Prostatitis

Overview

Prostatitis is a disorder of the prostate gland usually associated with inflammation. Prostatitis often causes painful or difficult urination, as well as pain in the groin, pelvic area or genitals. Bacterial infections cause some but not all cases of prostatitis.

The prostate gland, about the size of a walnut, is located just below the bladder in men. It surrounds the top portion of the tube that drains urine from the bladder (urethra). The prostate and other sex glands produce the fluid that transports sperm during ejaculation (semen).

Types

There are generally four types of prostatitis:

Acute bacterial prostatitis,a bacterial infection of the prostate usually with sudden, severe symptoms
Chronic bacterial prostatitis,ongoing or recurring bacterial infection usually with less severe symptoms
Chronic prostatitis/chronic pelvic pain syndrome,ongoing or recurring pelvic pain and urinary tract symptoms with no evidence of infection
Asymptomatic inflammatory prostatitis,signs of an inflamed prostate with no symptoms

Symptoms

Signs and symptoms of prostatitis can vary depending on the type of disorder. They may 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
Fever, chills, muscle aches and other flu-like symptoms (with acute bacterial prostatitis)

Causes

Prostate gland

Causes vary depending on the type of prostatitis.

Acute bacterial prostatitisis usually caused by common strains of bacteria. The infection may have spread from other parts of the urinary or reproductive systems.
Chronic bacterial prostatitisgenerally has the same cause as acute bacterial infection. It may occur when treatment for an acute infection isn't long enough or fails to kill all the bacteria.
Chronic prostatitis/chronic pelvic pain syndromeis not well understood. Research suggests that multiple factors may collectively play a role. These include previous infection, nervous system dysfunction, immune system dysfunction, psychological stress or irregular hormone activity.
Asymptomatic inflammatory prostatitis,which has no known cause, is generally found only during an exam for other medical conditions and is not treated.

Risk factors

Risk factors for prostatitis include:

Young or middle-aged adulthood
Previous prostatitis
Infection of the urinary or reproductive system
HIV infection or AIDS
Use of a tube inserted into the urethra to drain the bladder (urinary catheter)
Diagnostic sampling of prostate tissue (biopsy)

Additional risk factors for chronic prostatitis/chronic pelvic pain syndrome may include:

Psychological stress
Nerve damage in the pelvic region due to surgery or trauma

Complications

Complications of acute or chronic 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)
Infection that spreads to the upper pelvic bone or lower spine

Complications of chronic prostatitis/chronic pelvic pain syndrome may include:

Anxiety or depression
Sexual dysfunction, such as the inability to get and maintain an erection (erectile dysfunction)
Changes in sperm and semen that may cause infertility

There's no direct evidence that prostatitis can lead to prostate cancer. Researchers are investigating whether chronic inflammation of the prostate is a risk factor for cancer.

Diagnosis

The symptoms associated with prostatitis can be caused by a number of conditions. You may be referred to a specialist in urinary and reproductive system disorders (urologist). Your health care provider will conduct a physical exam, review your symptoms and medical history, and order tests to determine the cause and rule out certain conditions.

Test for diagnosing bacterial infections

Diagnostic tests to assess for infection will likely include:

Digital rectal exam.With this procedure, your health care provider inserts a lubricated, gloved finger into your rectum to detect inflammation of the prostate.
Urine test.You'll need to provide a urine sample to be tested for the presence and type of bacterial infection.
Blood test.Blood samples may be tested for signs of infection and other prostate problems.
Prostatic specimen test.In some cases, a health care provider may gently massage the prostate during a rectal exam to release prostate fluid into your urethra. A urine sample after the massage expels the prostate fluid for bacterial testing.

Other tests

If initial tests show no sign of infection, you may undergo other tests, including:

Urodynamic tests.A variety of tests can be used to measure how well the bladder and urethra hold and release urine. These tests can help characterize problems with urinating and identify the source of problems.
Imaging tests may be ordered for identifying irregularities in the prostate, abnormal growths or other problems in the pelvic region that may be contributing to pain.

Treatment

Treatment for prostatitis depends on the specific type diagnosed and your symptoms.
Treating infection
If you have acute or chronic bacterial prostatitis, you'll take antibiotics. Acute disease may require intravenous (IV) antibiotics in the hospital for a short period. The entire course of antibiotic treatment is usually 4 to 6 weeks — or longer in some cases. Taking all the prescribed medication is important for eliminating the infection and reducing the risk of chronic bacterial prostatitis.
Treating urinary symptoms
Medications, called alpha-blockers, help relax the bladder neck and the muscle fibers where your prostate joins your bladder. This treatment might ease urinary symptoms, such as painful or difficult urination. While this is commonly prescribed for men with chronic prostatitis/chronic pelvic pain syndrome, it may be prescribed to relieve urinary symptoms of bacterial infections.
Treating pain
Your health care provider may prescribe pain medication or recommend nonprescription drugs, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others).

Managing psychological symptoms

Your health care provider may recommend psychotherapy with a mental health care professional to help you manage stress, depression or anxiety that may be associated with chronic pain.

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Prostatitis

Men’s Health & Prostate

Prostatitis

Overview

Types

Acute bacterial prostatitis,a bacterial infection of the prostate usually with sudden, severe symptoms

Chronic bacterial prostatitis,ongoing or recurring bacterial infection usually with less severe symptoms

Chronic prostatitis/chronic pelvic pain syndrome,ongoing or recurring pelvic pain and urinary tract symptoms with no evidence of infection

Asymptomatic inflammatory prostatitis,signs of an inflamed prostate with no symptoms

Symptoms

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

Fever, chills, muscle aches and other flu-like symptoms (with acute bacterial prostatitis)

Causes

Acute bacterial prostatitisis usually caused by common strains of bacteria. The infection may have spread from other parts of the urinary or reproductive systems.

Chronic bacterial prostatitisgenerally has the same cause as acute bacterial infection. It may occur when treatment for an acute infection isn't long enough or fails to kill all the bacteria.

Chronic prostatitis/chronic pelvic pain syndromeis not well understood. Research suggests that multiple factors may collectively play a role. These include previous infection, nervous system dysfunction, immune system dysfunction, psychological stress or irregular hormone activity.

Asymptomatic inflammatory prostatitis,which has no known cause, is generally found only during an exam for other medical conditions and is not treated.

Risk factors

Young or middle-aged adulthood

Previous prostatitis

Infection of the urinary or reproductive system

HIV infection or AIDS

Use of a tube inserted into the urethra to drain the bladder (urinary catheter)

Diagnostic sampling of prostate tissue (biopsy)

Psychological stress

Nerve damage in the pelvic region due to surgery or trauma

Complications

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)

Infection that spreads to the upper pelvic bone or lower spine

Anxiety or depression

Sexual dysfunction, such as the inability to get and maintain an erection (erectile dysfunction)

Changes in sperm and semen that may cause infertility

Digital rectal exam.With this procedure, your health care provider inserts a lubricated, gloved finger into your rectum to detect inflammation of the prostate.

Urine test.You'll need to provide a urine sample to be tested for the presence and type of bacterial infection.

Blood test.Blood samples may be tested for signs of infection and other prostate problems.

Prostatic specimen test.In some cases, a health care provider may gently massage the prostate during a rectal exam to release prostate fluid into your urethra. A urine sample after the massage expels the prostate fluid for bacterial testing.

Urodynamic tests.A variety of tests can be used to measure how well the bladder and urethra hold and release urine. These tests can help characterize problems with urinating and identify the source of problems.

Imaging tests may be ordered for identifying irregularities in the prostate, abnormal growths or other problems in the pelvic region that may be contributing to pain.

Treatment

Treatment for prostatitis depends on the specific type diagnosed and your symptoms.

Treating infection

Treating urinary symptoms

Treating pain

Your health care provider may prescribe pain medication or recommend nonprescription drugs, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others).

Managing psychological symptoms