary problems (may be only one or may be more than one of those mentioned above).


Chronic Non-Bacterial Prostatitis: Symptoms


With the exception of fever (which is always absent), the symptoms and signs of chronic non-bacterial prostatitis are superimposed on the symptoms and signs of prostatitis of bacterial origin; therefore, those suffering from chronic pelvic pain syndrome may complain of: urinary problems, pain in the pelvic area, groin and / or scrotum, painful ejaculation, pain during defecation, malaise caused by bowel movements, hemospermia, etc.

Exactly as for bacterial prostatitis, also for chronic prostatitis of non-bacterial origin there is a lack of scientific evidence that demonstrates its connection with prostate neoplasms.

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Chronic Non-Bacterial Prostatitis - Pelvic Pain Syndrome  Diagnosis: how to recognize it?

In general, doctors use the same tests and laboratory tests to diagnose chronic non-bacterial prostatitis, which they would use in the presence of a suspected bacterial prostatitis (see below); after all, the only way to know if an inflammation of the prostate has a bacterial or non-bacterial origin is to look for the presence of bacteria in the blood, urine and prostatic fluid.

The absence of bacteria in these body fluids, combined with the typical symptoms of inflammation of the prostate gland, points in favor of chronic prostatitis of non-bacterial origin.

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Chronic Non-Bacterial Prostatitis - Pelvic Pain Syndrome: Treatment and Remedies

Chronic Non-Bacterial Prostatitis: Treatment and Remedies
Currently, there is no specific cure for chronic non-bacterial prostatitis.

In our urological clinic, Hiolisticandrology, we offer an innovative treatment aimed at reducing spasms of the pelvic muscles with excellent results.

Our holistic approach involves a combination of therapies to reduce contractures of the pelvic muscles. This approach is based on the use of physiotherapy, shock waves, heat therapy and muscle relaxant drugs. 

The mainstay of treatment for pelvic floor spasm is physical therapy (PT) that consists of myofascial release using Shockwave therapy.  The goal is to help relax the muscles, not to strengthen them. Therefore, Kegel exercises, which are often inappropriately applied as “generic physical therapy,” can make the symptoms worse.

Our Holistic approach  improves symptoms in about 80 percent of cases. 

Learn More about our New Holistic approach for pelvic pain syndrome  click here. 


What is Chronic Bacterial Prostatitis?


What is Chronic Bacterial Prostatitis?
Chronic prostatitis of bacterial origin is a gradual inflammation of the prostate, frequently induced by a persistent local infection.

Compared to acute prostatitis, chronic bacterial prostatitis is a milder medical condition, but of much longer duration (at least 3 months).

How common is Chronic Bacterial Prostatitis?

Chronic bacterial prostatitis is included in the list of chronic prostatitis, a group to which the chronic non-bacterial form with its two subtypes also belongs.

According to an interesting statistical study, as many as 20 out of 100 men would develop chronic prostatitis at least once in their life; however, according to the same study, only 10% of these subjects would suffer from a form of bacterial etiology.
Therefore, compared to other forms of chronic prostatitis, bacterial origin is a less common condition.

What are the causes of Chronic Bacterial Prostatitis

Chronic bacterial prostatitis can be:

The consequence of an acute bacterial prostatitis not treated adequately;
The result of recurrent urinary tract infections (urethritis, cystitis etc.);
The complication of a testicular infection (epididymitis).
It should be noted that, rarely, acute prostatitis due to a sexually transmitted infection involves the chronicization of inflammation; while it is more common for prostatitis resulting from a urinary tract infection to become chronic.

Chronic Bacterial Prostatitis: Risk Factors

Factors such as:

Use of the bladder catheter (bladder catheterization);
Presence of a urinary tract infection or testicular infection;
Presence of urethral stricture;
Presence of benign prostatic hypertrophy (or enlarged prostate);
Poor hydration
History of prostatitis;
Neglect in the treatment of acute bacterial prostatitis;
Trauma to the urinary tract or perineal area;
Systemic infections.

Chronic Bacterial Prostatitis:

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Chronic Bacterial Prostatitis: Symptoms and Complications


Symptoms and signs of chronic bacterial prostatitis resemble the typical manifestations of the acute bacterial form; different from the latter have that they appear gradually (in acute prostatitis they arise suddenly and abruptly), are in general less severe (for example, they are not associated with very high fever) and, finally, come and go (i.e. alternate periods in which they seem to have disappeared with periods in which they are particularly evident).

Specifically, the typical symptom picture of chronic bacterial prostatitis includes:

Pain in the base of the penis, in the pelvic area, around the anus, scrotum, lower back (lower back) and / or groin
Urinary problems, such as:
Feeling of urgent need to urinate,
Nocturia (need to urinate at night),
Dysuria (difficult urination, not necessarily accompanied by pain),
Hematuria (passing of blood with urine),
Stranguria (intermittent or slow, painful urination),
Foul smelling urine,
Reduced urinary flow e
Difficulty completely emptying the bladder.
Painful ejaculation;
Pain during defecation and discomfort caused by bowel movements;
Hemospermia (blood in the semen);
Fever, i.e. fever that does not exceed 38 ° C.

Complications
Without adequate treatment, a number of complications can arise from chronic bacterial prostatitis, including:

The inability to urinate;
The formation of a prostate abscess (an abscess is a small collection of pus). This is a very rare complication;
Bacteremia or, in particularly unfortunate cases, sepsis.
There is no reliable scientific evidence to support the thesis according to which chronic prostatitis of bacterial origin would favor the development of some neoplasm of the prostate.

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When to go to an urologist in London?


A man should go to his urologist in London and rely on his directions if he complains:

Episodes of fever associated with unusual pain in the pelvis, groin, scrotum, etc.
Painful ejaculation episodes;
Urinary problems (may be only one or may be more than one of those mentioned above).

Fabio Castiglione Urologist London

Chronic Bacterial Prostatitis Diagnosis: how to recognize it?


As a rule, the diagnostic process for the identification of chronic bacterial prostatitis and its precise cause (the triggering bacterium) begins with an accurate physical examination, accompanied by a careful medical history; then, it continues with the so-called digital rectal exploration (ERD) and palpation of the inguinal lymph nodes; finally, it ends with: blood tests, urine tests, laboratory analysis on a sample of prostate fluid (obtained after prostate massage), sperm culture, urethral swab (aimed at searching for sexually transmitted infections) and, sometimes (it depends a lot from the outcome of the previous investigation), urodynamic examination, transrectal prostatic ultrasound and cystoscopy.

Such in-depth diagnostic research is also explained by the need, on the part of the treating physician, to exclude conditions with similar symptoms (primarily chronic non-bacterial prostatitis).

Digital rectal examination (ERD)
During the digital rectal examination, the doctor (usually a urologist) manually examines the state of health of the prostate, gently inserting into the anus, until it reaches the rectum, a finger appropriately lubricated and protected by a glove.

Since the prostate resides just in front of the rectum, the doctor performing the examination can thus feel the upper surface of the prostate gland.

If on palpation the gland is enlarged, tender and painful, it is very likely that the prostate is inflamed or, in any case, not in perfect health.

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Chronic Bacterial Prostatitis: Treatment and Remedies


Similarly to the treatment of the acute form, the treatment of chronic bacterial prostatitis is also based on ad hoc antibiotic therapy.

The therapeutic management of chronic bacterial prostatitis is complex, for at least two reasons:

Poor sensitivity of the prostate to antibiotic drugs. It is due to a reduced ability of the prostate capsule to penetrate by the antibiotics currently available.
Poor sensitivity of the prostate to antibiotics is also an obstacle to the treatment of acute bacterial prostatitis.
The recurrence that characterizes chronic inflammations of the prostate, in particular those of bacterial origin.
To minimize the risk of relapse, it is essential to scrupulously follow the medical indications on the duration of antibiotic therapy and on how to take the drugs.
Remedies Against Symptoms

To relieve some typical symptoms of chronic bacterial prostatitis, especially pain and urinary disorders, doctors recommend:

Taking hot baths
Drink a lot of water (2 liters per day);
Avoid alcohol consumption; reduce or, better still, avoid coffee consumption; avoid the more general orange and citrus juices; avoid the consumption of hot and especially spicy foods;
Taking pain relieving and anti-inflammatory drugs, such as acetaminophen or ibuprofen (it is an NSAID);
Taking an alpha-blocker drug against urinary disorders;
Avoid using the bicycle;
Use phytotherapeutic decongestants (decoctions and infusions based on grass, horsetail, parsley root, artichoke leaves, sage, birch, bearberry or dandelion).

chronic prostatitis medication

Chronic Bacterial Prostatitis Prevention: What to Do?


For the prevention of chronic bacterial prostatitis, it is important:

Take water in adequate quantities to the needs of the organism;
Carefully provide for intimate hygiene;
Avoid, or at least limit, activities that can cause perineal trauma (eg horseback riding);
Promptly treat urinary tract infections;
During unsafe sexual intercourse, take appropriate precautions (eg use a condom).

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