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Prostatitis

Overview

Prostatitis is swelling and inflammation of the prostate gland, a walnut-sized gland situated directly below the bladder in men. The prostate gland produces fluid (semen) that nourishes and transports sperm.

Prostatitis often causes painful or difficult urination. Other symptoms include pain in the groin, pelvic area or genitals and sometimes flu-like symptoms.

Prostatitis affects men of all ages but tends to be more common in men 50 or younger. The condition has a number of causes. Sometimes the cause isn't identified. If prostatitis is caused by a bacterial infection, it can usually be treated with antibiotics.

Depending on the cause, prostatitis can come on gradually or suddenly. It might improve quickly, either on its own or with treatment. Some types of prostatitis last for months or keep recurring (chronic prostatitis).

Symptoms

Prostatitis signs and symptoms depend on the cause. They can include:

  • Pain or burning sensation when urinating (dysuria)
  • Difficulty urinating, such as dribbling or hesitant urination
  • Frequent urination, particularly at night (nocturia)
  • Urgent need to urinate
  • Cloudy urine
  • Blood in the urine
  • Pain in the abdomen, groin or lower back
  • Pain in the area between the scrotum and rectum (perineum)
  • Pain or discomfort of the penis or testicles
  • Painful ejaculation
  • Flu-like signs and symptoms (with bacterial prostatitis)

When to see a doctor

If you have pelvic pain, difficult or painful urination, or painful ejaculation, see your doctor. If left untreated, some types of prostatitis can cause worsening infection or other health problems.

Causes

Acute bacterial prostatitis is often caused by common strains of bacteria. The infection can start when bacteria in urine leak into your prostate. Antibiotics are used to treat the infection. If they don't eliminate the bacteria prostatitis might recur or be difficult to treat (chronic bacterial prostatitis).

Nerve damage in the lower urinary tract, which can be caused by surgery or trauma to the area, might contribute to prostatitis not caused by a bacterial infection. In many cases of prostatitis, the cause isn't identified.

Prostate gland

The prostate gland is situated just below the bladder and surrounds the urethra. Prostatitis is a disease of the prostate that results in pain in the groin, painful urination, difficulty urinating and other symptoms.

Risk factors

Risk factors for prostatitis include:

  • Being a young or middle-aged
  • Having had prostatitis
  • Having an infection in the bladder or the tube that transports semen and urine to the penis (urethra)
  • Having pelvic trauma, such as an injury from bicycling or horseback riding
  • Using a tube inserted into the urethra to drain the bladder (urinary catheter)
  • Having HIV/AIDS
  • Having had a prostate biopsy

Complications

Complications of prostatitis can include:

  • Bacterial infection of the blood (bacteremia)
  • Inflammation of the coiled tube attached to the back of the testicle (epididymitis)
  • Pus-filled cavity in the prostate (prostatic abscess)
  • Semen abnormalities and infertility, which can occur with chronic prostatitis

There's no direct evidence that prostatitis can lead to prostate cancer.

Diagnosis

Diagnosing prostatitis involves ruling out other conditions as the cause of your symptoms and determining what kind of prostatitis you have. Your doctor will ask about your medical history and your symptoms. He or she will also do a physical exam, which will likely include a digital rectal examination.

Initial diagnostic tests might include:

  • Urine tests. Your doctor might have a sample of your urine analyzed to look for signs of infection in your urine (urinalysis). Your doctor might also send a sample of your urine to a lab to determine if you have an infection.
  • Blood tests. Your doctor might examine samples of your blood for signs of infection and other prostate problems.
  • Post-prostatic massage. In rare cases, your doctor might massage your prostate and test the secretions.
  • Imaging tests. In some cases, your doctor might order a CT scan of your urinary tract and prostate or a sonogram of your prostate. CT scan images provide more detailed information than plain X-rays do. A sonogram is the visual image produced by an ultrasound.

Based on your symptoms and test results, your doctor might conclude that you have one of the following types of prostatitis:

  • Acute bacterial prostatitis. Often caused by common strains of bacteria, this type of prostatitis generally starts suddenly and causes flu-like signs and symptoms, such as fever, chills, nausea and vomiting.
  • Chronic bacterial prostatitis. When antibiotics don't eliminate the bacteria causing prostatitis, you can develop recurring or difficult-to-treat infections. Between bouts of chronic bacterial prostatitis, you might have no symptoms or only minor ones.
  • Chronic prostatitis/chronic pelvic pain syndrome. This type of prostatitis — the most common —isn’t caused by bacteria. Often an exact cause can't be identified. For some men, symptoms stay about the same over time. For others, the symptoms go through cycles of being more and less severe.
  • Asymptomatic inflammatory prostatitis. This type of prostatitis doesn't cause symptoms and is usually found only by chance when you're undergoing tests for other conditions. It doesn't require treatment.

Treatment

Prostatitis treatments depend on the underlying cause. They can include:

  • Antibiotics. This is the most commonly prescribed treatment for prostatitis. Your doctor will choose your medication based on the type of bacteria that might be causing your infection.

  • If you have severe symptoms, you might need intravenous (IV) antibiotics. You'll likely need to take oral antibiotics for four to six weeks but might need longer treatment for chronic or recurring prostatitis.

  • Alpha blockers. These medications help relax the bladder neck and the muscle fibers where your prostate joins your bladder. This treatment might ease symptoms, such as painful urination.
  • Anti-inflammatory agents. Nonsteroidal anti-inflammatory drugs (NSAIDs) might make you more comfortable.

Alternative medicine

Alternative therapies that show some promise for reducing symptoms of prostatitis include:

  • Biofeedback. A biofeedback specialist uses signals from monitoring equipment to teach you to control certain body functions and responses, including relaxing your muscles.
  • Acupuncture. This involves inserting very thin needles through your skin to various depths at certain points on your body.
  • Herbal remedies and supplements. There's no evidence that herbs and supplements improve prostatitis, although many men take them. Some herbal treatments for prostatitis include rye grass (cernilton), a chemical found in green tea, onions and other plants (quercetin) and extract of the saw palmetto plant.

Discuss your use of alternative medicine practices and supplements with your doctor.

Preparing for an appointment

You might start by seeing your primary care provider. Or you might be referred immediately to a specialist in urinary tract and sexual disorders (urologist).

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

  • Your symptoms, including any that might seem unrelated to the reason for your appointment, and when they began
  • Key personal information, including major stresses or recent illnesses
  • All medications, vitamins or other supplements you take, including doses
  • Questions to ask your doctor

Take a family member or friend along, if possible, to help you remember the information you're given.

For prostatitis, questions to ask your doctor include:

  • What is likely causing my symptoms?
  • What other conditions could be causing my pain?
  • What kinds of tests will I need?
  • What treatment do you recommend?
  • Are there other treatment options?
  • Are there brochures or other printed materials I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

  • When did you begin having symptoms?
  • How severe are your symptoms?
  • Have your symptoms been continuous, or do they come and go?
  • Were you recently diagnosed with a urinary tract infection?
  • Have you had frequent urinary tract infections in the past?
  • Have you had a recent injury to your groin?
  • What, if anything, seems to improve your symptoms?

Lifestyle and home remedies

The following might ease some symptoms of prostatitis:

  • Soak in a warm bath (sitz bath) or use a heating pad.
  • Limit or avoid alcohol, caffeine, and spicy or acidic foods, which can irritate your bladder.
  • Avoid activities that can irritate your prostate, such as prolonged sitting or bicycling.
  • Drink plenty of caffeine-free beverages. This will cause you to urinate more and help flush bacteria from your bladder.

Last updated: November 23rd, 2016

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