As the suffix -ite reminds us, prostatitis is a generic inflammation of the prostate. It is a very common condition that affects men of all ages.However, the group most at risk of developing prostatitis is between 20 and 40 years of age. Therefore, unlike other prostate diseases, such as benign prostatic hypertrophy or prostate cancer, prostatitis is not typical of old age. In the elderly, the onset of prostatitis is however favored by the insertion of urinary catheters.
As we have seen, the term prostatitis indicates an inflammation of the prostate. It tells us, therefore, that there is an "inflammation at the level of the prostate gland, but it does not specify its origin, duration and intensity. To clarify these aspects, the various forms of prostatitis are divided into two large groups, that of acute prostatitis and that of chronic prostatitis. Acute prostatitis is often the result of a "bacterial infection of the prostate. In these cases, the inflammation develops rapidly and has a rather short course. On the other hand, the symptoms are quite intense and arise abruptly, suddenly. Among the typical symptoms of acute prostatitis, I remind you of high fever, chills, low back pain, Frequent, painful and difficult urination and general malaise. The urine is also often cloudy or contains traces of blood. Finally, perineal pain may be present, ie in the area between the anus and the base of the penis.
We have seen that acute prostatitis occurs suddenly and that its rather intense symptoms appear quickly and follow a rather short course. With proper treatment, complete recovery is observed in most cases. However, when acute prostatitis is neglected, it can become chronic. In the case of chronic prostatitis, the symptoms are milder than in the acute form, but they persist or recur several times over a prolonged period, often more than three months. Chronic prostatitis manifests itself with disorders of various kinds, however more nuanced than the acute form. Pain or burning during urination, soreness of the perineal, suprapubic and inguinal area, testicular discomfort and impairment of general health may be present. Fever, if present, is generally mild. In addition to those already listed, occasionally prostatitis , both chronic and acute, can also manifest itself with symptoms affecting the genital sphere, thus showing the presence of blood in the sperm and pain during sexual intercourse or ejaculation. In any case, these are not very specific symptoms, because they are similar to those caused by other diseases, such as cystitis, tumors of the bladder, benign prostate enlargement and prostatic tumors. To complicate the situation, there are also cases in which the " inflammation of the prostate occurs without symptoms. In these cases, we do not speak of either acute prostatitis or chronic prostatitis, but of asymptomatic prostatitis. The asymptomatic term indicates precisely that the inflammation is not accompanied by pain or particular discomfort. The patient basically does not complain of any problems, therefore the diagnosis may be delayed or completely occasional.
The causes that determine the onset of prostatitis are many and not always easy to identify. Let's briefly see the main ones. First of all, the inflammation of the prostate can depend on bacterial or infectious causes. As anticipated, acute bacterial prostatitis is often caused by fecal bacteria, therefore coming from the intestine. This is, for example, the case of the famous Escherichia coli. Favored by poor hygiene, inadequate immune defenses and behavioral factors (such as stress, smoking, alcohol, dietary imbalances and sedentary lifestyle), these bacteria can go up the urethra and reach the prostate. Often this rise is the result of sexual intercourse not protected, or by the direct spread of bacteria from the urinary or genital tract to the urethra. Other times there are problems with urine reflux. More rarely, the germs responsible for prostatitis are transported to the prostate by the blood or lymphatic route from other organs of the " body. As we have seen, chronic bacterial prostatitis is the result of an "infection in the prostate, and is characterized by continuous healing and relapses. Normally, this type of chronic inflammation of the prostate is due to the implantation and proliferation of bacteria that escape. to antibiotic therapy, and nestle in the prostate facilitated by its anatomical conformation. The most common feature of chronic bacterial prostatitis is that it accompanies recurrent urinary tract infections. However, bacteria and other infectious agents are not the only ones responsible for prostatitis. Inflammation of the prostate can in fact also arise from non-infectious causes and in this case we speak of non-bacterial prostatitis or abacterial prostatitis or prostatosis. In this case, it is often not possible to identify specific causes directly responsible for the inflammation and symptoms may present, subside, regress, and then reappear. To explain the phenomenon of abacterial prostatitis, the intervention of several predisposing factors is hypothesized, such as stress, anxiety, immune disorders, malformations of the urinary tract, constipation or hemorrhoids, professional or sports trauma and sexual habits. to be attributed to the irritation caused by incorrect dietary regimes and excessive alcohol intake. Having clarified this, before moving on to the diagnosis of prostatitis, it is important to remember that the disease is often associated with benign prostatic hypertrophy. In fact, the enlargement of the prostate, due to the alteration of urinary flow and stagnation of urine, can favor the "onset of" infections and inflammatory processes. The recent insertion of a catheter into the bladder, the infection of the HIV virus (which causes AIDS), the practice of intense efforts with a full bladder, diabetes, severe constipation , prolonged sexual arousal without vent and the practice of sports such as cycling or horse riding complete the picture of risk factors favoring the onset of prostatitis.
To diagnose prostatitis, the doctor first of all proceeds with the anamnesis, that is, with the collection of information on the patient's clinical history, asking him questions about the perceived symptoms, general health conditions, possible use of drugs, sexual habits and away talking. The history is followed by a complete examination, including rectal exploration to palpate the prostate and evaluate its consistency with a finger through the anterior wall of the rectum. In acute forms of prostatitis, palpation of the prostate gland causes severe pain. The rectal exploration also allows to perceive the possible enlargement of the prostate or the presence of adenomas. An important role in the diagnosis of prostatitis is played by a "urine analysis. This test, called urine culture, is designed to demonstrate the presence of signs of inflammation and to identify any pathogens responsible. For the same purpose, fluid analyzes can be performed. seminal and a urethral swab. Regarding blood tests, it is necessary to consider that prostatitis, both acute and chronic, can cause a significant increase in PSA (also known as Prostate Specific Antigen). The parameter, however, generally returns to the basic values after healing A simple uroflowmetry - thanks to the analysis of one or more urinations inside a special device that measures the intensity of the urinary flow - helps to define any urinary reflux problems. To complete the clinical picture, a "vesico-prostatic ultrasound and, more rarely, a" trans-rectal ultrasound followed by a prostate biopsy can be performed. In relapsing and chronic forms, it is in fact essential to exclude obstructive factors that can predispose to prostatitis.
Regarding treatment, treatment depends on the type of prostatitis diagnosed. In cases of non-infectious prostatitis, where there is "no" infection and the cause is uncertain, treatment is obviously more difficult. In these cases, prostatitis can be managed with analgesics and anti-inflammatories, to keep painful symptoms under control. In addition, it is possible to resort to alpha-blocking drugs, useful for relaxing the prostate and bladder neck muscles, thus favoring a better outflow of urine. On the other hand, when prostatitis is caused by a "bacterial infection, the therapy is based on the use of antibiotics, possibly associated with anti-inflammatory drugs." Antibiotics can be chosen according to the pathogen identified through microbiological analyzes and the antibiogram, although often, given the severity of the symptoms, the tests are postponed until after resolution of the acute picture with broad spectrum antibiotics. After completing a course of antibiotics, another urinalysis will be performed to ascertain that the pathogen has been eradicated. If the test is positive for the presence of bacteria, an additional course of antibiotics will then be required. To avoid relapses and phenomena of bacterial resistance, I remind you of the extreme importance of following medical instructions to the letter, both in terms of doses and treatment times. Finally, especially as regards the management of chronic prostatitis and abacterial prostatitis, it is useful to adopt changes to the diet, abolishing alcohol and irritants - such as hot spices, chocolate, coffee and artificial sweeteners - and trying to take in adequate quantities of liquids and fibers, possibly supported by laxatives if recommended by the doctor. Physical activities that can cause perineal trauma, such as, for example, horseback riding and cycling, should also be avoided.
