Prostatitis

Prostatitis at a glance

  • Prostatitis is inflammation or infection of the prostate, the small gland in the male reproductive system that produces semen.
  • A bacterial infection sometimes causes prostatitis, but often the cause is unknown.
  • Primary symptoms are urination problems, pain, sexual dysfunction and general health issues such as being depressed or tired.
  • The most common treatment is a course of antibiotic medication. Treatment is usually effective, although symptoms sometimes return.
  • About 5-10 percent of men will experience prostatitis during their lifetime, and is more common among younger men (under age 50).

What is prostatitis?

Prostatitis is an inflammation or infection of the prostate, a small walnut-shaped gland that is part of man’s reproductive tract. The prostate produces semen, the fluid that carries and nourishes sperm. Prostatitis is the most common prostate problem among men younger than age 50. It affects about 5-10 percent of men in their lifetime, and some urologists estimate that about 5-10 percent of men have prostatitis at any given time.

Types of prostatitis and their causes

Men may experience any of four kinds of prostatitis. Each type may have a different cause:

  • Chronic nonbacterial prostatitis. This type is most common. It is also called chronic pelvic pain syndrome. A man with this type of prostatitis may experience symptoms over a long period. Symptoms may vary in their intensity, and often include pain and discomfort. Physicians aren’t sure what causes it.
  • Acute bacterial prostatitis. This type of prostatitis is the least common. It can happen suddenly, and may include flu-like symptoms (chills, fever, nausea, vomiting). Serious cases can require treatment in a hospital. Bacteria in the prostate cause this type.
  • Asymptomatic inflammatory prostatitis. A doctor may discover this type of prostatitis only if a man is having other problems, such as infertility. It usually doesn’t have symptoms or require treatment. The cause is unknown but asymptomatic inflammatory prostatitis is often diagnosed after infection-fighting cells are noted to be present.
  • Chronic bacterial prostatitis. This ongoing form of prostatitis is caused by a prostate infection that isn’t completely cleared up with antibiotics. Symptoms may come and go.

In addition to bacterial infection, other causes of prostatitis may include injury, immune system disorder or nervous system disorder. But physicians often can’t identify the specific cause.

Symptoms of prostatitis

Prostatitis symptoms may occur all of a sudden or develop over time.

One common warning sign of chronic bacterial prostatitis (sometimes called chronic infectious prostatitis) is a man experiencing repeated bladder infections. If a man has prostatitis that lasts longer than three months, his condition is considered chronic.

For other types of prostatitis, symptoms might include:

  • Fever and/or chills, similar to flu (with bacterial prostatitis)
  • Pain in the prostate gland, abdomen, groin, genitals and/or low back
  • Painful ejaculation
  • Frequent urination, especially at night
  • Difficulty urinating, including dribbling or hesitant urination
  • Pain or burning while urinating
  • Bladder infection
  • Pain in the perineum (the area between the rectum and scrotum)
  • Urgent need to urinate
  • Blood in semen or urine.

It is also possible that a man will discover he has prostatitis after he seeks treatment for another condition, such as infertility. Having prostatitis can impair the prostate gland’s production of semen, which can affect a man’s fertility.

In some men, prostatitis might raise the level of prostate-specific antigen (PSA). PSA is a substance produced by the prostate cells that doctors measure to screen for the possible presence of prostate cancer. If a man’s level is high, his physician will do more tests to determine whether prostatitis or prostate cancer is raising the PSA level.

Treatment of prostatitis

Before choosing a treatment method, physicians will evaluate a man’s symptoms and condition to determine what type of prostatitis he has. The doctor will likely do a physical examination and ask questions about the man’s health to understand if another illness might be causing the symptoms.

Other tests might include:

  • Bladder tests. The physician may order tests to check how well a man can empty his bladder. The purpose is to discover how much prostatitis is affecting his ability to urinate. These tests sometimes are called voiding studies or urodynamic tests.
  • Blood test and blood culture. If a blood test shows signs of infection, the physician may order a blood culture test to identify what is causing the infection.
  • Digital rectal exam. To understand whether the prostate is enlarged, and how much, the physician will insert a gloved and lubricated finger into the rectum to feel the prostate gland.
  • Urine tests. Urine samples can tell physicians whether an infection is present.

After a physician has identified the suspected cause of prostatitis, he or she will recommend a course of treatment. Treatment options include one or more of the following.

Medications

A number of medical approaches are available to treat prostatitis. A physician can identify which drugs are most likely to help any given patient. The most common options include:

  • Antibiotics are the most common prostatitis treatment. The type of antibiotic will depend on which bacteria might be causing an infection. For most men, a physician prescribes oral antibiotics for four to six weeks. Chronic or recurring prostatitis may need to be treated longer. For severe symptoms, a physician might prescribe intravenous (IV) antibiotics. These are usually delivered in the hospital.
  • Alpha blockers. Men whose main symptom of prostatitis is difficulty with urination might be prescribed alpha blocker medications. These drugs ease urination by relaxing prostate and bladder muscles.
  • Drugs to lower hormone levels. In some men, these medications can help shrink the prostate gland to reduce discomfort.
  • Muscle relaxants. These medicines can help relieve pain caused by an enlarged prostate pressing on nearby muscles.
  • Over-the-counter anti-inflammatory pain relievers. Men who suffer from groin or back pain from prostatitis may be more comfortable with the help of pain relievers such as ibuprofen, acetaminophen or aspirin.

Other treatment options

Some treatment options are available for men outside the doctor’s office.

  • Certain exercises (usually taught by a physical therapist) can help to strengthen and stretch the pelvic muscles. This activity relieves symptoms for some men.
  • Soaking or sitz baths. Applying warm water to the pelvic area, or soaking the area, also can relieve symptoms. A sitz bath, a shallow warm bath that cleanses the perineum area, can also provide relief.
  • Several studies have indicated acupuncture may help minimize symptoms of prostatitis. An acupuncturist inserts very fine needles in the skin at certain points on the body.
  • The practice of biofeedback involves electrical sensors that measure and communicate biologic activities. It can help men learn how to mentally alter body functions, such as relaxing certain muscles, which can minimize some prostatitis symptoms.

Surgery

Rarely, men with bacterial prostatitis sometimes require surgery to open blocked ducts (the tiny tubes that carry semen within the prostate). In addition to relieving symptoms, physicians may do surgery to restore fertility.

For most men, treatment for prostatitis is effective and resolves the symptoms. However, all forms of this condition have a chance of coming back. If it does, symptoms may return. In that case, a man will need treatment again.

Preventing or controlling symptoms

Doctors can’t always identify what causes prostatitis, which makes it difficult to avoid prostatitis completely. However, men can take steps to try to reduce the likelihood of experiencing the condition. The same actions can help control symptoms of chronic prostatitis.

  • Stay hydrated. Drinking plenty of water helps men to urinate frequently, which flushes out the urethra (the tube that carries urine and semen out of the body).
  • Avoid irritating the urethra. Avoiding or limiting caffeine, spicy foods and alcohol can help to avoid prostatitis.
  • Reduce prostate pressure. Men who ride a bicycle frequently might consider wearing padded shorts and using a split seat to reduce pressure on the prostate region.
  • Stay sexually active. Some physicians advise that men ejaculate regularly as another way to flush the urethra.