What are Prostatitis and Related Chronic Pelvic Pain Conditions?

Prostatitis and related pelvic pain conditions involve pain in and around the prostate. In most cases, you feel pain because of:

  • a prostate infection
  • inflammation
  • some other problem

Prostatitis and pelvic pain conditions can happen in men of all ages.

Male Reproductive System
Male Reproductive System
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

The Prostate

The prostate is a small, walnut-shaped gland that is part of the male reproductive system. The prostate sits under the bladder and in front of the rectum. The prostate is surrounded by muscles and nerves. The urethra (the tube that carries urine and semen out of the body) passes through the prostate.

The prostate's main job is to help make fluid for semen. This seminal fluid protects and energizes sperm as they travel to the female egg.



What are Signs of Prostatitis?

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.

Some of the signs are:

  • Trouble urinating (and sometimes pain with urination)
  • Pain in the bladder, testicles and penis, and between the sex organs and anus
  • Trouble and pain with ejaculation

Chronic Bacterial Prostatitis

This health problem may come and go over a long period of time.

Some of the signs are:

  • Burning feeling while urinating
  • Needing to urinate often (mainly during the night)
  • Pain in the bladder, testicles and penis, and between the sex organs and anus
  • Painful ejaculation

Acute (Sudden) Bacterial Prostatitis

Symptoms for this problem are sudden and painful. They may cause you to seek health care right away.

They are:

  • Chills
  • Fever
  • Severe burning while urinating
  • Trouble draining your bladder

Asymptomatic Inflammatory Prostatitis

You will have no signs for this type of prostatitis. It may be found while you're being checked for other problems.



What Causes Prostatitis and Related Chronic Pelvic Pain?

Male Genitourinary Anatomy
Male Genitourinary Anatomy
NIH Medical Arts, National Cancer Instutute (NCI)

It isn't clear what causes most cases of prostatitis. Generally, the nerves and muscles in the pelvis cause you to feel pain because of:

  • prostate infection
  • inflammation
  • some other problem

Some cases are due to infections. Bacteria can get into the prostate when infected urine flows backwards from the urethra. Bacterial prostatitis cannot be passed from one person to another during sex. So a sex partner can't catch this infection.

CP/CPPS may be caused by bacteria such as chlamydia, mycoplasma (which may be passed during sex), or ureaplasma. Or it may occur if your body reacts to an infection or injury that happened in the past.

What are the Risk Factors for Prostatitis?

Prostatitis is a common, painful disease that can occur in men of all ages.

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, you have a greater chance of getting bacterial prostatitis if you have had:

  • a catheter (a tube to drain fluid from the body) or other instrument recently 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. If you practice safe sex, you can lower your chances of getting the types of prostatitis caused by infections.



How is Prostatitis Diagnosed?

If your health care provider suspects you have a problem with your prostate or nearby tissues, he or she may send you to a urologist.  A urologist is a doctor who treats problems of the urinary system and male reproductive system. Your urologist or other health care provider may run tests to figure out what is going on and how to help.

Each type of prostatitis calls for a different treatment. Your doctor will want to know which type you have and make sure other health problems aren't causing your symptoms. To find the answers, many types of tests are used.

Questionnaire

Your health care provider may ask you to fill out a questionnaire called the NIH Chronic Prostatitis Symptom Index. This questionnaire asks about your symptoms and how they affect you. You may be asked to fill this out many times during treatment to find out how well your treatment is working.

Digital Rectal Exam of the Prostate
Digital Rectal Exam of the Prostate
Alan Hoofring (Illustrator), National Cancer Institute

Transrectal Ultrasound
Transrectal Ultrasound
© 2010 Terese Winslow, U.S. Govt. has certain rights

Male Cytoscopy
Male Cytoscopy
Cancer Research UK

Uroflowmetry Equipment
Uroflowmetry Equipment
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Cystometric test
Cystometric test
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Physical Exam

Your health care provider may do a digital rectal exam (DRE). This is done by putting a lubricated, gloved finger into your rectum.

Your health care provider will press and feel the prostate to see if it is enlarged or tender. Lumps or firmness can suggest prostate cancer. Your health care provider will ask you how much pain or discomfort you feel when areas around the prostate are pressed. If you have prostatitis, this exam may be uncomfortable and hurt a bit. But it doesn't cause any harm or lasting pain.

Tests

Ultrasound

To get a closer look at the prostate gland, your health care provider may order a transrectal ultrasound. Ultrasound uses sound waves bouncing off an organ to show a picture of the organ. To "see" the prostate, the ultrasound probe is placed in the rectum.

Specimens

Your health care provider may test your urine and fluid from your prostate gland to find out what is causing your problems. 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 also show whether your 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, that can change the test 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.



How is Prostatitis Treated?

The treatment for prostatitis depends on the type you have.

If an antibiotic is prescribed, it is important to stay on schedule and finish the whole prescription. Unless your doctor tells you to stop, continue to take your antibiotics. Even if your symptoms go away, don't stop taking the drugs early.

Acute Bacterial Prostatitis

For acute bacterial prostatitis, you'll need to take antibiotics for at least 14 days. You 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 suddenly are cured with this treatment. Sometimes, you'll need to stay on the antibiotics for as long as 4 weeks. If one antibiotic doesn't work, your health care provider 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 3 in 4 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

CP/CPPS may be caused by bacteria that isn't easy to find but could still be cured by antibiotics. This is why you may be given antibiotics even if your tests don't prove that bacteria are the cause. Your health care provider will decide if you should stay on antibiotics. Patients who don't have an infection may feel better while taking antibiotics because many antibiotics can also reduce inflammation.

Other Treatments

Your doctor may offer other treatments to help you feel better. Some health care providers order drugs called alpha-blockers. These drugs help relax the muscles around the prostate and the base of the bladder. You may also be given anti-inflammatory drugs, pain medications, muscle relaxants, or plant extracts. Prostatic massages can help ease pressure by draining fluid from the prostate ducts while specialized physiotherapy may relax the nearby muscles.

Hot baths, hot water bottles, or heating pads may help ease pain. If sitting is painful, a donut pillow or inflatable cushion may help. Relaxation exercises may also ease some of the symptoms. Your health care provider may suggest that you stop eating and drinking some irritating foods. These may include spicy or acidic foods and caffeinated, fizzy or alcoholic drinks. Your health care provider may also suggest that you stop things that can make your pain worse (such as bicycle riding).

In rare cases, surgery on either the urethra or prostate may be needed. There must be a specific problem with the body, such as scar tissue in the urethra, for prostatitis surgery to work.



What Happens after Treatment?

Most cases of acute bacterial prostatitis are cured with treatment.

Unfortunately, CP/CPPS is not as easy to treat. Antibiotics may have trouble reaching and killing bacteria deep in the prostate. And in most cases of CP/CPPS, antibiotics won't work because bacteria are not the cause. If this is the case, frequent prostate massages, physiotherapy, or alpha-blockers and other medicines may help.

Chronic bacterial prostatitis can come back even after you've been cured. Your health care provider may use more than 1- treatment at a time. Some men have to manage living with the symptoms until the inflammation hopefully "burns itself out."



More Information

Additional Facts

  • Getting the right diagnosis is the key to taking care of prostatitis.
  • Prostatitis does not always involve the prostate. The problem may be in the nearby tissues.
  • Prostatitis can't always be cured, but its symptoms can be managed.
  • Treatment should be followed even if you feel better.
  • Patients with prostatitis aren't at higher risk for getting prostate cancer.
  • There's no reason to stop normal sex unless it bothers you.
  • You can live a reasonably normal life with prostatitis.