Written by Dr.Albana Greca Sejdini, Md, MMedSc

Chronic Prostatitis at a glance

Clinically the medical term prostatitis (including chronic prostatitis) involves a wide variety of different symptoms ranging from obvious acute bacterial prostatitis to a complicated prostatitis. In some cases, it might not even reveal signs of inflammation. Some experts describe prostatitis as the sum of all medical ignorance.

Usually, diagnosis as well as differential diagnosis of all prostatitis problems is very frustrating for both; the patient and his physician.

Acute prostatitis is a sort of infective prostatitis. It is mainly caused by a bacterial infection of the prostate gland, and it is known to be a subtype of urinary tract infection. Usually, symptoms of acute prostatitis are severe with sudden onset and accompanied with fever.

Meanwhile chronic prostatitis has nearly the same symptoms but with less severity, gradual onset and no fever. It is described as chronic because its symptoms are persistent and reoccur from time to time.

The symptoms of this kind of prostatitis persist for at least 3 months; and based on this, your doctor will give the diagnose of “chronic type prostatitis”. On contrary, acute prostatitis symptoms come and disappear more quickly.

Furthermore, there are two main types of chronic prostatitis classification:

  • Chronic bacterial prostatitis
  • Chronic pelvic pain syndrome CPPS

Similar to acute prostatitis, chronic bacterial prostatitis is a sort of infective prostatitis, but it is caused by chronic or persistent bacterial infection of prostate gland. It is thought to be the main cause of recurrent urinary tract infection in men. Bacterial type is not transmitted by sexual route.

Chronic prostatitis/CPPS is a persistent painful or discomfort sensation in the region of lower pelvic, particularly, at the base of the penis and around the anus.

The cause of it is not completely known, but myriad explanations are suggested recently; including:

    1 - Infection with unknown type of pathogens

    2 - Nerve disorder influencing the prostate gland

    3 - Autoimmune disease affecting prostatic tissues

    4 - Inflammation due to violent regurgitation (coming back) of urine into prostate gland during urination


Acute prostatitis
Chronic prostatitis


Chronic bacterial prostatitis
Chronic prostatitis/CPPS
Symptoms
Symptoms start and develop quickly.
1-Severe pain at base of penis, testes, around anus, above pubic bone, and lower back area.
2-Severe LUTS; like painful urination, urgency to pass urine, frequent urination, blood in urine, and urinary retention.
3-High temperature (fever), general illness, body aches and pain.
4-Thick fluid discharge coming from urethra through penis
5-Prostate is painful and tender on clinical examination

Symptoms wax and wane. In the periods of flare ups:
1-Pain and discomfort at base of penis, testicles, around anus, above pubic bone, and lower back.
2-Pain while passing stools
3-Symptoms of urinary tract infection; painful and frequent urination, urgency to urinate.
4-Symptoms are less severe than those of acute prostatitis; e.g. no fever, less body aches
5-Inbetween episodes between flare-ups; there will be mild residual pain, and mild LUTS (lower urinary tract symptoms).
The symptoms of syndrome include:
1-Main symptom is pain with varying degree of severity; in the base and tip of penis, around anus, lower abdomen, and lower back area.
2-Urinary symptoms, which include painful urination, urgent desire to pass urine at any time, weak urine stream, and some hesitancy when urination.
3-Impotence, and painful ejaculation
4-Tireness, and general body aches and pain.
Treatment
-Antibiotics; a thirty days course can be very effective
-Analgesic and antipyretic drugs, like paracetamol and ibuprofen
-Laxatives; to relief the pain of hard stools in the rectum press on the tender prostate.
There is no standard or routine treatment, but most experts will recommend the following:
-Long course of antibiotics; which might reach up to 90 days of treatment.
-Prostatectomy; surgical removal of prostate gland. This treatment is suggested when there are stones in the prostate.
-Antibiotics; may be given at the beginning of the treatment, but they have limited effect. It is preferred to use antibiotics which have anti-inflammatory effect at the same time.
-Alpha blockers; which are used mainly for the treatment of BPH, these help in treatment of CPPS.
-Medications, like bioflavinoids (quercetin) and finasteride (Drug used to shrink prostate).
-Pain killers and drugs to mange stress


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