Symptoms

 
The symptoms of prostatitis differ for every individual. The symptoms usually come and go over a period of a few months. It is also possible for symptoms to start suddenly and abruptly. In general the symptoms of prostatitis are the following:

  • Painful urination
  • The patient with prostatitis may experience pain during urination. This is also called dysuria.

  • Painful ejaculation
  • Painful ejaculation is when there is pain or a burning sensation experienced in the penis or genital area during or just after ejaculation has occurred. This could interfere with sexual pleasure.

  • Pain and Discomfort
  • Pain and/or discomfort may be experienced in the genital region, pelvis, lower back and buttocks. This pain may vary from mild to severe.

  • Lower urinary tract symptoms (LUTS)

    Bladderscan

    BladderScan evaluates lower urinary tract symptoms

    The patient may experience LUTS which may include:

    • Frequency
    • Urinary frequency is when one needs to urinate more regularly than usual.

    • Urgency
    • Urinary urgency is when one gets a sudden urge to urinate and this urge is difficult to control.

    • Nocturia
    • Nocturia is the need to get up at night to urinate. If nocturia is severe it causes disrupted sleep.

    • Hesitancy
    • Urinary hesitancy is when one feels the need to urinate but is unable to start urinating or takes a long time to start urinating.

    • Weak stream
    • A man has a weak urinary stream when his urine does not pass through the urethra with a strong force but instead trickles out slowly. Men with a weak stream also take longer to empty their bladder.

    • Incomplete voiding
    • The bladder is not emptied during urination or the man has a feeling as if the bladder is not emptied completely after urination is complete.

  • Malaise
  • Prostatitis may cause the patient to experience a general feeling of being unwell which is called malaise.

  • Fever and Chills
  • Fever and chills may be present when the prostatitis is caused by an acute bacterial infection. The patient will have a high temperature and will describe that he feels very hot one moment and then very cold the next.

  • Urethral discharge
  • A urethral discharge is a fluid-like discharge which comes out of the urethra. It may vary in consistency and colour. If a discharge is present the cause is most likely due to a bacterial infection.

  • Haematuria
  • Haematuria is when blood is present in the urine. Haematuria may be present in acute bacterial prostatitis.

  • Infertility
  • Prostatitis may contribute to infertility. In some men who are being investigated for infertility, asymptomatic prostatitis is discovered to be a likely cause of their infertility.

  • Asymptomatic
  • It is possible for prostatitis to be present without any symptoms being experienced. It is then said to be asymptomatic. The prostate may be inflamed but not cause any pain or any urinary tract symptoms. Asymptomatic prostatitis is discovered when the man is being tested for other reasons.

 

Acute bacterial prostatitis

Acute bacterial prostatitis is the least common form of prostatitis.

Only 5-10% of cases of prostatitis are caused by a bacterial infection of the prostate. (This includes acute and chronic bacterial prostatitis) Prostatitis is not contagious. This means that a man cannot pass it on to his partner during sexual relations. Although men with multiple sexual partners are more at risk to develop bacterial prostatitis.

Acute bacterial prostatitis is when there is a documented bacterial infection of the prostate gland with symptoms that have been present for a short duration.

e-coli-bacteria

The most common bacteria causing acute bacterial prostatitis are E.Coli

Acute bacterial prostatitis is caused by bacteria which infect the prostate gland. Bacteria can reach the prostate via the blood stream from another infection in the body or bacteria can enter the prostate during a medical procedure like a prostate biopsy. The bacteria that cause acute bacterial prostatitis are the same bacteria which cause bladder infections and sexually transmitted diseases.

The most common bacteria causing acute bacterial prostatitis are Klebsiella, E.Coli and Proteus.

Symptoms are usually more severe in acute bacterial prostatitis and develop more rapidly. Symptoms include chills, fever, lower urinary tract symptoms and may include a urethral discharge and haematuria.

Acute bacterial prostatitis may be seen as a medical emergency. Without treatment the patient may develop permanent damage to his prostate gland.

The following factors may increase a man’s chances of developing acute bacterial prostatitis:

  • Epididymitis
  • Infection of the epididymis can increase a man’s chances of developing acute bacterial prostatitis. The epididymis is the tube which connects the testicles to the vas deferens.

  • Injury to perineum
  • An injury to the perineal area which is the area between the scrotum and the rectum, may increase a man’s risk of developing acute bacterial prostatitis.

  • Urinary catheter
  • The insertion of a urinary catheter or the presence of a permanent urinary catheter may be a source of infection and a cause of acute bacterial prostatitis.

  • Cystoscopy
  • Cystoscopy is when the bladder is examined by inserting a tube with a small camera through the urethra. This may increase a man’s chances of developing acute bacterial prostatitis.

  • Phimosis
  • Phimosis is when the foreskin is not able to be pulled back over the penis. This makes it difficult to clean the penis properly and can cause an increase in bacteria with an increased risk of bacterial prostatitis.

  • Bladder outlet obstruction
  • Bladder outlet obstruction may occur in the presence of an enlarged prostate or when bladder stones are present. Men over the age of 50 years are more likely to have enlarged prostates so they will be more susceptible to develop bladder outlet obstruction. When bladder outlet obstruction occurs it increases a man’s chances of developing acute bacterial prostatitis.

  • Psychological stress
  • Stress lowers immunity and thus increases the chances of developing acute bacterial prostatitis.

  • HIV/AIDS
  • Men who are infected with HIV or have developed AIDS have a low immune system and are therefore more likely to develop acute bacterial prostatitis.

  • Risky sexual behaviour
  • Men with multiple sexual partners and men who have anal sex without using condoms are more at risk to develop bacterial prostatitis.

 

Chronic bacterial prostatitis

Chronic bacterial prostatitis clinically is clinically similar to acute bacterial prostatitis. Chronic bacterial prostatitis is present when there is a documented bacterial cause of prostatitis which has been present for 3 months or longer.

Chronic bacterial prostatitis is caused by recurrent urinary tract infections. The condition may be present for a few years before producing any symptoms.

The symptoms of chronic bacterial prostatitis are the same, but not as severe as those of acute bacterial prostatitis and the symptoms may also come and go. Chronic bacterial prostatitis may affect men of any age group but it is more common in young and middle-aged men.
 

Chronic prostatitis\chronic pelvic pain syndrome (CPPS)

Chronic non-bacterial prostatitis or chronic pelvic pain syndrome is the most common form of prostatitis and accounts for 90% of cases of prostatitis. If chronic prostatitis is not treated it may lead to long term sexual and urinary problems.

In order to be classified as chronic prostatitis patients must have had urinary and genital pain for 3 months out of the last 6 months. Patients with this type of prostatitis have no bacteria present in their urine and there should be no documented or suspected bacterial cause of their prostatitis.

The cause of chronic non-bacterial prostatitis is not always known. Further research is still needed for doctors to know more about chronic non-bacterial prostatitis.

Some potential causes of this type of chronic prostatitis are:

  • Parasites
  • Some studies have shown that chronic prostatitis may be caused by parasite and yeast infection. These infections do not usually respond to antibiotics.

  • Viruses
  • Viruses (like the herpes virus) have been suspected in causing some cases of chronic non-bacterial prostatitis.

  • Atypical bacteria
  • Some bacteria do not respond to antibiotics or are not easily identified in microscopy of urine or prostate fluid. It therefor may seem as if the prostatitis is non-bacterial when it actually is.

  • Cold
  • Cold weather seems to aggravate chronic non-bacterial prostatitis or may even trigger an episode of chronic prostatitis.

  • Nerve problems
  • The prostate may be affected with local nervous system problems of the prostate region. This may result from previous nervous system injury or by chronic pelvic tensing which may be caused unconsciously from psychological stress.

  • Stress
  • Psychological stress involves the hypothalamus, pituitary gland and adrenal glands. This may result in endocrine abnormalities which may play a role in chronic prostatitis.

Patients may respond to treatment even when a specific cause is not identified.
 

Asymptomatic inflammatory prostatitis

Asymptomatic inflammatory prostatitis is often just discovered when tests for other conditions are being done. Patients with asymptomatic inflammatory prostatitis don’t have any pain or other symptoms and often don’t even know they have prostatitis.

In asymptomatic inflammatory prostatitis the prostate is inflamed without any genital or urinary tract symptoms. Asymptomatic prostatitis can be a cause if infertility but is otherwise left untreated.