Quick Facts
Prostatitis
- Swelling and irritation of the prostate gland
- Often caused by bacterial infection
Prostatitis
Our Prostatitis Specialists
Prostatitis (Infection of the Prostate)
There are three types of prostatitis, each with a range of symptoms.
- Acute Bacterial Prostatitis: Usually caused by a sudden bacterial infection. The symptoms include painful urination; pain in the lower back, abdomen, groin or pelvic area; and fever and chills. A visit to a doctor or hospital is required.
- Chronic Bacterial Prostatitis: Symptoms are similar to acute bacterial prostatitis but develop gradually, are less severe, and do not produce a fever. The condition is caused by a bacterial infection. It can be episodic with flare-ups and remissions associated with treatment and subsequent recurrence.
- Chronic Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome: The symptoms can be indistinguishable from of chronic bacterial prostatitis, but tests for a bacterial infection are negative. Men with chronic nonbacterial prostatitis should be evaluated for interstitial cystitis/chronic pelvic pain syndrome.
Symptoms
How you feel (your symptoms) will help your doctor diagnose you.
There are 4 types of prostatitis:
- Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)
- Chronic Bacterial Prostatitis
- Acute (Sudden) Bacterial Prostatitis
- Asymptomatic Inflammatory Prostatitis
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)
CP/CPPS is the most common type of prostatitis. It is an inflammation of the prostate and an irritation of the nerves which supply this area. This is NOT an infection!
Some of the symptoms are:
- Trouble passing urine (and sometimes with pain)
- Pain in the bladder, testicles and penis, and between these and the anus
- Trouble and pain with ejaculation
Chronic Bacterial Prostatitis
Chronic bacterial prostatitis is an uncommon type of bacterial prostatitis. This requires a urine and prostate fluid culture to verify this as present. As the name implies it is known to come and go over a long period of time.
Some of the symptoms are:
- A burning feeling while passing urine
- The need to urinate often
- Pain in the bladder, testicles and penis, and between the sex organs and anus
- Pain with ejaculation
Acute (Sudden) Bacterial Prostatitis
Acute bacterial prostatitis is also an uncommon type of bacterial prostatitis. This requires a urine test to see if there is any bacteria. Symptoms for this problem are sudden and can be painful. They may cause you to seek help right away.
They are:
- Chills
- Fever
- Very painful burning while passing urine
- Trouble draining your bladder
Asymptomatic Inflammatory Prostatitis
Asymptomatic Inflammatory Prostatitis is an inflammation of the prostate but does not cause symptoms. It is NOT an infection! You will have no symptoms for this type of prostatitis. It may be found while you’re being checked for other problems.
Causes
It isn’t clear what causes most cases of prostatitis. Most often, the nerves and muscles in the pelvis cause pain because of a local inflammation that effects the nerves in the area, or less commonly, bacterial infection. It may take a few tests to figure out exactly why you feel pain. It’s important to try to find the cause.
Bacterial prostatitis is caused by a bacterial infection in the prostate. Bacteria can get into the prostate when infected urine flows backwards from the urethra. A sex partner can’t “catch” this type of infection. Bacteria can be found in urine, prostate fluid or blood tests.
Nonbacterial prostatitis may be linked to stress, nerve inflammation or irritation, injuries or prior urinary tract infections. Or it may occur if your body reacts to an infection or injury that happened in the past. This form of prostatitis has no signs of bacteria in the urine or seminal fluid.
Other possible causes for pelvic pain may also be from:
- Pelvic floor muscle tension
- Prostate stones
- A urethral stricture (narrowing of the urethra) or scar tissue
- Prostate cancer
- Benign prostatic hyperplasia (BPH, non-cancerous growth of the prostate)
What are the Risk Factors for Prostatitis?
The causes of most cases of prostatitis are not fully understood. But there are certain things that can raise the risk of getting prostatitis caused by bacteria. For example, bacteria can enter the body if you’ve had:
- A catheter (a tube to drain fluid from the body) or something else placed in your urethra
- An abnormality found in your urinary tract
- A recent bladder infection
Can Prostatitis be Prevented?
Most cases of prostatitis cannot be prevented. Having safe sex can lower your chance of getting prostatitis caused by some infections.
Testing and Treatment
Tests
Ultrasound
To get a closer look at the prostate gland, your health care provider may order a transrectal ultrasound. An ultrasound uses sound waves to show a picture of the prostate. To “see” the prostate, the ultrasound probe is placed in the rectum.
Urine and prostate fluid tests
Your doctor may test your urine and fluid from your prostate gland. When the prostate is massaged during the DRE, a fluid called expressed prostatic excretion (EPS) comes out of the penis. Urine and EPS are checked for signs of inflammation and infection. The test results may tell the doctor if the problem is in your urethra, bladder, or prostate.
Your blood and semen may also be tested for bacteria, white blood cells, or other signs of infection. Because it can be hard to get good samples, health care providers can sometimes have trouble telling if prostatitis is caused by bacteria. Also, if you have been treated with antibiotics in the recent past, this can change the results.
If you are at risk for cancer, your health care provider may order a blood test to check your prostate specific antigen (PSA) level. But if you have a prostate infection, your PSA can be falsely raised. Because of this, doctors are careful about how they read your PSA test results.
Cystoscopy
Your urologist may look inside your urethra, prostate, and bladder with a cystoscope. A cystoscope is a long, thin telescope with a light at the end. First, your urologist will numb your urethra. Then, he or she will gently guide the cystoscope through your urethra into the bladder.
Urine Flow Studies (Urodynamics)
Your urologist may also order urine flow studies or urodynamics. These help measure the strength of your urine flow. These tests also spot any blockage caused by the prostate, urethra, or pelvic muscles.
Treatment
The treatment for prostatitis depends on the type you have.
Acute Bacterial Prostatitis
For acute bacterial prostatitis, you’ll need to take antibiotics for at least 14 days. Occasionally some men may be admitted to the hospital and given antibiotics through an IV (into your vein). If you have trouble urinating, your health care provider may use a tube (a catheter) to drain your bladder. Almost all infections that start quickly are cured with this treatment. Sometimes, you’ll need to stay on the antibiotics for as long as four weeks. If one antibiotic doesn’t work, your doctor will try others.
Chronic Bacterial Prostatitis
For chronic bacterial prostatitis, you’ll need to take antibiotics longer, most often for 4 to 12 weeks. About three in four of chronic bacterial prostatitis cases clear up with this treatment. Sometimes the symptoms return and antibiotics are needed again. For cases that don’t react to this treatment, long-term, low dose antibiotics are used to ease the symptoms.
CP/CPPS
Because the exact cause of CP/CPPS is not known, some doctors may give antibiotics even if your tests don’t prove that bacteria are the cause. Other times anti-inflammatory or medicines which reduce painful nerves will be tried.
Antibiotics
If an antibiotic is prescribed, it is important to take your medicine at the same time(s) each day and to take all of them, even if you start to feel better.Alpha-blockers
Some health care providers order drugs called alpha-blockers to help you feel better. These drugs help relax the muscles around the prostate and the base of the bladder.
Anti-inflammatory agents
Nonsteroidal anti-inflammatory drugs (NSAIDs) might make you more comfortable. These are pain medicines (aspirin, ibuprofen, etc.) and muscle relaxers.
Prostatic Massage
Prostatic massages can help ease pressure in the prostate. It is done by draining fluid from the prostate ducts while specialized physiotherapy may relax the nearby muscles.
Biofeedback
Biofeedback uses signals from monitors to teach you to control your body and how it reacts. This includes learning to relax certain muscles. It is done with a specialist to help you reduce tension in your pelvic floor.
Home Remedies and Other Techniques to Reduce Pain
Hot baths, hot water bottles, or heating pads may also help ease pain. If sitting is painful, a donut pillow or inflatable cushion may help.
Relaxation exercises and dietary changes may also ease some of your symptoms. Your health care provider may suggest that you stop eating and drinking some foods. These may include spicy or acidic foods, and caffeinated, fizzy or alcoholic drinks. Aim to drink more water, and eat more fresh/unprocessed foods and less sugar. Your health care provider may also suggest that you stop doing things that can make your pain worse (like bicycle riding).
There is no evidence that herbs and supplements improve prostatitis. Options which have been tried and fail to help prostatitis include rye grass (cernilton), a chemical found in green tea, onions and a saw palmetto extract. Supplements can affect other treatments, so if you want to try herbal supplements, please tell your doctor first.
Some men use acupuncture to reduce pain. Acupuncture involves inserting very thin needles through your skin at different depths and points on your body.
Surgery
In rare cases, surgery on either the urethra or prostate may be needed. There must be an exact problem with the body, such as scar tissue in the urethra, for prostatitis surgery to work.
Prevention
- For acute prostatitis, patients take antibiotics for 4 to 6 weeks.
- For chronic bacterial prostatitis, patients take antibiotics for 4 to 12 weeks. About 75 percent of all cases of chronic bacterial prostatitis clear up with this treatment. Sometimes the symptoms recur and antibiotic therapy needed again. For cases that do not respond to this treatment, long-term, low dose antibiotic therapy is recommended to relieve the symptoms.
- Treatment for nonbacterial prostatitis is difficult. The goal is to control symptoms because it is hard to cure this condition. Some doctors prescribed anti-inflammatory drugs, pain medications and muscle relaxants. Therapies used to treat interstitial cystitis or chronic pelvic pain syndrome may also be helpful.
Frequently Asked Questions
With the exception of acute prostatitis, the diagnosis of prostatitis can be very difficult and sometimes quite frustrating for the patient and his physician. The symptoms are variable and there is much overlap in symptoms between the various types of prostatitis. Once the patient has been treated with antibiotics, it can be difficult to differentiate a bacterial prostatitis from chronic pelvic pain syndrome.
Patients with chronic bacterial prostatitis can have persistence of their infectious problem despite antibiotic use. This is because of the difficulty antibiotics have in penetrating the prostate gland to completely kill all the bacteria deep within the prostatic ducts.
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