Etiology, precipitating factors and clinical manifestations of prostatitis

What causes prostatitis?

Acute bacterial prostatitis is an acute infection caused by pathogenic microorganisms (including bacteria, chlamydia, mycoplasma, trichomonas, and viruses) invading the prostate. Common triggers include catching a cold, excessive alcohol consumption, colds, fatigue, frequent sexual activity, and unhygienic underwear. If treated improperly or incompletely, it can develop into chronic bacterial prostatitis. Prostatic calculi and urinary reflux may be important reasons for the persistence of pathogens and recurrence of infection.

The etiology of chronic nonbacterial prostatitis/chronic pelvic pain syndrome (CP/CPPS) is currently unclear. The prevailing view is that it involves pelvic autonomic dysfunction and bladder detrusor and sphincter ataxia, along with a series of complex pathological mechanisms. Possible causes include: ① urethral flora imbalance leading to occult bacterial infection of the prostate, or the presence of nanobacteria; ② abnormal immune response causing an immune-inflammatory reaction; ③ high urethral pressure in some individuals, causing reflux of irritants such as uric acid into the prostate, leading to the disease; ④ oxidative stress causing damage; ⑤ endocrine (hypothalamic-pituitary-adrenal axis) dysfunction; ⑥ neurosensitization causing bladder and urethral dysfunction, leading to abnormal contraction of the perineum and pelvic floor muscles, resulting in referred pain in corresponding areas outside the prostate; ⑦ chronic pelvic congestion; ⑧ negative emotions such as anxiety, depression, fear, pessimism, and tension often promote the development of the disease. It is now recognized that no single mechanism can explain the full pathophysiological process of chronic nonbacterial prostatitis/chronic pelvic pain syndrome; most cases are the result of a combination of multiple pathogenic factors.

What are the contributing factors to prostatitis?

Chronic prostatitis is prone to recurrence, largely because there are several triggering factors that many patients are unaware of or disregard. Common triggers include the following:

(1) Insufficient water intake: Some people cannot guarantee timely and sufficient water intake due to personal habits or work, which will cause the body to be in a state of mild dehydration, concentrated urine, and easy to suffer from urethritis and cystitis, thus inducing prostatitis. In addition, those who do not drink enough water often have constipation, which is also not good for prostate health.

(2) Smoking: The incidence of prostate disease is 1 to 2 times higher in smokers than in non-smokers. This is because tobacco contains more than 1,000 harmful compounds that can damage the prostate. The more one smokes, the greater the damage to the prostate.

(3) Unhealthy diet: Frequent consumption of spicy and acidic foods and alcohol can cause prostate congestion due to vasodilation. The prostate of long-term alcoholics is constantly stimulated by alcohol, which can aggravate congestion, cause inflammation, or worsen the original condition.

(4) Getting cold: The prostate has abundant adrenergic receptors. When it gets cold, it is very easy to cause sympathetic nerve excitation, which leads to gland contraction, increases urethral pressure, and affects urination. Difficulty urinating will have an adverse effect on the prostate. This vicious cycle can cause prostate disease.

(5) Holding urine: Frequently holding urine can cause the bladder to become full and distended, increasing bladder pressure and leading to weak urination. This can increase local pressure and impair blood flow, thus aggravating the symptoms of prostatitis. More dangerously, for patients who already have cystitis or posterior urethritis, their urine can flow back into the prostate tissue through the prostatic ducts, which can easily lead to prostatitis.

(6) Compression of the perineum: Prolonged sitting or frequent cycling can cause the prostate to be compressed for extended periods, leading to poor local blood circulation. Prolonged sitting at work causes congestion in the pelvic cavity and prostate area, resulting in slow and stagnant blood flow, weakened resistance to pathogens, and increased susceptibility to prostatitis. When cycling, the seat rubs against the perineum, stimulating the upper urethra and prostate, causing chronic hyperplasia, hardening, and swelling of the subcutaneous tissue in the perineum, and even inflammatory reactions. This compresses the urethra and prostate, easily leading to prostate diseases and difficulty urinating.

(7) Improper ejaculation: Frequent sexual activity or masturbation within a short period of time can cause the prostate to be in a state of congestion for a long time or frequently, which may induce acute prostatitis. Conversely, those who cannot ejaculate for a long time due to abstinence or separation from their spouses may experience a large accumulation of prostatic secretions, which can lead to excessive expansion and congestion of the prostate over time, also causing inflammation. At the same time, seminal vesiculitis is also likely to occur, and seminal vesiculitis and prostatitis often induce each other. In addition, methods such as withdrawal or interrupted intercourse during sexual activity can also cause congestion and swelling of the prostate, thus aggravating inflammation.

(8) Fatigue: Long hours of work, lack of sleep, and physical exhaustion can weaken the body's resistance to disease and are also one of the causes of prostatitis.

What are the clinical manifestations of prostatitis?

Acute prostatitis often has a sudden onset, manifesting as systemic poisoning symptoms such as chills, fever, and fatigue, along with severe pain in the perineum (between the anus and external genitalia) and suprapubic region (lower abdomen), urinary tract irritation symptoms (frequent urination, urgency, and painful urination), difficulty urinating, or even inability to urinate (acute urinary retention).

Chronic prostatitis is prone to recurrence and has complex and diverse symptoms. Common symptoms can be summarized as follows.

(1) Urinary tract symptoms: urinary frequency, urgency, dysuria, urination hesitancy, urinary stream splitting, incomplete urination, etc. Mucus or purulent discharge may be seen at the urethral opening after waking up in the morning. White discharge may be seen from the urethral opening after defecation, and hematuria and difficulty urinating may occur in severe cases.

(2) Pain: Prostatitis can cause pain, mainly in the penis, perineum and anus, manifested as distending pain or dull discomfort, which is aggravated when squatting or defecating. The pain can radiate to the testicles, scrotum, groin, lower abdomen, thighs, buttocks, rectum and other areas. Simply put, pain may occur in the area from the navel to the knee, but the pain is tolerable.

(3) Sexual dysfunction: It can be mainly manifested as decreased libido, poor erection, and premature ejaculation. These symptoms can occur at the same time as chronic prostatitis.

(4) Neuropsychological symptoms: manifested as neurasthenia, depression, fatigue, irritable bowel (abdominal pain and increased bowel movements), etc.

Patients with chronic prostatitis may experience a combination of one or more of the above symptoms. It should be noted that the severity of chronic prostatitis symptoms is not directly proportional to the degree of inflammation: some patients have a large number of pus cells in their prostatic fluid but are asymptomatic; while others have no obvious abnormalities in their prostatic fluid examination but exhibit severe symptoms.

Asymptomatic prostatitis is discovered during examination and has no clinical manifestations.

How is chronic prostatitis diagnosed?

Whether you have chronic prostatitis is mainly diagnosed based on your symptoms. In other words, if you have the above clinical manifestations, you can consider the disease. Physical examination (such as digital rectal examination) and laboratory tests (such as prostate fluid examination) are only for reference.

You should have a Chronic Prostatitis Symptom Index (CPSI) and a psychological assessment done. You can score yourself to see if you have chronic prostatitis and how severe it is.

The National Institutes of Health Chronic Prostatitis Symptom Score (CPSI)

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