What are Prostatitis and Related Chronic Pelvic Pain Conditions?

Symptoms

What are Symptoms 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. 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

What Causes Prostatitis and Related Chronic Pelvic Pain?

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.

Diagnosis

How is Prostatitis Diagnosed?

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.

Questionnaire

Your health care provider may ask you to fill out a questionnaire to understand your pain. One kind is the NIH Chronic Prostatitis Symptom Checklist. This questionnaire asks about your symptoms and how they feel to you.

Male Cytoscopy
Digital Rectal Exam of the Prostate

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.

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

How is Prostatitis Treated?

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.

After Treatment

What Happens after Treatment?

Most cases of acute bacterial prostatitis are cured with treatment.

Unfortunately, CP/CPPS is not as easy to treat. If used, antibiotics may have trouble reaching and killing bacteria deep in the prostate. In most cases of CP/CPPS, antibiotics won't work because bacteria are not the cause. If this is the case, anti-inflammatories, 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 one treatment at a time. Some men have to manage living with the symptoms until the inflammation goes away.

More Information

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.