A prostate massage reduces inflammation

Inflammation of the prostate (prostatitis)

What is prostatitis?

In men, the prostate or prostate gland surrounds the beginning of the urethra. The gland, about the size of a walnut, produces a milky secretion that is part of the seminal fluid. In around 15 percent of men, it becomes infected at least once in a lifetime, often between the ages of 40 and 50. Then the diagnosis is prostatitis.

Patients often experience pelvic pain and difficulty urinating. In 30 percent of cases, the disease is protracted and lasts longer than a year. The suffering of the men concerned is high and the quality of life is significantly reduced. The National Institute of Health (NIH) has divided prostatitis syndrome into four categories:

Category I - acute bacterial prostatitis

Acute bacterial prostatitis is a bacterial infection of the prostate associated with severe symptoms such as pain, fever and difficult micturition (urination)

Category II - chronic bacterial prostatitis

Chronic bacterial prostatitis is a long-standing bacterial infection of the prostate with or without symptoms. Common symptoms are a feeling of pressure in the lower abdomen and perineum and the sperm turning brown.

Category III - chronic prostatitis / chronic pelvic pain syndrome

Chronic prostatitis or chronic pelvic pain syndrome was also called "abacterial prostatitis" in the past, as no bacterial involvement can be detected in it. It is divided into an inflammatory form (IIIa) and a non-inflammatory form (IIIb). Typically, the patients suffer from chronic pelvic pain.

Category IV - asymptomatic prostatitis

An inflammation of the prostate is detectable, but the patient has no symptoms.

Causes: where do you get prostate inflammation from?

In acute bacterial prostatitis, the pathogens usually ascend via the urethra into the prostate. Frequently involved germs are Escherichia coli and other enterobacteria and enterococci.

With delayed or ineffective therapy, acute prostatitis can become chronic. Most of the time, however, chronic prostatitis is caused by urinary tract infections. Prostate stones can also be a source of infection.

For example, patients with immunodeficiency or certain pre-existing conditions Diabetes are at greater risk of developing bacterial inflammation of the prostate.

Chronic prostatitis or chronic pelvic pain syndrome can be triggered by various causes.

Anatomical changes, for example cysts or adhesions, in the area of ​​the prostate, urethra, bladder neck and rectum can trigger inflammation and the typical pain. Most of the time, however, the reason for chronic pelvic pain syndrome remains unclear.

In the inflammatory form, inflammatory cells (leukocytes) are detected in the prostate secretion, but no pathogens. There is evidence that pathogens that are difficult to detect, such as chlamydia, ureaplasma and mycoplasma, can cause the inflammation.

Experts discuss other possible causes of chronic prostatitis:

Detrusor-sphincter dysfunction

This is understood to be a bladder emptying disorder, which is caused by insufficient relaxation (relaxation) of the muscles of the bladder neck. This causes urine to flow back into the tubules in the prostate, which can cause inflammation.

Immune dysfunction

In some cases, indications of a malfunction of the immune system and of autoimmune processes have been found.

Neuropathic pain

Pain caused by damage to the nerves is called neuropathic pain. Many nerves run near the prostate. Irritation of these surrounding nerves could lead to the typical chronic pelvic pain.

Psychosomatic dysfunction

Mental health problems can affect the body. Well-known symptoms include headache or back pain and irritable bowel syndrome. It is believed that mental health problems can also trigger chronic pelvic pain syndrome.

Symptoms: what does prostate inflammation feel like?

Acute bacterial prostatitis is characterized by typical symptoms:

  • Fever with chills
  • general feeling of illness
  • severe pain in the back and perianal area
  • frequent, difficult and painful urination
  • in severe cases urinary behavior; that is, the patient cannot pass urine

Chronic bacterial prostatitis and chronic pelvic pain syndrome cannot be distinguished based on symptoms. These are more unspecific. The following complaints can occur:

  • Pain, especially in the anorectal and genital areas, but also in the entire pelvis
  • Discomfort when urinating
  • sexual dysfunction (erectile dysfunction, loss of sexual drive)
  • recurring urinary tract infections with the associated symptoms
  • The ejaculate turns brown from blood in the semen
  • at times no symptoms

Asymptomatic prostatitis is an incidental finding because the patient has no symptoms. It is diagnosed, for example, during examinations for infertility or when diagnosing prostate cancer.

Diagnosis: How do you recognize an inflammation of the prostate?

Acute bacterial prostatitis is noticeable due to the typical symptoms. During the rectal exam, the doctor will notice an enlargement of the prostate. To clarify an abscess, he can do an ultrasound scan. Enormous amounts of leukocytes (inflammatory cells) are found in the urine. The diagnosis is confirmed by the pathogen detection in midstream urine. The PSA values ​​(values ​​of the prostate-specific antigen) in the serum are often increased.

If chronic bacterial prostatitis is suspected, the doctor first rules out a urinary tract infection. To do this, he compares the number of germs (number of pathogens) in urine, midstream urine, prostate secretion and expressin. Exprimaturin is the name given to the urine that is collected after a prostate massage. The number of bacteria in the prostate secretion or expressin must be 10 times higher than in the urine. In addition, an increased number of leukocytes in the prostate secretion must be detected in order to be able to make the diagnosis.

In chronic pelvic pain syndrome, no bacteria can be detected in the prostate secretion, but sometimes an increased number of inflammatory cells (leukocytes). If the leukocyte count is increased, it is referred to as inflammatory prostatitis. If it is not, the prostatitis is classified as non-inflammatory.

The doctor examines the patient rectally and can thus determine changes in the pelvic and prostate area and, if necessary, initiate further examinations.

Often the doctor cannot find a cause for the symptoms. Then he makes the diagnosis based on the typical symptoms of pelvic pain syndrome. Above all, pain in the anogenital area and pelvis that lasts or recurs for months is an important criterion for the diagnosis.

The diagnosis of asymptomatic prostatitis is made by detecting inflammatory cells and an increased number of leukocytes in the prostate secretion.

Prostatitis treatment

After the diagnosis of acute bacterial prostatitis, the patient is initially treated with antibiotics in the hospital. The agents of choice are modern fluoquinolones. These are given intravenously first and then orally for 4 weeks. After a germ determination with a resistance test, the antibiotic is changed if necessary. If the patient cannot empty the bladder sufficiently, alpha-receptor blockers can be used. Alpha-blockers relax the muscles of the prostate and bladder, making it easier to empty the bladder.

If the patient is unable to urinate, the doctor places a catheter. A disposable catheter can be placed in the urethra or the urine is drained through a catheter that is inserted above the pubic bone through the abdominal wall into the bladder.

Chronic bacterial prostatitis is also treated with fluoquinolones for 4 weeks. If the bacteria are resistant, therapy with clotrimazole for 3 months is recommended. If the disease recurs, an antibiotic long-term therapy for 6 months can be tried. Surgical removal of the prostate should only be considered if all therapeutic attempts have failed.

For the treatment of chronic pelvic pain syndrome, therapy with alpha-receptor blockers for 6 months is recommended to make it easier to empty the bladder. If a dysfunction of the pelvic floor muscles is suspected, muscle relaxants can help relax the muscles. In addition, antibiotic therapy should be carried out, since undetectable pathogens are also discussed as the cause of the chronic pelvic pain syndrome. The doctor usually prescribes nonsteroidal anti-inflammatory drugs (NSAIDs) as pain relievers, and stronger pain relievers if necessary.

If there are anatomical changes (e.g. cysts or adhesions), these are treated surgically if possible. According to previous doctrine, asymptomatic prostatitis does not need to be treated. However, there are reasons in favor of therapy:

An infection of the genital tract can lead to infertility. In 6 to 10 percent of cases, a genital tract infection is blamed for male infertility.

In addition, chronic inflammation of the prostate can develop into cancer, the so-called inflammation-associated prostate carcinoma. An increase in PSA that is typical of the Prostate cancer is also found in patients with prostatitis. Treatment with anti-inflammatories and antibiotics can lower the PSA level.

Risks and Forecast

The prognosis of an acute bacterial prostate inflammation is quite good, the probability of getting sick again is only 13 percent. Serious complications such as a prostate abscess and / or blood poisoning occur only very rarely. Prostatitis can promote the development of prostate cancer. That is why timely value therapy is important.

The treatment of chronic pelvic pain syndrome is much more complicated and protracted, and a cure is not always possible, as the cause of the disease is often not found. Therefore, the aim is to reduce the symptoms as much as possible through an adapted therapy so that the patients regain quality of life.

Which doctors and clinics are specialists in prostate inflammation?

Anyone who needs a doctor wants the best medical care for themselves. This is why the patient asks himself, where can I find the best clinic for me? Since this question cannot be answered objectively and a serious doctor would never claim that he is the best doctor, one can only rely on the experience of a doctor.

We help you to find an expert for your illness. All doctors and clinics listed have been checked by us for their outstanding specialization in the area of ​​prostate inflammation and are awaiting your inquiry or your treatment request.


  • "Prostatitis and Male Pelvic Pain Syndrome - Diagnostics and Therapy", Dtsch. Ärzteblatt, 2009
  • "Urogenital Infections as a Risk for Male Infertility", Dtsch. Ärzteblatt, 2017
  • Urologie, Hautmann and Huland, Springer Verlag 2006
  • RKI, Issue 36 Prostate Diseases
  • "Prostatitis - Stubborn and Difficult to Treat", Pharmazeutische Zeitung, issue 12/2007