Symptoms of chronic prostatitis

Symptoms of chronic prostatitis include pain, urinary dysfunction, and sexual dysfunction. The pain may be shooting, pulling, dull, burning, constant, paroxysmal; localized in the perineum, above the pubis, in the sacrum area; radiating to the head of the penis and/or the scrotum. The intensity of pain also varies - from mild to intense, preventing the patient from doing his usual activities or sleeping. Sometimes the patient does not describe the pain as such, but complains of a feeling of discomfort, inconvenience in the specified areas. Pain may appear or intensify during urination or during or after ejaculation. Urination disorders are expressed in frequent urges, including at night, and burning during urination. The general condition does not suffer, hyperthermia does not develop with chronic inflammation, there are no signs of intoxication. Of course, such symptoms of chronic prostatitis negatively affect the patient's quality of life, although the disease itself does not pose an immediate threat to life and is extremely rarely an indication for hospitalization; usually, patients with chronic prostatitis are subject to outpatient treatment.

Patients with chronic pelvic pain experience constant emotional distress caused not only by the pain itself, but also by its consequences - disturbances in sexual and social interactions. Such patients are characterized by a high level of anxiety, which makes some researchers consider nonbacterial prostatitis a psychosomatic pathology. "Urinary hypochondriacs" persistently seek consultations from more and more specialists who would establish the "correct" diagnosis, insist on repeated urological examinations, each time not trusting their results. Psychogenic disorders are inevitably accompanied by muscle tension, which closes a vicious circle: spasm of the smooth muscle sphincter and striated muscles of the pelvic floor - separately or in combination - leads to increased pressure in the prostatic part of the urethra and to urine reflux in the prostate gland.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]

Dystrophic-degenerative prostatitis, prostatosis

In this form of the disease, the symptoms of chronic prostatitis include pain and sexual dysfunction. A vicious circle is formed, neurological disorders occur. In the treatment of these patients, great importance is given to psychotherapy, physiotherapy, angioprotectors, and sanatorium and resort treatment.

Currently, three main pathogenetic mechanisms for the development of symptoms typical of chronic prostatitis are considered:

• spasm of the smooth muscle sphincter of the bladder, leading to reflux of urine into the prostate and the development of “chemical” prostatitis;
• spasm of the striated muscles of the pelvic floor;

[ 5 ], [ 6 ], [ 7 ]

Smooth muscle sphincter spasm

Spasm of the smooth muscle sphincter of the bladder and the prostatic part of the urethra probably reflects dyssynergy (uncoordinated work) of the bladder - internal vesical sphincter, the exact cause of which remains unclear. As a result of such spasm, the pressure of urine in the prostatic part of the urethra during urination is increased; this leads to the reflux of urine from the urethra into the prostate and ejaculatory ducts and to the development of "chemical" prostatitis and even epididymitis. In severe cases, such urine reflux can be detected by voiding cystourethrography.

Spasm of the pelvic floor striated muscles

Constant overstraining of the pelvic floor muscles, leading to the development of muscle tension pain, or myofascial pain, is also one of the possible causes of the symptoms typical of nonbacterial prostatitis. Spasm of the striated muscles of the pelvic floor is detected in a significant number of patients. In this case, pelvic pain and discomfort increase when sitting, running or other physical activity that leads to tension of the perineal muscles, and rectal examination reveals painful tension of the anus and paraprostatic tissues, while the prostate itself is painless.

Sexual dysfunctions, along with pain of various localizations and dysuric phenomena, represent the triad of symptoms most often encountered in chronic prostatitis. In turn, patients complaining of sexual disorders often have inflammatory diseases of the genitourinary system (including prostatitis). And sometimes it is difficult to understand what is the cause and what is the effect; most likely, both these conditions are interconnected and interdependent; we tend to consider sexual dysfunction to a greater extent not as a manifestation, but as a complication of chronic prostatitis. At the same time, the existence of two independent diseases is also possible - sexual dysfunction and chronic prostatitis, developed by an independent mechanism. However, having arisen simultaneously, they will certainly aggravate each other's course.

Sexual disorders in chronic prostatitis are very diverse even in one patient at different periods of the disease. The variability of symptoms depends on the activity of inflammation, the degree of involvement of neighboring organs, the state of the nervous and endocrine systems, the patient's age, and concomitant diseases. Nevertheless, most researchers talk about suppression of libido, disorder of adequate erections and accelerated ejaculation. However, statistical data on the frequency of occurrence of disorders of the copulative function in patients with chronic prostatitis in different population groups vary significantly: from 6.6 to 100%.