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Prostate pain - symptoms, causes and therapy

Prostate pain - symptoms, causes and therapy


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Pain in the prostate: these are the causes and treatments

About ten percent of all men become acquainted with prostate pain in the course of their lives. Often these are not limited to the organ itself. This is due to the anatomical position: the chestnut-sized prostate is located directly under the bladder near the penis root. It surrounds the urethra in a ring and borders on the rectum in the rear area. The bottom boundary is the pelvic floor. Its main function is to produce part of the semen, which is important for sperm motility and fertility. Depending on the cause and intensity, pain from the prostate can spread to the surrounding organs or even spread to more distant regions.

Symptom development

During the development phase, pain that arises in the prostate also affects the penis root and the anal area. In the further course they can also radiate into the testicles, the groin and the legs and spread over the entire pelvic floor, in the lumbar region and in the lower abdomen. Psychological factors, especially stress and general well-being, and digestion often affect pain intensity.

Increasing the pressure from inside or outside also often increases the pain. This happens, for example, when sitting on hard chairs or on a bicycle saddle. Pressure peaks occur from the inside when sneezing, coughing, during strenuous exertion or during bowel movements. The symptoms can also appear shortly before or after ejaculation and cause erectile dysfunction. The close relationship of the prostate to the ureter can cause the pain to be triggered or aggravated by urination. They are often accompanied by an increased urge to urinate and frequent visits to the toilet.

Basically, pain causes protective tension in the muscles of the affected and surrounding tissue. Because of its close proximity to the rectum, this may have an impact on digestion: irregular and painful bowel movements are not uncommon. In extreme cases, the pain can extend to the entire pelvic floor. Then one speaks of the so-called pelvic pain syndrome, which is often chronic and difficult to treat.

Men often describe the quality of pain with attributes such as stinging, pulling or burning. In addition, they often complain of an uncomfortable feeling of pressure in the area of ​​the prostate and in the surrounding regions, especially in the pelvic floor. Sensitive disorders such as nerve irritation and numbness also occur in rare cases.

Causes of prostate pain

Prostate pain is usually part of an entire complex of symptoms, which often also affects the surrounding organs and regions. Accordingly, their causes can be different and originate from the prostate itself or the surrounding tissue. The most common starting point in the organ itself is inflammatory processes, which doctors call prostatitis syndrome. They show a specific characteristic and are divided into four categories:

  1. Acute bacterial prostatitis
  2. Chronic bacterial prostatitis
  3. Chronic non-bacterial prostatitis
  4. Asymptomatic prostatitis

Acute bacterial prostatitis

Acute bacterial prostatitis is triggered by bacteria that often migrate into the prostate from the urethra and, where there is general immune deficiency, attach themselves there. As a result of the inflammatory process, the organ swells and becomes more sensitive to pressure. In acute bacterial prostatitis, the typical signs of inflammation and other prostate-specific symptoms can be observed in addition to the pain. These include fever, chills, burning urination, increased urination and incomplete voiding. If left untreated, it can lead to complete urinary retention, pus accumulation in the prostate and sepsis, or become chronic.

Chronic bacterial prostatitis

Symptoms are the same for chronic bacterial prostatitis as for acute. However, fever and chills are absent.

Chronic non-bacterial prostatitis

Non-bacterial prostatitis is the most common cause of prostate pain. There are no signs of bacteria in the blood. As long as only the prostate is affected, one speaks of a prostatodynia. In the course of the chronification, however, the pain builds up and affects the entire pelvic floor area and the anal region.

This disease, known as pelvic pain syndrome, is very uncomfortable and difficult to treat for the men concerned. The reasons for this have not been finally clarified. However, it is assumed that psychosocial components play an important role. These can be problems that are relevant in partnership, in sex life, in finding gender identity and in role expectations.

Sometimes depression and other mental disorders also influence the development of the disease. The starting point for the complaints can be the prostate itself or the surrounding structures. With continuous development, a vicious circle arises, in which the processes emanating from the different tissues mutually condition and reinforce each other.

Preconditions that favor the development of such a complaint cycle are previous surgeries and radiation that leave adhesions in the tissue. Prostate stones and cysts can also cause irritation, which causes pain. External stimuli such as cold, longer sitting, consumption of alcohol or hot spices also favor the development. The doctor makes the diagnosis of pelvic pain syndrome only when acute inflammation, tumors and other serious diseases have been excluded.

Asymptomatic prostatitis

Asymptomatic prostatitis is characterized by the fact that signs of inflammation are detected, but no symptoms occur. The disease is usually found as a secondary finding in the context of infertility and cancer studies. Research is currently being carried out intensively on whether asymptomatic prostatitis is involved in the development of infertility and prostate cancer. No meaningful results are yet available.

Prostate enlargement and prostate cancer

The relationship between prostate enlargement and prostate cancer and prostate pain is ambiguous. Enlargement of the prostate (benign prostatic hyperplasia) is a benign process in which the prostate tissue increases. The change remains completely symptom-free for a long time and initially affects the surrounding tissues due to the space requirement. Prostate pain and other complaints from the organ appear very late.

Prostate cancer is the most common type of cancer in men in Germany. It is the third leading cause of cancer-related death after colon cancer. Pain and other complaints only appear in the late stage. They are difficult to distinguish from those that occur with prostate hyperplasia. This makes early detection, which is important for a good prognosis, difficult.

Diagnosis

At the beginning of a targeted prostate diagnosis is the patient consultation, in which the affected person describes his symptoms in detail and as precisely as possible. In the case of prostate pain, it is particularly important for the doctor to know when the symptoms have existed, how they developed, where they are located and which mechanisms influence them. The medical history also includes a discussion of the living conditions and the psychological situation.

The information collected in this way usually gives the doctor a clear picture that confirms the suspected diagnosis. This is followed by a physical examination, in which the doctor scans the lymph nodes in the groin to find out whether there are enlargements. These can indicate an inflammatory event or a malicious process. The doctor examines the prostate during the rectal examination. He can determine any structural changes and enlargements of the organ.

The blood and urine values ​​are checked in the laboratory. In the urine, the protein values ​​as inflammation markers and any blood admixtures are particularly important for the diagnosis. The inflammation parameters and possibly also the PSA value (prostate-specific antigen) are also determined in the blood. PSA is an enzyme of the prostate, the value of which can be increased in inflammation and prostate cancer. The meaningfulness of an increased PSA value with regard to an existing cancer is controversial.

With an ultrasound examination, the doctor quickly gets an overview of the size and condition of the prostate and all other pelvic organs. If there is reasonable suspicion of prostate cancer, a tissue biopsy is performed for the laboratory examination. In individual cases, imaging methods such as magnetic resonance tomography, computer tomography or bone scintigraphy are also used for validation. With their help, doctors can help diagnose cancer if they recognize signs of malignant changes in the lymph nodes, unusual fluid retention or metastases.

Therapy

The early detection of the causes of prostate pain or the complaints in the prostate area is important from various points of view. Prostate cancer and prostate enlargement remain asymptomatic long after they develop. Early detection is particularly important for cancer in order to improve the prognosis through timely therapy.

The second important reason for early identification of causes concerns inflammatory prostate pain: they threaten to become chronic and can develop into pelvic pain syndrome, which is difficult to treat. Targeted therapy that starts early can prevent this process from developing so far. Basically, depending on the type and intensity of the disease, three therapeutic aspects are important: conventional medical care, support with natural remedies and adaptation of eating and drinking behavior, and finally psychosomatic care.

Conventional medical care

Acute bacterial inflammation should be treated as soon as possible with antibiotics. The treatment lasts two to four weeks and is usually carried out in hospital. This is important because doctors have to react quickly when resistance to antibiotic therapy develops. Urine behavior may also require catheter placement. In the case of intense pain, pain medication can also be administered. Muscle relaxants or alpha blockers are used when there are accompanying symptoms such as a strong feeling of pressure and tension and urine behavior. They relax the smooth muscles in the prostate and in the bladder, relieve the symptoms and promote urine drainage.

Prostate enlargement or prostate cancer may require surgery in some cases. With the transurethal resection of the prostate (TURP), the doctor can remove constricting tissue using electricity. He introduces the surgical instrument through the urethra to the prostate. Other minimally invasive procedures use the same access route, but destroy excess tissue by heating them using microwaves or lasers. Prostate carcinomas inevitably lead to the complete removal of the organ (prostatectomy) with subsequent radiation, chemotherapy or hormone withdrawal therapy.

Natural remedies, nutrition and drinking

Herbal products can help to reduce the symptoms, particularly in the case of chronic forms of prostatitis and prostatic hyperplasia. A herbal preparation that has been studied for a long time is the extract from saw palmetto fruits. These contain certain fatty acids and phytosterols (plant hormones), which are said to have some beneficial effects. They are said to have anti-inflammatory effects, promote urine flow and relax the smooth muscles.

However, the studies on efficacy are still unclear. While some studies confirm the effectiveness and even put saw palmetto extract on a par with pharmaceutical alpha blockers, other studies tend to come to negative results. However, the positive effect of multiple urges to urinate at night (nocturia) is clearly proven.

Scientific studies have shown that pumpkin seeds are able to significantly improve urine output in prostatitis. Similar results are available for nettle extracts. The nettle has long been known in naturopathy as a diuretic (diuretic). So far, positive effects on other prostate complaints have not been scientifically proven for either preparation.

Pollstimol is a preparation with a mixture of grass pollen. These are said to have an anti-inflammatory effect on prostate cells and reduce their growth activity. Since prostate problems are almost always accompanied by urination problems, regular and adequate drinking is important. Irregular digestion and stiff emptying also create pressure in the lower abdomen, which increases prostate pain. A balanced diet with lots of fruits, vegetables and whole grains can prevent these problems. Teas can also help to relax and calm you down. Chamomile, lemon balm and St. John's wort tea are suitable for this.

Psychosomatic treatment approaches

Psychotherapy assumes that hidden fears, unresolved role conflicts and hidden behavior patterns around the topic of sexuality and gender favor the development of prostate pain. In order to really solve this, external help from an experienced therapist is necessary. Psychodynamic and behavioral therapy methods are suitable methods to bring the hidden patterns to the surface and to dissolve them. Therapy also includes specific training programs that help those affected learn how to cope better with their stress and problems in everyday life.

In addition, they can use techniques such as autogenic training, progressive muscle relaxation and meditation to independently improve their ability to relax and their psychological situation. They relieve stress and relax the smooth muscles of the organs and the pelvic floor muscles. Regular exercise can support these effects. Warming applications with hot water bottles or cherry stone pillows also help you to calm down and regulate muscle tone.

Not yet scientifically proven, but nevertheless represented by many experts, is the thesis that frequent ejaculations prevent prostate problems and increase the chances of a cure for chronic prostatitis. The idea behind this is that the prostate ducts are flushed through the semen and bacteria and inflammation products are flushed out. (fp)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters

Swell:

  • Ros Eeles, Sonja Berndt, Ali Amin Al Olama, Fredrik Wiklund: Prostate cancer meta-analysis from more than 145,000 men to identify 65 novel prostate cancer susceptibility loci., Journal of Clinical Oncology, (accessed 02.07.2019), Journal
  • Guideline program oncology (German Cancer Society, German Cancer Aid, AWMF): Interdisciplinary guideline of quality S3 for early detection, diagnosis and therapy of the various stages of prostate cancer, long version 5.1, 2019, AWMF registration number: 043 / 022OL, (accessed on 02.07.2019), AWMF
  • Gerald L. Andriole: Benign Prostatic Hyperplasia (BPH), MSD Manual, (accessed July 2, 2019), MSD
  • Stephen Bent, Christopher Kane, Katsuto Shinohara, John Neuhaus, Esther S. Hudes, Harley Goldberg, Andrew L. Avins: Saw Palmetto for Benign Prostatic Hyperplasia, The New England Journal of Medicine, (accessed 02.07.2019), NEJM
  • Sayed Tantawy, Hany Elgohary, Dalia Shewitta: Trans-perineal pumpkin seed oil phonophoresis as an adjunctive treatment for chronic nonbacterial prostatitis, Research and Reports in Urology, (accessed 02.07.2019), Dovepress

ICD codes for this disease: N41ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


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