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 examination, including a digital rectal examination. 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.
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.
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Most men with prostatitis have chronic prostatitis, which may also be called pelvic pain syndrome. The cause of this type of prostatitis is not known.
Acute prostatitis and chronic bacterial prostatitis
Bacteria infecting the prostate cause acute prostatitis and chronic bacterial prostatitis. Bacteria most likely enter the prostate by:
The symptoms are similar for all forms of prostatitis, with the exception of acute prostatitis.
Symptoms of chronic prostatitis 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.
Prostatitis, especially if it continues for a long time, can cause stress, anxiety, and depression.
Chronic prostatitis often gets better over time without serious complications. But the symptoms sometimes return unexpectedly.
Men with acute prostatitis have severe pain and fever. Most men recover fully when treated with antibiotics. Delaying treatment increases the risk of complications, such as sepsis or an abscess in the prostate.
Chronic bacterial prostatitis
Chronic bacterial prostatitis can be difficult to treat, because some medicines 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.
What Increases Your Risk
Things that can increase your risk for prostatitis include:
- A recent urinary tract infection (UTI).
- Insertion of a urinary catheter or having a cystoscopy.
- Sexually transmitted infections (STIs).
- 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 doctor 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 point to acute 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.
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 non-prescription pain medicines, such as aspirin, ibuprofen, or acetaminophen, to relieve pain. But if your urinary symptoms and pain continue, be sure to see a doctor.
Who to see
Examinations and Tests
If your doctor suspects that you have prostatitis, he or she will begin with a complete medical history and physical examination. The type of prostatitis that you have cannot be determined solely from your history and symptoms. Your doctor will do tests to find out 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 examination show that you do not have acute prostatitis, a pre- and post-massage test (PPMT) or expressed prostatic secretions test may be done to find out 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 doctors believe that massaging an infected prostate increases the risk of developing a bacterial infection of the blood (septicemia).
More tests may be needed 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 doctor suspects you have a complication related to prostatitis, such as an abscess.
Tests that may be done include:
- Complete blood count (CBC).
- Digital rectal examination, 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).
Treatment for prostatitis usually begins with taking an antibiotic for several weeks. If you begin to feel better, you may have to take the medicine for 2 to 3 months. If you do not get better while taking antibiotics, more tests may be done.
You may need to try more than one treatment. There isn't a standard treatment that works well for all men.
- Antibiotics are tried first. If your symptoms do not improve, treatment with these medicines is usually stopped.
- Muscle relaxants and alpha-blockers may be used if muscle spasms are causing pain or problems urinating.
- Medicines to reduce inflammation, such as non-steroidal anti-inflammatory drugs (NSAIDs), may relieve pain.
- 5-alpha reductase inhibitors, medicines that slow the growth of the prostate, may be used.
- Physical therapy, exercise, or massage therapy may help some men.
- Counselling, biofeedback, or relaxation techniques may help reduce stress that is contributing to the pain
- Certain plant extracts, such as bee pollen extract (Cernilton) or quercetin may provide some relief.footnote 1
Treatment for acute prostatitis is aimed at curing the infection and preventing complications. Acute bacterial prostatitis is treated with antibiotics, pain and fever medicine, stool softeners, fluids, and rest.
- If you are unable to urinate or need intravenous antibiotics, you may be admitted to a hospital for a short time for treatment.
- Most men get better quickly. Treatment (usually at home) 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. 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 is used only as a last resort.
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.
Prostatitis is usually treated with antibiotics and other medicines prescribed by your doctor. But there are some things you can do at home that may help you be more comfortable:
- Take non-prescription pain relievers, such as aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), or acetaminophen. Be safe with medicines. Read and follow all instructions on the label.
- 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-fibre 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 needed.
- Be physically active. Sitting for long periods of time can make this problem worse. But exercise, especially aerobic exercise, seems to help.footnote 2
- 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, light exercise, and elimination of stressful circumstances. Stress and anxiety may make your symptoms worse.
Treatment of prostatitis usually begins with antibiotics and possibly other medicines to relieve symptoms. If you begin to get better, you may have to continue taking antibiotics for 2 to 3 months. During this time, be sure to take the antibiotics as prescribed. If you do not begin to get better while taking medicines, your doctor may want you to have more tests.
Chronic prostatitis is usually treated first with antibiotics based on the possibility that an infection was missed during testing. But experts advise against long-term treatment with antibiotics unless an unusual bacterial infection is suspected.
Medicines that may be used to treat chronic prostatitis include:
- Antibiotics. If the symptoms begin to improve, it is possible that an undiagnosed infection is responsible for the symptoms.
- Medicines that reduce pain and inflammation (non-steroidal anti-inflammatory drugs [NSAIDs]).
- Medicines that relax muscles throughout the body (muscle relaxants) or that relax muscles in the prostate (alpha-blockers).
- Medicines that slow the growth of the prostate (5-alpha reductase inhibitors).
- Medicines that reduce anxiety, such as benzodiazepines. These medicines work best when combined with counselling.
- Medicines that are used for chronic pain (anticonvulsants).
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 medicines may also be used to help control symptoms, including:
- Medicines to reduce pain, fever, and inflammation. These include non-steroidal 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).
Surgery for prostatitis may be needed 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). But this does not always cure the infection, and it may make the symptoms worse. Surgery is typically done only if all other treatments have failed.
Surgical removal of part of the prostate to remove prostate stones or to treat an infection that does not respond to antibiotic treatment is called transurethral prostatectomy.
Surgery to remove part of the prostate that is blocking urine flow is called transurethral resection of the prostate (TURP). This type of surgery may be done in men with benign prostatic hyperplasia (BPH) who are having problems with prostatitis.
Other treatments that may be helpful for prostatitis include:
- Anothaisintawee T, et al. (2011). Management of chronic prostatitis/chronic pelvic pain syndrome. JAMA, 305(1): 78–86.
- Nickel JC (2012). Prostatitis and related conditions, orchitis, and epididymitis. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 1, pp. 327–356. Philadelphia: Saunders.
Other Works Consulted
- Gupta K, Trautner BW (2015). Urinary tract infections, pyelonephritis, and prostatitis. In DL Kasper et al., eds., Harrison's Principles of Internal Medicine, 19th ed., vol. 2, pp. 861–868. New York: McGraw-Hill Education.
- Powell CR (2015). Prostatitis. In ET Bope, RD Kellerman, eds., Conn's Current Therapy 2015, pp. 1008–1010. Philadelphia: Saunders.
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Donald Sproule, MDCM, CCFP - Family Medicine
Adam Husney, MD - Family Medicine
Christopher G. Wood, MD, FACS - Urology
Current as ofDecember 3, 2017
Current as of: December 3, 2017