Chronic inflammation of the prostate (chronic prostatitis)

What is it about ?

Chronic prostatitis is painful, long-lasting inflammation of the prostate. The prostate is a gland the size of a chestnut; it is located just under the bladder and in front of the rectum. It surrounds the urethra which goes from the bladder to the penis. The prostate produces part of the semen.

We talk about chronic prostatitis if the symptoms last more than three months.

There are two types of chronic prostatitis:

• the bacterial form, which is an infection of the prostate caused by bacteria.
• chronic pelvic pain syndrome (CPPS), with chronic pain in the prostate, the cause of which is difficult to find. This form is also still often referred to as prostatodynia, which means prostate pain. It is this form in more than 90% of cases.

What is its frequency?

Chronic prostatitis is found in general medicine in about 10% of adult men. Most often, it is chronic pelvic pain syndrome (CPPS), and infection is not found. In only 10% of cases, symptoms appear to be linked to chronic bacterial prostatitis.

How to recognize it?

Symptoms are similar to those of acute inflammation of the prostate, but are milder:

• voiding disorders: urinate frequently, difficulty passing urine, pain when passing urine, feeling that the bladder is not completely emptied;
• pain: burning sensation in the lower abdomen, in the scrotum, in the area between the penis and the anus, in the glans or on the inner side of the thighs;
• feeling of compression in the area between the penis and the anus or around the anus;
• sexual symptoms: decreased libido, erection problems, painful ejaculation, semen containing blood,
• general symptoms: fatigue, pain in other parts of the body, feelings of depression.

How is the diagnosis made?

The doctor usually starts by asking you a series of questions. He will ask you to urinate in a pot that he will send to the laboratory for analysis. Sometimes additional tests are done to check for sexually transmitted infections (STIs).

In some cases, the doctor will feel the prostate to look for abnormalities and find out if the palpation is causing pain. To perform this test, called a “digital rectal exam,” the doctor will put on gloves and insert a finger into the anus to feel the prostate.

In case of repeated infections, the doctor will also perform a urine analysis complex: to do this, two urine samples are needed. For the first, you immediately urinate into the pot. Then the doctor massages the prostate and you have to urinate a second time. The massage caused bacteria to escape from the prostate, and they end up in the urine.

If necessary, the doctor will refer you to a urologist (doctor specializing in the urinary tract). The urologist will still perform additional examinations.

What can you do ?

Warm baths and warm clothes can ease the pain. Avoid the cold.

Massaging the prostate can provide relief. Push your index finger as deep as possible into the anus, up to your prostate, which forms a bulge at the front of the intestine. Go back and forth with your finger on the prostate (massage). Fluid is flowing through the penis, which may give a feeling of relief. Prostate massage is very tedious. You can optionally ask your partner to perform the prostate massage.

Ejaculations (discharge of semen during an orgasm) may also ease symptoms.

Chronic prostatitis is often a frustrating and difficult problem for you and your doctor to deal with. Different treatments can be tried, but they often go unsuccessful. Remember that chronic prostatitis is not dangerous, but it usually lasts for some time.

What can the doctor do?

The doctor will explain to you that this is a mild condition, and he will try to reassure you. He will also be alert to any depressive feelings.

Your doctor may prescribe medicine to relieve the symptoms:

• a pain reliever, such as paracetamol or ibuprofen;
• antibiotics, only if there are signs that the prostatitis is due to bacteria;
• medicines used for benign swelling of the prostate (benign prostatic hyperplasia), for example:
• an alpha blocker: these drugs dilate the urinary tract;
• 5-alpha-reductase inhibitors: these drugs affect the size of the prostate.

Want to know more?

• Prostate: adenoma and prostatitis (image) – mongeneraliste.be – SSMG – Scientific Society of General Medicine
• What are STIs? (video) – LoveAttitude

• Paracetamol – CBIP – Belgian Center for Pharmacotherapeutic Information
• Ibuprofen – CBIP – Belgian Center for Pharmacotherapeutic Information
• Alpha₁-blockers – CBIP – Belgian Center for Pharmacotherapeutic Information
• 5α-reductase inhibitors – CBIP – Belgian Center for Pharmacotherapeutic Information

Source

Foreign clinical practice guide ‘Chronic prostatitis’ (2000), updated on 23.05.2017 and adapted to the Belgian context on 28.02.2019 – ebpracticenet