Patient's question:
How to determine if it is prostatitis?Doctor's answer:
Prostatitis is divided into acute prostatitis and chronic prostatitis, as follows:The clinical manifestations of acute prostatitis vary depending on different pathological types and infection routes. Catarrhal and follicular prostatitis may be asymptomatic, while solid prostatitis presents typical systemic and local symptoms. Hematogenous infections cause sudden onset with acute systemic infection signs or sepsis. Prostatitis caused by urinary tract infections often has significant urinary symptoms. Symptoms are generally classified into five categories.
(1) Systemic symptoms: Fatigue, weakness, anorexia, nausea, vomiting, high fever, chills, collapse, or sepsis. In sudden onset cases, systemic symptoms may mask local symptoms.
(2) Local symptoms: Heavy pressure in the perineum or suprapubic region, worsening with prolonged sitting or defecation, and radiating to the waist, lower abdomen, back, thighs, etc.
(3) Rectal symptoms: Rectal fullness, urgent defecation, defecation pain, and white discharge from the urethra during bowel movements.
(4) Urinary symptoms: Burning pain during urination, urinary urgency, frequency, dribbling, and purulent urethral discharge. Edema of the bladder neck may cause difficulty urinating, thinning or interruption of urine flow, and severe cases may lead to urinary retention.
(5) Sexual symptoms: Decreased libido, dyspareunia, impotence, and hematospermia.
If a patient with acute prostatitis exhibits the above symptoms for 7–10 days or longer, with persistent fever and elevated white blood cell and neutrophil counts, suspicion of prostatitis abscess formation should arise. Abscesses are more common in individuals aged 20–40 and are often accompanied by rectal symptoms and urinary retention. An abscess in the seminal vesicle may spontaneously discharge a large amount of purulent blood through the urethra after the edema of the ejaculatory duct subsides, similar to an abscess rupture, leading to immediate symptom relief. Acute prostatitis may also lead to complications such as orchitis, seminal vesitis, and epididymitis, with severe cases possibly causing groin or renal colic.
What symptoms are associated with chronic prostatitis? The symptoms of chronic prostatitis are diverse and do not correlate with the severity of inflammation. Some patients may have a large number of pus cells in their prostatic fluid but show no symptoms, while others may have normal or near-normal prostatic fluid tests but severe clinical manifestations. Common symptoms can be categorized into five types:
(1) Urinary discomfort: Frequent urination, urethral burning pain, which may radiate to the glans penis; morning urethral discharge of mucus, mucus threads, or purulent fluid; cloudy urine or white discharge after bowel movements; severe cases may present with terminal hematuria, difficulty urinating, or urinary retention.
(2) Local symptoms: Discomfort, pressure, or fullness in the posterior urethra, perineum, and anus, worsening during squatting or defecation.
(3) Radiating pain: The prostate and seminal vesicles are richly innervated by sympathetic nerves. During inflammation, increased tension within the glands can stimulate the sympathetic nerves, causing referred lower back pain that may radiate to the penis, testicles, scrotum, groin, perineum, lower abdomen, thighs, buttocks, or rectum.
(4) Sexual dysfunction: Chronic prostatitis may cause decreased or lost libido, painful ejaculation, hematospermia, premature ejaculation, impotence, nocturnal emissions, and infertility. Unmarried young males often exhibit nocturnal emissions, neurasthenia, and depression.
(5) Other symptoms: Chronic bacterial prostatitis can trigger allergic reactions such as iritis, arthritis, and neuritis. Chronic prostatitis may also lead to neurosis,、、、。