Irritative and inflammatory affections of the lower bowel produce reflex irritation of the vesical neck with associated hyperemia of the prostate. The hyperemia and spasm may be so severe that reten tion of urine results. This is observed after operations about this part and in inflamed hemorrhoids. Rectal tenesmus, as seen in cer tain cases of dysentery and acute proctitis, is apt to produce some what similar conditions affecting the prostate and vesical neck. In cases of chronic disease of the lower bowel, such as polypi, stricture, tumors,' and particularly hemorrhoids, passive congestion of the prostate results from obstruction to the venous circulation. The author has observed well-marked enlargement of the prostate asso ciated with stricture of the rectum and hemorrhoids, and has seen the prostatic disturbance completely disappear after an operation on the lower bowel. Constipation, excessive horseback riding, and the modern exercise of bicycle riding, are efficient causes of prostatic hyperemia in some cases.
Hyperemia of the prostate exists in all cases of strangury pro duced by drugs. Cantharides, turpentine, and, it is said, the vari ous balsamic preparations may produce this condition. Prostatic hyperemia rarely, if ever, goes on to acute inflammation idiopathi cally. Instrumental interference with associated trauma and sepsis, or a mixed infection from posterior urethritis, is usually necessary to precipitate acute inflammation. Obstructive affections of the urethra are likely to produce more or less marked prostatic hyperamnia. Urethral strictures of small calibre are usually associated with more or less marked engorgement of the prostate. Large-calibred penile strictures may produce prostatic hyperemia reflexly, even where there is no appreciable obstruction to the passage of urine. The slightest
degree of coarctation in the bulbo-membranous region is quite likely, from the close association of the nervous and vascular supply of the affected part with that of the prostate, to produce circulatory distur bance in the latter structure.
Whether or not chronic hyperemia of the prostate may be the foundation of hypertrophy of the organ in after-life has been the subject of much difference of opinion. The author inclines to the affirmative, as will hereafter appear.
Hyperemia of the prostate may become chronic. Under such circumstances it is usually of a passive character, and is generally associated with constipation and ungratified sexual desire. Sexual excitement is the most important factor in its production, and it is especially likely to exist in masturbators. This form of chronic hyperaemia is characterized by the escape of prostatic fluid at various times, and is usually supposed by the patient to be spermatorrhcea, while to the profession at large most cases are classified as prostator rhcea. The congestion of the affected organ brings about hyperse cretion, and in all probability a relaxed condition of the mouths of the prostatic ducts. The condition might be classified as prostatic catarrh were it not for the quite general association of this term with true inflammation. Follicular prostatitis as described by most authors implies this result of hypersecretion, and appears to the present writer to be a misnomer.
The principal disturbances from this form of prostatic disease are of a psychical rather than physical character.