What Is Prostatitis?

Prostatitis is a condition that involves inflammation of the prostate, a walnut-shaped gland responsible for producing the fluid portion of semen. Prostatitis can also involve inflammation in areas adjacent to the prostate (though this cannot happen without inflammation of the prostate first).

Male prostate and surrounding structures.

Interestingly, the symptoms of prostatitis can include pain in the male genitourinary system, or it may be completely painless. There are several variations of the condition. Prostatitis treatment, symptoms, and likeliness depend on the type of prostatitis that one experiences.

Types of Prostatitis

There are four types of prostatitis.

Chronic Prostatitis, or Chronic Pelvic Pain Syndrome (CP/CPPS)

The exact underlying origin of chronic, or long-term, prostatitis is unknown, but researchers believe it may be linked to the immune system’s response to a previous UTI (urinary tract infection).

This type of prostatitis is not caused by a bacterial infection, but, rather, is the result of other causes. A study published in the Indian Journal of Urology reports that chronic prostatitis/chronic pain syndrome “accounts for 90 percent of prostatitis cases in outpatient clinics and is characterized by chronic pelvic pain symptoms lasting at least three months during the past six months, in the absence of a urinary tract bacterial infection, but in the presence of urinary symptoms and sexual dysfunction.”

However, it is not completely evident that CPPS symptoms are caused by prostate disease in all cases. One biopsy study showed that CPPS patients had the same prostate biopsy results as people with healthy prostates.

Acute Bacterial Prostatitis

This type of prostatitis involves symptoms (such as pain) which are usually severe and come on suddenly.  

Chronic Bacterial Prostatitis

A type of prostatitis that is also caused by a bacterial infection, but develops slowly, over time. The symptoms are usually mild in comparison with acute bacterial prostatitis.

Asymptomatic Inflammatory Prostatitis

A type of prostatitis that is not associated with pain or any other symptoms. The condition oftentimes is found unexpectedly in laboratory results when a person is being tested for urinary tract or reproductive disorders, such as fertility problems. It is usually not treated.

Prostatitis Symptoms

Symptoms of (CP/CPPS)

CP/CPPS involves pain (lasting three months or longer) in one or more areas, including:

• The penis (including during ejaculation)
• The scrotum (skin sack under the penis)
• Between the anus and scrotum (the perineum).
• The lower abdomen (in the center area)
• The lower back
• The urethra (after urination) in the penis (during urination)

Other symptoms of CP/CPPS may include:

• Urinary frequency (urinating more than seven times per day)
• Difficulty urinating, such as dribbling or hesitant urination
• Urinary urgency (inability to hold it when needing to urinate)
• A weak or interrupted urine stream.

Symptoms of Acute Prostatitis

Acute prostatitis usually occurs suddenly and involves:

• Urinary frequency and/or urgency
• Severe pain in the genital area, perineum, groin, lower back, and abdomen
• Difficulty urinating, such as dribbling or hesitant urination
• Fever and chills
• Burning or pain during urination (dysuria)
• Nocturia (frequent urination during sleep)
• Nausea and vomiting
• Body aches
• Inability to empty the bladder completely (urinary retention)
• Trouble starting the urine stream
• A weak or an interrupted urine stream
• The complete inability to urinate (urinary blockage)
• Bacteria in the urine (urinary tract infection, referred to as a UTI)
• Cloudy or bloody urine.

Symptoms of Chronic Bacterial Prostatitis

While some symptoms occur in multiple types of prostatitis, others are unique to each kind.

• Urinary frequency or urgency
• Pain in the genital area, groin, lower abdomen, or lower back
• Painful ejaculation
• Urinary retention
• Touble starting a urine stream or a weak or interrupted urine stream
• Urinary blockage (inability to urinate)
• Urinary tract infection (UTI)

Causes

Prostatitis accounts for two million visits to healthcare providers each year in the United States, according to the National Institute of Diabetes and Digestive and Kidney Diseases. In men under age 50, prostatitis is said to be the most common urinary tract condition. In men over age 50, it’s the third most common urinary tract problem.  

There are several factors that put a person at higher risk for getting prostatitis, including:

• Age (young or middle-aged men are more at risk)
• Having a previous diagnosis of prostatitis
• Having an infection in the bladder or in the urethra (urethritis)
• Having pelvic trauma (like a biking or horseback riding injury)
• Using a urinary catheter (a tube used to drain the bladder)
• Having HIV/AIDS
• Having had a prostate biopsy

In conversations with your healthcare provider, it's important to share the details of your medical history so that your practitioner can assess your risk.

Diagnosis

In addition to your medical history and a physical rectal exam to check for abnormalities of the prostate, a healthcare provider may recommend prostatitis treatment based on the results of a battery of tests.

• Urinalysis: a test from a urine sample, to check for bacteria
• Blood tests: Blood samples check for signs of infection or other prostate problems, such as prostate cancer
• Cystoscopy: a scope that is inserted into the penis under local anesthesia; used to examine the urinary tract for narrowing, a blockage, or stones
• Transrectal ultrasound: a device that is placed in the rectum to portray an ultrasound picture of the prostate, allowing for the assessment of the size and any abnormalities of the prostate, such as tumors
• Biopsy of the prostate: a procedure performed under anesthesia involving the removal and examination of very small pieces of prostate tissue to check for prostate cancer                    
• Semen analysis: often used to measure the quality and amount of sperm in semen; for prostatitis, the fluid can be evaluated for markers of infection with semen culture to look for microorganisms. Bacteria in semen can reduce semen quality and be one of many reasons for male infertility.

The detection and diagnosis of asymptomatic inflammatory prostatitis is usually made as a result of lab test results (such as a urinalysis or PSA test to evaluate the risk of prostate cancer). Your healthcare provider will do workup to ensure there are no other causes to your symptoms before determining it as asymptomatic inflammatory prostatitis.

Treatment

Just like the symptoms and characteristics of the condition differ according to the type of prostatitis, so too do prostatitis treatment strategies.

Chronic Prostatitis Treatment (CS/CPPS)

Because there is such a wide range of symptoms that may occur in CS/CPPS, treatment is not the same for everyone with this type of prostatitis. Although antibiotics are not usually effective in CS/CPPS (because it’s not caused by a bacterial infection) the treating healthcare provider may initially prescribe antibiotics until bacterial prostatitis can be ruled out and the exact type of prostatitis can be diagnosed.

Other medications that may be prescribed include:

• Anti-inflammatory drugs such as NSAIDS, including ibuprofen or naproxen for pain and inflammation.
• Muscle relaxants such as Robaxin (methocarbamol) and Flexeril (cyclobenzaprine) to relax pelvic muscles and relieve pain while lowering anxiety.
• Anti-depressants such as amitriptyline (Elavil) or nortriptyline (Pamelor) for neuropathic pain, urinary problems, or psychological depression that can occur from dealing with a chronic medical condition like prostatitis. Neuropathic pain is pain caused by damage or disease that affects the sensory system in the body.
• Alpha blockers such as Flomax (tamsulosin) or Uroxatral (alfuzosin) to help with pain and discomfort a well as improving urinary retention.
• 5 alpha reductase inhibitors such as Proscar (finasteride) and Avodart (dutasteride) to improve urinary symptoms by helping to relax the muscles of the bladder. This improves urine flow.
• Anticholinergic agents such as Ditropan for symptoms of overactive bladder or “sudden urge” to urinate.
• Gabapentinoids such as Neurontin (gabapentin) and Lyrica (pregabalin) are non-opioid, non-NSAID, non-acetaminophen medications for neuropathic pain.

Supplements that may be useful include:

• Quercetin, a flavonoid-type antioxidant found in fruit, including red grapes and apples; quercetin is thought to have very strong anti-inflammatory properties).
• Graminex pollen-including extracts of rye grass pollen (Secale cereal), corn pollen (Zea mays), and timothy pollen (Phleum pretense)

Other Types of Prostatitis Treatment for CS/CPPS

Some at-home strategies may also help, including:

• Warm sitz baths (warm soaks)
• Heat therapy to the local area (using heating pads or hot water bottles)
• Physical therapy (including pelvic muscle exercises to improve urinary function).
• myofascial release
• Stress management techniques (such as relaxation exercises, yoga, or meditation)

Acute Bacterial Prostatitis Treatment

Antibiotics are considered the gold standard of treatment for bacterial types (chronic and acute) of prostatitis. Oral antibiotics are usually prescribed for at least 14 days. If symptoms recur, oral antibiotics may be prescribed for up to six to eight weeks. In severe cases of bacterial prostatitis, hospitalization may be required so that IV antibiotics can be given. 

In addition to antibiotics, changes in the diet may include avoiding foods that irritate the bladder, including caffeinated beverages, acidic foods, and spicy foods.

Chronic Bacterial Prostatitis Treatment

Although antibiotics are given for both acute and chronic bacterial prostatitis, a longer course may be prescribed for the chronic type of bacterial prostatitis. In fact, a low dose of antibiotics may be given for up to six months, according to the NIDDK. Just like in the treatment of acute bacterial type prostatitis, a diet change, eliminating foods that irritate the bladder and increasing fluids, may be ordered.

Alpha blockers, such as Flomax (tamsulosin) or Uroxatral (alfuzosin) may be prescribed for urinary retention caused by bacterial prostatitis. Alpha blockers help relax the bladder muscles and relieve painful urination (dysuria).  

Another prostatitis treatment that may be recommended for the chronic bacterial type is surgical removal of enlarged prostate tissue or scar tissue in the urethra. This can help improve the urine flow and reduce symptoms of urinary retention.

Asymptomatic Prostatitis Treatment

As the name of the condition indicates, there are typically no symptoms of pain or urinary problems associated with asymptomatic prostatitis, but there is inflammation of the prostate. Oftentimes, however, when a urinalysis is done, bacteria and other organisms are discovered in the urine. In this instance, the healthcare provider will usually prescribe antibiotics.

Studies have discovered a link between asymptomatic inflammatory prostatitis and the PSA level. In fact, one report showed that as many as one-third of men with increased PSA levels have asymptomatic inflammatory prostatitis. A PSA level, also known as prostate-specific antigen level, is one indicator that a man could have an increased risk of prostate cancer. After a biopsy is performed to rule out prostate cancer, a diagnosis of asymptomatic prostatitis may be considered. 

Complications

Complications of prostatitis may occur, particularly when prostatitis treatment is postponed. These may include:

• Abacterial infection in the bloodstream (bacteremia)
• An abscess (pus-filled area in the prostate, called a prostatic abscess)
• Inflammation of reproductive organs near the prostate (such as the epididymis, a coil-shaped tube attached to the back of the testicle)
• Sexual dysfunction
• Infertility and semen abnormalities (from chronic prostatitis)

If acute prostatitis does not respond well enough to antibiotic treatment, prostatitis is likely to recur, making it more difficult to treat and longer term. In this scenario, acute prostatitis transforms into chronic (long-term) prostatitis.