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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.

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

Learning about prostatitis:

Being diagnosed:

Getting treatment:

Cause

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

About 1 out of 10 men have prostatitis caused by bacteria.

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. But doctors believe the possible causes include:

  • Blocked urine flow.
  • Abnormal movement of urine and prostate secretions into the prostate.
  • Microorganisms that may infect the prostate. 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 doctors think that a combination of things—including nervous system problems and strained pelvic floor muscles—causes the pain. Emotional problems and anxiety can make the pain worse.

Symptoms

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

Symptoms of the chronic forms of prostatitis, including chronic prostatitis/pelvic pain syndrome, inflammatory and 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.

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. 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.

Chronic prostatitis/pelvic pain syndrome, inflammatory and noninflammatory

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

What Increases Your Risk

Things that can increase your risk for prostatitis include:

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.

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 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

Health professionals who can evaluate and treat your prostatitis include:

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

Exams and Tests

If your doctor suspects that you have prostatitis, he or she will begin with a complete medical history and physical exam. 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 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 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:

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 medicine 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 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.

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 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 nonsteroidal anti-inflammatory drugs (NSAIDs), may relieve pain.
  • 5-alpha reductase inhibitors, medicines that slow 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.
  • Certain plant extracts, such as bee pollen extract (Cernilton) or quercetin (Prosta-Q) may provide some relief.1

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. Many treatments are tried, including:

  • Nonnarcotic pain medicines.
  • Muscle relaxants.
  • Alpha-blockers.
  • Medicines to reduce anxiety.
  • Physical therapy, exercise, massage therapy, biofeedback, or stress reduction. These may help some men.
  • Certain plant extracts, such as bee pollen extract (Cernilton) or quercetin (Prosta-Q). These may provide some relief.1

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

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 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 needed.
  • 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.
Stress Management

Medications

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.

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 medicines may also be used to help control symptoms, including:

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. 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/pelvic pain syndrome, inflammatory or noninflammatory, include:

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 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.

Surgery choices

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.

What to think about

This surgery may not cure prostatitis, because the surgery may not remove the portion of the prostate causing the problem.

Other Treatment

Prostatic massage

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

To massage your prostate gland, the doctor 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:

Other Places To Get Help

Organizations

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Building 31, Room 9A06
31 Center Drive, MSC 2560
Bethesda, MD  20892-2560
Phone: (301) 496-3583
Web Address: www.niddk.nih.gov
 

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is part of the U.S. National Institutes of Health. It conducts and supports research on many of the most serious diseases affecting public health, particularly the diseases of internal medicine. NIDDK sponsors the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). It has information about diseases of the kidneys and urologic system for people with these diseases and their families, health professionals, and the public.



Prostatitis Foundation
1063 30th Street, Box 8
Smithshire, IL  61478
Phone: 1-888-891-4200
Fax: (309) 325-7184
Web Address: www.prostatitis.org
 

Publications and links to medical journal articles about prostatitis are available at this site. The Prostatitis Foundation also sponsors a moderated e-mail discussion group.



Urology Care Foundation: The Official Foundation of the American Urological Association
1000 Corporate Boulevard
Linthicum, MD 21090
Phone: 1-800-828-7866
Phone: (410) 689-3700
Fax: (410) 689-3998
Email: info@urologycarefoundation.org
Web Address: www.urologyhealth.org
 

UrologyHealth.org is a website written by urologists for patients. Visitors can find specific topics by using the "search" option.

The website provides information about adult and pediatric urologic topics, including kidney, bladder, and prostate conditions. You can find a urologist, sign up for a free quarterly newsletter, or click on the Urology A–Z page to find information about urologic problems.



References

Citations

  1. Anothaisintawee T, et al. (2011). Management of chronic prostatitis/chronic pelvic pain syndrome. JAMA, 305(1): 78–86.

Other Works Consulted

  • 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.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer J. Curtis Nickel, MD, FRCSC - Urology
Last Revised December 2, 2011

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