AUA Summit - What are Prostatitis and Related Chronic Pelvic Pain Conditions?


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What are Prostatitis and Related Chronic Pelvic Pain Conditions?

Prostatitis is a common, often painful condition that can happen to men of all ages. Pelvic pain in and around the prostate may be from:

  • An infection caused by bacteria
  • Inflammation (painful, red, swollen tissue) from an injury or infection
  • Some other problem

If you think you have prostatitis or have long-term or sharp pelvic pain, talk to a doctor so you can get help.

The Prostate

The prostate is a small, walnut-shaped gland that is part of the male reproductive system. It 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 helps make fluid for semen. Semen protects and energizes sperm as they travel to the female egg.


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 (CBP)
  • Acute (Sudden) Bacterial Prostatitis (ABP)
  • Nonbacterial 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 or the nerves which supply this area. Pain from CP/CPPS can last for weeks to months to years. This pain may also be due to the muscles in the pelvis. This is NOT an infection but symptoms may be like those in men with CBP.

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 (CBP)

Chronic bacterial prostatitis occurs from a bacterial infection. Symptoms are often more gradual and may take longer to treat. Fever and chills are not common but pain in the pelvis is still felt along with urinary symptoms and/or ejaculatory pain.

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 (ABP)

Acute bacterial prostatitis is an infection of the prostate due to bacteria. Symptoms can come on quickly and include fever, chills, urinary changes, ejaculatory pain and pain in the pelvis or nearby zones. Treatment with antibiotics often leads to quick relief.

They are:

  • Chills
  • Fever
  • Very painful burning while passing urine
  • Trouble draining your bladder

Nonbacterial Prostatitis

Nonbacterial Prostatitis is inflammation of the prostate that causes pain. It is not due to a bacterial infection and may be from stress, nerve irritation, injuries or past urinary tract infections. This form of prostatitis has no signs of bacteria in the urine or semen.


The cause for prostatitis or pelvis pain is not always known. Some things can raise the risk of a bacterial infection of the prostate like a bladder infection, a catheter, an infection from sex, or a problem in the urinary tract. 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 cannot "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 muscle tightness
  • Prostate or bladder stones
  • Prostate abscess
  • Benign prostatic hyperplasia (BHP)
  • Urethral stricture
  • Prostate cancer
  • Bladder cancer

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.


Your health care provider may start by asking you questions about your pain to find out what’s wrong. A digital rectal exam (DRE) may be done to check the prostate. Your doctor may do a transrectal ultrasound to look at your prostate or do a test called cystoscopy to check your urinary system.

You may also be asked to get lab tests to look for bacteria in your urine or prostate fluid. A urine flow study or urodynamics test may be done to look for a block in your urinary system.

If your health care provider suspects a problem with your prostate or nearby tissues, he/she may send you to a urologist. A urologist is a doctor who treats problems of the urinary tract and male reproductive systems.

Each type of prostatitis calls for a different treatment. Your doctor will want to know exactly what is causing your symptoms. To find the answers, more than one type of test may be used.

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 doctor will press and feel the prostate to see if it is enlarged or tender. Lumps or firmness can suggest prostate cancer. He/she will ask you how much pain you feel during this test. If you have prostatitis, this exam may hurt a bit. But it doesn't cause any harm or lasting pain.



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.


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.


Your treatment will depend on your symptoms, lab tests and findings during your visit. Patients may need many treatments. 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.


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 are often used as a first step to kill any bacteria. 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.


Some health care providers order drugs called alpha-blockers to help you feel better. These drugs may help relax the muscles around the prostate and the base of the bladder.

Anti-inflammatory agents

Anti-inflammatory drugs are non-steroidal drugs to reduce pain from inflammation in the prostate or muscles. 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.

Pelvic Floor Physical Therapy

Pelvic Floor Physical Therapy is a way to learn how to relax certain muscles in your pelvis. It is done with an expert to help you lessen tension in your pelvic floor muscles.

Home Care

There are many things that can be done at home to help reduce pain. These include hot baths, hot water bottles, heating pads and a donut-shaped pillow.

Lifestyle Changes

Lifestyle changes such as weight loss and diet changes, learning to relax and exercises may ease 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).

Unfortunately, supplements have not helped when tested in medical studies. 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.


Acupuncture involves an expert placing very thin needles through the skin at many depths and points on your body to help reduce pain. Some men use acupuncture to reduce pain.


In rare cases, surgery on either the urethra or prostate may be needed. There must be a trackable problem that could cause pain for surgery to work.

After Treatment

Most cases of acute bacterial prostatitis are cured with treatment.

Sometimes prostatitis can come back even after you've been cured. Your health care provider may use more than one treatment at a time. Some men have to manage living with the symptoms until the inflammation goes away.

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.


November 2021

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