Symptoms of chronic prostatitis

Symptoms of chronic prostatitis include pain, urination disorders and sexual disorders. Pain can be firing, pulling, dull, burning, constant, paroxysmal; localize in the perineum, above the bosom, in the sacrum; irradiate to the glans penis and / or the scrotum. The intensity of pain also varies - from mild to intense, preventing the patient from doing the usual thing or sleeping. Sometimes the patient does not describe the pain as such, but complains of a feeling of discomfort, inconvenience in these areas. Pain may appear or increase during urination or during or after ejaculation. Violations of urination are expressed in rapid urge, including at night, cutting at urination. The general condition does not suffer, hyperthermia with chronic inflammation does not develop, there are no signs of intoxication. Of course, such symptoms of chronic prostatitis adversely affect the quality of life of the patient, although the disease itself is not an immediate threat to life and is rarely an indication for hospitalization, usually patients with chronic prostatitis are subject to outpatient treatment.

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

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]

Dystrophic degenerative prostatitis, prostatosis

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

Currently, there are three main pathogenetic mechanisms of symptom development, typical of chronic prostatitis:

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

[11], [12], [13], [14]

Spasm of smooth muscle sphincter

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

Spasm of striated pelvic floor muscles

Constant overstrain of the muscles of the pelvic floor, leading to the development of muscle tension pains, or myofascial pain, is also one of the possible causes of the appearance of typical for non-bacterial prostatitis symptoms. Spasm of the striated pelvic floor muscles is detected in a significant number of patients. In this case, pelvic pain and discomfort are amplified by sitting, running or other physical activity, resulting in muscle tension of the perineum, and rectal examination reveals painful straining of the anus and paraprostatic tissues, while the prostate itself is painless.

Sexual disturbances, along with pain of different localization and dysuric phenomena, represent a triad of symptoms most common in chronic prostatitis. In turn, patients who complain of sexual disorders often have inflammatory diseases of the genitourinary system (including prostatitis). And sometimes it is not easy to understand what is the cause, and what is the consequence; most likely, both these states are interrelated and interdependent; we tend to view sexual dysfunction more as a manifestation, but as a complication of chronic prostatitis. However, the existence of two independent diseases - sexual dysfunction and chronic prostatitis, developed by an independent mechanism, is possible. However, having emerged simultaneously, they will certainly aggravate the flow of each other.

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