Signs of Prostatitis in Men: First Symptoms and Prostate Pain

Prostatitis is inflammation of the prostate gland, a small organ below the bladder in men. Some of its manifestations require urgent medical care. Below are definitions, a list of symptoms, the nature of the pain, and the examination sequence.

What prostatitis is and what forms it takes

Prostatitis is a term denoting inflammatory lesions of the prostate gland. In the USA it accounts for 8% of all urological diseases and 1% of reasons for initial visits to a doctor. According to the 1995 criteria of the US National Institutes of Health (NIH USA), four categories are distinguished: I — acute, II — chronic bacterial, III — chronic prostatitis or chronic pelvic pain syndrome (IIIa — with signs of inflammation, IIIb — without them), IV — asymptomatic.

Prostatitis often coexists with urethritis and vesiculitis, and in older age — with benign prostatic hyperplasia. Category IV is asymptomatic.

First signs of prostatitis

Symptoms affect any man with a prostate gland. Initial manifestations:

• pain, stinging, or burning during urination;
• difficulty urinating or straining;
• urinating more often than usual;
• pain in the penis, scrotum, testicles, or anal area;
• pain during ejaculation, elevated body temperature.

In an acute process, chills, fever, weakness, and muscle and joint pain are added. Symptoms that persist for 3 months or longer are classified as chronic prostatitis.

Pain in prostatitis: where it hurts and what it feels like

Location of pain: lower back and lumbar region, lower abdomen, perineum, pelvis, groin area, scrotum, anus. In chronic nonbacterial prostatitis, pain is localized in the genital area and lower back; tenderness during defecation and ejaculation is possible.

During urination, pain is described as burning or stinging in the urethra. In acute prostatitis, the gland is sharply painful on digital examination; in chronic nonbacterial prostatitis, there may be prolonged pain and urinary symptoms.

Urinary disorders and other symptoms

Dysuria, frequent urination, nocturia, difficulty up to acute urinary retention. Constipation is possible due to compression of the rectum by the gland, urethral discharge, hemospermia, blood in the urine, and sexual dysfunction. In an acute process, the urine may be cloudy.

How different forms of prostatitis manifest

Acute prostatitis is rare but requires emergency care: the infection can lead to sepsis or ascending urinary tract involvement — cystitis, pyelonephritis. Chronic bacterial prostatitis is associated with a bacterial infection. Among men with chronic prostatitis, the nonbacterial form is more common: it is not caused by bacteria and manifests as prolonged pain and urinary symptoms.

Possible causes of the nonbacterial form include a prior bacterial infection, cycling, reflux of urine into the prostate, irritation by chemicals, disorders of nervous regulation of the lower urinary tract, parasites, viruses, pelvic floor muscle problems, and stress. The most commonly identified causative agent of prostatitis is Escherichia coli (86%).

How prostatitis is diagnosed and when to see a urologist

When an acute process is suspected, the scope of examination includes measurement of rectal temperature, palpation of the inguinal and perineal lymph nodes, a complete blood count with leukocyte differential, a test for C-reactive protein and prostate-specific antigen, a urinalysis, and urethral smears. In the chronic form, examination is often normal, but the gland may be enlarged and tender; leukocytes and erythrocytes are found in the urine, an elevated leukocyte count in the semen; bacterial culture does not detect any.

For symptoms of prostatitis, patients consult a urologist. If manifestations persist for 3 months or longer, the patient is referred to a specialist. An urgent consultation is needed when urination is impossible and when there is no improvement after 48 hours of antibacterial treatment.

Prostatitis by itself is not a reason to call an ambulance. Calling 103 or 112 is necessary for signs of severe infection: sudden confusion, slurred speech, bluish, gray, or mottled skin and tongue, a rash that does not disappear when pressed with glass, severe shortness of breath.

This material is for informational purposes and does not replace consultation with a doctor.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer