Prostatic congestion is a medical condition of the prostate gland that happens when the prostate becomes swollen by excess fluid and can be caused by prostatitis. The condition often results in a person with prostatic congestion feeling the urge to urinate frequently. Prostatic congestion has been associated with prostate disease, which can progress due to age. Oftentimes, the prostate will grow in size which can lead to further problems, such as prostatitis, enlarged prostate, or prostate cancer. [1]
Prostatic congestion is commonly observed in individuals between the ages of 20 and 40 years. It can however occur at any age. [2] Chronic prostatitis is one of the main causes of this condition and this occurs when there is accumulation of fluid that can lead to swelling of the prostate that can therefore lead to congestion. [3] Other possible causes of prostatic congestion include benign prostatic hyperplasia, [4] prostate cancer, [5] urinary tract cysts, [6] and infrequent ejaculations. [7] [8]
Symptoms are often patient-specific, and diagnosis includes a workup and a digital rectal examination. Individuals are often referred to a urologist for further examination.
Treatments identified for prostatic congestion include mechanical treatments such as varicocele sclerotherapy, [4] minimally invasive treatments, [9] and alternative treatments such as massaging the prostate regularly, [10] [11] acupuncture combined with traditional Chinese medicine, dietary supplementation, exercise, and other therapies such as warm baths, local therapy with heating pads, and physical therapy. An alternative form of medicine called ayurveda is also used for treatment. Medical consultation is recommended before attempting these treatments.
There is limited information available on prostatic congestion, as it has been commonly associated as a side effect or complication of other conditions, such as chronic prostatitis. Due to this, there are lifestyle factors that can influence the symptoms of such conditions due to their relation to prostatic congestions. In a nationwide epidemiological survey in China, it was found that an increase in alcohol consumption was related to an increase in symptoms of discomfort or pain from their chronic prostatitis. This was due to the understanding that alcohol in circulation can exacerbate prostatic congestion, contributing to such symptoms. [16] The prostate is sensitive to alcohol, therefore, alcohol consumption can also increase how severe the congestion may be. [17] This is because acetaldehyde, a breakdown product of ethanol, can lead to vasodilation and therefore prostate congestion and cause inflammation. [15]
Symptoms vary depending on the cause of the prostatic congestion. [8] [18]
In addition to these symptoms, prostatitis can be a complication of recurrent prostatic congestion. In cases where an individual engages in minimal sexual activities resulting in reduced ejaculation frequency, there can be an accumulation of secretion leading to prostatic congestion. This can block the prostatic ducts, ultimately increasing the person's risk of developing prostatitis. [19]
If an individual experiences the following symptoms, it is highly encouraged to seek medical attention for a proper diagnosis. [18]
A workup is an important factor for diagnosis since symptoms can vary and are patient-specific. One exam that is performed is a digital rectal examination to examine the prostate. The doctor may refer the individual to another doctor that specializes in urinary tract disease, also known as a urologist. A urologist may perform additional tests such as a prostate-specific antigen (PSA) blood test or a bladder pressure testing. Imaging tests such as transrectal ultrasound and magnetic resonance imaging (MRI) might also be performed. Although prostatitis does not increase the risk of prostate cancer, a prostate biopsy may be performed. [20]
Since the testicular and prostatic veins are connected, backflow of fluid from the testicular veins can cause fluid to be backed up into the prostate. Varicocele sclerotherapy is a procedure that seals off veins that contain a lot of fluid and redirects blood flow through other veins, thereby relieving fluid backed up to the prostate. A study with 36 participants aged 40–80 was conducted, and the results were statistically significant in that varicocele sclerotherapy helps relieve pressure on the prostate, thereby relieving prostatic congestion. [4]
Although there are not many studies on this, due to expense and lack of support from healthcare systems, minimally invasive therapies include a form of heating the prostate. A needle is inserted directly into the prostate, or, a catheter, endoscope, or probe is inserted into the urethra. There are two types of heating: low energy and high energy. Low-energy heating includes using laser, microwave, or electrical methods, and high energy includes vaporization of the prostatic tissue. Vaporization usually requires anesthesia. [9]
Physicians have recommended massaging the prostate regularly to reduce congestion in the prostate. In 1980, a study was conducted in which participants were given 10 sessions of prostate massages in 3–4 weeks and hyperplasia (enlargement of an organ) was reduced in almost all participants. [11] Massaging the prostate causes a release of accumulated fluids. This method has been historically used as a treatment for prostatitis, as prostatic congestion has been commonly associated with prostatitis. [10]
There is still limited information available on prostatic congestion treatment, however, there have been studies that combined therapies to address prostatic congestion in the presence of prostatitis. For example, the combination of antibiotics and prostatic massage was found to help relieve chronic pelvic pain syndromes in people with chronic prostatitis. This was based on the understanding that massage treatment has been previously shown to help relieve prostatic congestion. [21]
Acupuncture combined with Chinese medicine can alleviate symptoms caused by prostate congestion and can be used as an effective treatment method for chronic prostatitis. A systematic review and meta-analysis published in 2021 used 19 randomized controlled trial studies with a total of 1831 cases to come to this conclusion. The results highlighted that acupuncture combined with traditional Chinese medicine could improve patients’ urination symptoms, alleviate pain symptoms, and overall improve quality of life. In addition, results showed that with these alternative treatments there was no increase in adverse reactions. [22]
Saw palmetto, a phytotherapeutic agent, has been shown to reduce prostatic congestion and urinary symptoms related to benign prostate hyperplasia. The exact mechanism is unknown however it is commonly believed to work by inhibiting the enzyme 5-alpha reductase that converts testosterone into dihydrotestosterone, its active metabolite. [23] An individual with benign prostate hyperplasia may produce an excessive amount of dihydrotestosterone. Increase in dihydrotestosterone levels can lead to enlargement of the prostate since it plays a role in the hyperplasia of the prostate stomal and epithelial cells. [24]
Bangshil and Fortege, two drugs that are part of an alternative medicine practice called Ayurveda, are sometimes used for prostatic conditions. Bangshil tablets contain herbal ingredients that some believe have antibacterial properties to help keep the prostate free of infection, while some of the ingredients found in Fortege are thought to help strengthen the genitourinary system. [2] However, there is very little evidence that any Ayurveda treatment has significant antimicrobial effects or use in genitourinary conditions. [25]
Walking or performing regular exercise for 30 minutes a day, 5 times a week can help alleviate symptoms of an enlarged prostate or acute prostatitis that can lead to congestion. It can also help prevent the development of congestion in the prostate in the future and help reduce any pain experienced due to congestion. [26]
Other treatments can include warm baths, local heat therapy with heating pads, and physical therapy. Some examples of physical therapy would be pelvic muscle exercises which strengthen and relax muscles that hold the bladder in place. Myofascial release is a trigger point release which can also help in relieving pain symptoms. This includes pressing and stretching with a warming or cooling device the muscles in the lower back and pelvic area. [27]
