Prostatitis

Topic Overview

What is prostatitis?

Prostatitis is swelling or infection of the prostate gland. It often hurts. The prostate gland sits just below a man's bladder and makes part of the fluid for semen. In young men, the prostate is about the size of a walnut. It usually grows larger as you grow older.

There are several types of prostatitis. They vary based on how long a man has had the problem and what kind of symptoms he has.

What causes prostatitis?

Sometimes prostatitis is caused by bacteria, but often the cause is not known.

What are the symptoms?

Symptoms of long-term (chronic) prostatitis are often mild and start slowly over weeks or months. They may include:

• An urge to urinate often. But you may pass only small amounts of urine.
• A burning pain when you urinate.
• A problem starting the urine stream, urinating in waves rather than in a steady stream, urine flow that is weaker than normal, and dribbling after urinating.
• Waking up at night to urinate often.
• A feeling of not completely emptying your bladder.
• Pain in your lower back, in the area between the testicles and anus, in the lower belly or upper thighs, or above the pubic area. Pain may be worse during a bowel movement.
• Some pain during or after ejaculation.
• Pain in the tip of your penis.

Symptoms of acute prostatitis are the same, but they start suddenly and are severe. They may also include a fever and chills.

Some men may have no symptoms.

How is prostatitis diagnosed?

A doctor can often tell if you have prostatitis by asking about your symptoms and past health. He or she will also do a physical exam, including a digital rectal exam. In this test, the doctor puts a gloved, lubricated finger in your rectum to feel your prostate. You may also need blood and urine tests to find out which type of prostatitis you have or to look for another cause of your problems.

How is it treated?

Prostatitis caused by bacteria is treated with antibiotics and self-care. If it is not caused by bacteria, it usually gets better with home treatment.

Home treatment includes drinking plenty of fluids and getting lots of rest. Taking over-the-counter pain relievers can also help.

Your doctor may prescribe medicine to control pain and reduce swelling. He or she may also prescribe medicine to soften your stool and relax your bladder muscles.

Surgery is rarely used to treat prostatitis.

Frequently Asked Questions

Cause

Most men with prostatitis have chronic prostatitis/pelvic pain syndrome, inflammatory or noninflammatory. The cause of this type of prostatitis is not known. Few men with prostatitis have prostatitis associated with a bacterial infection.

Acute prostatitis and chronic bacterial prostatitis

Bacteria infecting the prostate cause acute prostatitis and chronic bacterial prostatitis. Bacteria most likely enter the prostate by:

• Traveling through the urethra.
• Being present in the urine because of a bladder infection.
• Being introduced through the use of a urinary catheter.

Chronic prostatitis/pelvic pain syndrome, inflammatory (nonbacterial prostatitis)

The specific cause of chronic prostatitis/pelvic pain syndrome, inflammatory, is usually not known. However, health professionals believe the possible causes include:

• Blocked urine flow.
• Abnormal movement of urine and prostate secretions into the prostate.
• Microorganisms that may infect the prostate. However, if they are present, they usually are not detectable in the urine.
• The immune system attacking the prostate (autoimmune disease).
• Chemicals normally found in the urine, such as uric acid, which may get into the prostate and cause irritation.
• Abnormal nerve or muscle function.

Chronic prostatitis/pelvic pain syndrome, noninflammatory (prostatodynia)

The causes of chronic prostatitis/pelvic pain syndrome, noninflammatory, may be the same as those for chronic prostatitis/pelvic pain syndrome, inflammatory. Some health professionals think that the prostate may not be involved at all but that a combination of factors, including nervous system problems, strained pelvic floor muscles, and emotional issues, cause the pain.

Symptoms

The symptoms are similar for all forms of prostatitis, with the exception of acute prostatitis and asymptomatic inflammatory prostatitis.

Symptoms of the chronic forms of prostatitis, including chronic prostatitis/pelvic pain syndrome, inflammatoryand noninflammatory, may include:

• A frequent urge to urinate, although you may pass only small amounts of urine.
• A burning sensation when urinating (dysuria).
• Difficulty starting urination, interrupted flow (urinating in waves rather than a steady stream), weaker-than-normal urine flow, and dribbling after urinating.
• Excessive urinating at night (nocturia).
• A sensation of not completely emptying the bladder.
• Pain or discomfort in the lower back, in the area between the testicles and anus, in the lower abdomen or upper thighs, or above the pubic area. Pain may become worse during a bowel movement.
• Pain or vague discomfort during or after ejaculation.
• Pain in the tip of the penis.

With acute prostatitis, symptoms are severe, come on suddenly, and include fever and chills. Signs of chronic bacterial prostatitis may be milder and come on suddenly or gradually over weeks or months, and the symptoms may come and go. Symptoms alone cannot be used to determine the type of prostatitis you have.

Numerous other conditions, such as a bladder infection or benign prostatic hyperplasia (BPH), can cause symptoms similar to those of prostatitis.

What Happens

Prostatitis, especially if it continues for a long time, can cause stress, anxiety, and depression.

Acute prostatitis

Men with acute prostatitis have severe pain and fever and may need hospitalization. Most men recover fully when treated with antibiotics. Delaying treatment increases the risk of developing complications, such as sepsis or an abscess in the prostate.

Chronic bacterial prostatitis

Chronic bacterial prostatitis can be difficult to treat, because some medications have a hard time reaching the prostate.

Men with chronic bacterial prostatitis commonly have repeated urinary tract infections. The infection may spread to the epididymis.

The presence of infected prostate stones (prostatic calculi) can make treatment of chronic bacterial prostatitis more difficult.

Chronic prostatitis/pelvic pain syndrome, inflammatory and noninflammatory

Chronic prostatitis/pelvic pain syndrome, inflammatory and noninflammatory, often get better over time without serious complications. However, the symptoms sometimes return unexpectedly.

What Increases Your Risk

Factors that can increase your risk of developing prostatitis include:

• A recent urinary tract infection (UTI).
• Insertion of a urinary catheter or having a cystoscopy.
• Sexually transmitted diseases (STDs).
• Injury, such as from riding a bicycle or horse.

If you have had chronic bacterial prostatitis, you have an increased chance of developing it again.

When To Call a Doctor

Contact your health professional immediately if you have sudden fever, chills, and urinary symptoms, such as pain or burning with urination or blood or pus in the urine. These symptoms may indicate acute bacterial prostatitis.

Call your doctor if you have:

• Urinary symptoms and persistent pain in the low back, scrotum, penis, or the area between the scrotum and anus, or if you have pain with ejaculation or with a bowel movement.
• Recurring urinary tract infections (UTIs).
• Discharge from your penis or sores on your genitals.
• Problems urinating, such as excessive nighttime urination, trouble starting urinating, decreased urinary stream, or frequent urination that is not related to drinking lots of fluids.

Watchful Waiting

Most men will have some discomfort in their prostate (prostatitis) at some time during their lives. If you do not have a fever and chills or extreme pain, you may try home treatment for a few weeks. Take nonprescription pain medications, such as aspirin, ibuprofen, or acetaminophen, to relieve pain. However, if your urinary symptoms and pain continue, you need to see a health professional.

Who To See

Health professionals who can evaluate and treat your prostatitis include:

• Family medicine doctors.
• Internists.
• Urologists.
• Nurse practitioners.
• Physician assistants.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

If your health professional suspects that you have prostatitis, he or she will begin with a complete medical history and physical exam. The type of prostatitis you have cannot be determined solely from your history and symptoms. Your doctor will do tests to determine the cause of your prostatitis.

Acute prostatitis is the least common type but the easiest to diagnose. If acute prostatitis is suspected, a urine culture will be done to test for the presence and type of bacteria.

If your history and physical exam show that you do not have acute prostatitis, a pre- and post-massage test (PPMT) or expressed prostatic secretions test may be done to determine which type of prostatitis you have. An expressed prostatic secretions test is not done if acute prostatitis is suspected, because when the prostate is inflamed or infected, massaging it to obtain a sample for tests is very painful and possibly dangerous. Some health professionals believe that massaging an infected prostate increases the risk of developing a bacterial infection of the blood (septicemia).

More tests may be necessary if:

• Your symptoms do not improve with treatment.
• You continue to have prostate infections.
• The symptoms could be caused by bladder or prostate cancer.
• Your health professional suspects you have a complication related to prostatitis, such as an abscess.

Tests that may be done include:

• Complete blood count (CBC).
• Digital rectal exam, to check for growths in the prostate gland or to see if it is larger than normal.
• Blood culture, to check for bacteria in your blood if you have acute prostatitis.
• Computed tomography (CT) scan or magnetic resonance imaging (MRI) of your pelvic area.
• Transrectal ultrasound of your pelvic area.
• Prostate specific antigen (PSA) to rule out prostate cancer.

Treatment Overview

Treatment for prostatitis usually begins with taking an antibiotic for several weeks. If you begin to feel better, you may have to take the medication for 2 to 3 months. If you do not get better while taking antibiotics, more tests may be done.

Acute prostatitis

Treatment for acute prostatitis is aimed at curing the infection and preventing complications. Acute bacterial prostatitis is treated with antibiotics, pain and fever medication, stool softeners, fluids, and rest.

• If you are unable to urinate or need intravenous antibiotics, you may be admitted to a hospital for treatment.
• Most men recover quickly with treatment, which lasts for 4 to 6 weeks.

Chronic bacterial prostatitis

Treatment for chronic bacterial prostatitis is aimed at curing the infection and preventing complications. Antibiotics are given for 6 to 12 weeks. Long-term antibiotic treatment may be needed if the infection returns.

• Infected prostate stones (prostatic calculi) can make the infection more difficult to cure. If present, they may need to be surgically removed.
• Surgery may be needed if urinary tract problems, such as narrowing of the bladder neck or urethra, are causing the prostatitis.
• Surgical removal of the prostate (prostatectomy) for repeated infections is rarely used, and only as a last resort.

Chronic prostatitis/pelvic pain syndrome, inflammatory

Treatment of chronic prostatitis/pelvic pain syndrome, inflammatory, may be difficult.

• Antibiotics are tried first. If your symptoms do not improve, treatment with these medications is usually stopped.
• Muscle relaxants and alpha-blockers may be used if muscle spasms are causing pain or problems urinating. Medications to reduce inflammation may relieve pain.
• Finasteride, a medication that slows the growth of the prostate, may be used.
• Massaging the prostate 3 or 4 times a week may help relieve symptoms.
• Counseling, biofeedback, or relaxation techniques may help reduce stress that is contributing to the pain.

Chronic prostatitis/pelvic pain syndrome, noninflammatory

Chronic prostatitis/pelvic pain syndrome, noninflammatory, is difficult to treat because it is not clear what causes this form of prostatitis. The primary goal of treatment is to relieve symptoms. Nonnarcotic pain medications, muscle relaxers, and alpha-blockers are used.

Physical therapy, medications to reduce anxiety, exercise, massage therapy, biofeedback, or stress reduction may help some men. It may be helpful to avoid alcohol, caffeine, and spicy foods such as hot peppers, chili, pickles, and salsa, especially if they make your symptoms worse.

Prevention

You may be able to prevent prostatitis.

• Practice good hygiene, and keep your penis clean.
• Drink enough fluids to cause regular urination.
• Seek early treatment of a possible urinary tract infection.

Home Treatment

Acute or chronic bacterial prostatitis

If you have prostatitis caused by a bacterial infection (acute or chronic bacterial prostatitis), contact a health professional about your symptoms, especially if you have a fever. Antibiotics and other medications will be prescribed as needed.

However, there are some things you can do at home that may help you be more comfortable:

• Take nonprescription pain relievers, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or acetaminophen.
• Sit in a tub of warm water with the water just covering your buttocks, or try a sitz bath.
• Take care of yourself when you have an infection. Get plenty of rest, and drink lots of fluids. This will make you feel better and may speed your recovery.
• Eat plenty of high-fiber foods, such as fruit, vegetables, and whole-grain breads and cereal, and drink enough water to avoid constipation. Straining to pass a bowel movement may be very painful when your prostate is inflamed, so use a stool softener if necessary.

Chronic prostatitis/pelvic pain syndrome, inflammatory or noninflammatory

Home treatment may help control symptoms and relieve pain if you have chronic prostatitis/pelvic pain syndrome, inflammatory or noninflammatory. In addition to trying the above home treatment tips for acute and chronic bacterial prostatitis:

• Avoid alcohol, caffeine, and spicy foods such as hot peppers, chili, pickles, and salsa, especially if they make your symptoms worse.
• Try stress management: deep breathing, relaxation, exercise, and elimination of stressful circumstances. Stress and anxiety may cause your symptoms to get worse. For more information, see the topic Stress Management.
• Ask your health professional about plant extracts, such as saw palmetto, quercetin (Prosta-Q), or bee pollen extract (Cernilton), which may provide some relief.¹

Medications

Treatment of prostatitis usually begins with antibiotics and possibly other medications to relieve symptoms. If you begin to get better, you may have to continue taking antibiotics for 2 to 3 months. During this time, it is important to take the antibiotics as prescribed. If you do not begin to get better while taking medications, your doctor may want you to have more tests.

Medication Choices

Acute and chronic bacterial prostatitis

Antibiotics are central to treating acute or chronic bacterial prostatitis. Your doctor may prescribe certain antibiotics based on your medical history, symptoms, and other factors such as your age. Other medications may also be used to help control symptoms, including:

• Medications to reduce pain, fever, and inflammation. These include nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, or acetaminophen.
• Stool softeners, to prevent or eliminate constipation.

Chronic bacterial prostatitis may require long-term antibiotics, especially if the symptoms return. Some men need treatment with low doses of antibiotics over a long period to control infection and prevent repeated urinary tract infections (UTIs).

Chronic prostatitis/pelvic pain syndrome, inflammatory and noninflammatory

Chronic prostatitis/pelvic pain syndrome, inflammatory and noninflammatory, are usually treated first with antibiotics based on the possibility that an infection was missed during testing. However, experts advise against long-term treatment with antibiotics unless an unusual bacterial infection is suspected.

Medications that may be used to treat chronic prostatitis/pelvic pain syndrome, inflammatory or noninflammatory, include:

• Antibiotics. If the symptoms begin to improve, it is possible that an undiagnosed infection is responsible for the symptoms.
• Medications that reduce pain and inflammation.
• Medications that relax muscles throughout the body (muscle relaxants) or that relax muscles in the prostate (alpha-blockers).
• Medications that slow the growth of the prostate (finasteride).
• Medications that reduce anxiety (anxiolytic drugs). These medicines also may relax the muscles around the prostate and make it easer to urinate. These medications work best when combined with counseling.

What To Think About

Prostate stones (prostatic calculi) can make chronic bacterial prostatitis more difficult to cure. If you have prostate stones, they may need to be surgically removed.

Surgery

Surgery for prostatitis may be necessary to treat chronic bacterial prostatitis that does not respond to long-term antibiotic treatment and that causes repeated urinary tract infections. Surgery may be done to remove part of the prostate or to remove infected prostate stones (prostatic calculi). However, this does not always cure the infection, and it may make the symptoms worse. Surgery is generally done only if all other treatments have failed.

Surgery Choices

Surgical removal of part of the prostate to treat an infection that does not respond to antibiotic treatment or to remove prostate stones is called transurethral prostatectomy.

What To Think About

Removing prostate stones may not cure prostatitis, because the surgery may not remove the portion of the prostate containing the stones.

Other Treatment

Prostatic massage

Prostatic massage for prostatitis ("milking" of the prostate by a health professional) is an old treatment that many doctors are beginning to use again because medications do not always successfully cure prostatitis.

To massage your prostate, the health professional inserts a lubricated, gloved finger into your rectum and presses several times on your prostate. This may need to be done 2 or 3 times a week. Why this works is not certain, but it is believed that the massage helps open blocked ducts in the prostate, improving circulation and antibiotic penetration into the prostate.

Prostatic massage is not done for acute prostatitis, because it could cause the bacteria to spread from the prostate and cause a wider infection (sepsis).

Other treatments that may be helpful for chronic prostatitis/pelvic pain syndrome, inflammatory or noninflammatory, include:

• Acupuncture.
• Biofeedback.
• Counseling.
• Relaxation techniques.

Other Places To Get Help

Organizations

References

Citations

1. Nickel JC (2007). Inflammatory conditions of the male genitourinary tract: Prostatitis and related conditions, orchitis, and epididymitis. In AJ Wein et al., eds., Campbell-Walsh Urology, 9th ed., vol. 1, pp. 304-329. Philadelphia: Saunders Elsevier.

Other Works Consulted

• Cheah PY, et al. (2003). Terazosin therapy for chronic prostatitis/chronic pelvic pain syndrome: A randomized, placebo controlled trial. Journal of Urology, 169(2): 592-596.

• Gambert SR, Chow RD (2003). Prostatitis. Geriatrics, 56(4): 32-37.

• Nickel JC (2001). Consensus development of a histopathological classification system for chronic prostatic inflammation. BJU International, 87(9): 797-805.

• Nickel JC, et al. (2003). Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls. Journal of Urology, 170(3): 818-822.

• Shoskes DA, et al. (2003). Long-term results of multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome. Journal of Urology, 169(4): 1406-1410.

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