Chronic Prostatitis: State-of-the-art diagnosis and treatment.

Prostatitis is a condition that affects the prostate gland, the walnut-shaped organ that lies just below a man's bladder and surrounds the urethra (the tube through which urine passes). The prostate gland produces most of the fluid in semen.

Prostatitis is sometimes an infection of the prostate, but it can also be an inflammation (swelling) with no sign of infection.

Prostatitis can affect men of all ages. Nearly half of all men have prostatitis-like symptoms at some point during their lifetime.

Types of prostatitis include the following:

  • Acute bacterial prostatitis: a sudden bacterial infection with inflammation of the prostate. This is the least common form of prostatitis, but the symptoms are usually severe. Patients with this condition:
    • have an acute urinary tract infection, and have to urinate more often (including at night);
    • have pain in the pelvis and genital area;
    • often have fever, chills, nausea, vomiting, and burning when urinating.
    Acute bacterial prostatitis must be treated right away, as the condition can lead to sepsis (bacteria in the blood). If it is not treated, the condition can cause confusion and low blood pressure, and may be fatal. Acute bacterial prostatitis is usually treated in the hospital with intravenous antibiotics, pain relievers, and fluids.
  • Chronic bacterial prostatitis: This condition is characterized by repeated urinary tract infections that come from bacteria that chronically infect the prostate gland. There may be burning with urination, urinary frequency, and pain. The diagnosis of this condition is often challenging because it’s often difficult to find the bacteria in the urine, and a sample of prostate fluid needs to be collected and cultured. Treatment includes prolonged antibiotics. Sometimes men are given low-dose antibiotics over a long period of time.
  • Chronic nonbacterial prostatitis/chronic pelvic pain syndrome: This is the most common form of prostatitis (90% of cases). Symptoms include pain (genital, abdominal, pelvic), urinary symptoms, and often erectile dysfunction. Patients have no bacteria in their urine, but may have other signs of inflammation.
  • Asymptomatic prostatitis: In this form, patients have no symptoms but are found to have inflammation in the prostate, either through a prostate biopsy or semen analysis. There is no evidence that this form of prostatitis requires therapy.

What causes prostatitis?

This completely depends on what type of prostatitis it is. Bacterial infection usually enters from the urinary tract. Chronic pelvic pain syndrome may come from an initial infection or injury or from clenching and spasm of the pelvic floor muscles.

What are the symptoms of prostatitis?

You may have no symptoms or symptoms so sudden and severe that you seek emergency medical care.

Symptoms of prostatitis include:

  • Having to urinate often
  • Difficulty urinating
  • Pain or burning during urination
  • Chills and fever
  • Pain that comes and goes in the lower abdomen, around the anus, in the groin, or in the back
  • Pain during ejaculation
  • Pain during sexual intercourse

In addition, the prostate may swell, causing a less powerful urine stream.

How is prostatitis diagnosed?

If your doctor thinks that you have prostatitis or another prostate problem, he or she may refer you to a urologist (a doctor who specializes in diseases of the urinary tract and the male reproductive system) to confirm the diagnosis.

Patients usually have a full examination. The examination will include a digital rectal exam, in which the doctor inserts a gloved, lubricated finger into the rectum to feel the prostate.

At the first appointment, the patient should have a full bladder and should not be on any antibiotics. The patient will urinate into a machine to measure urine flow, and will also have an ultrasound of the bladder to see how it is emptying. Cultures are obtained from urine and from prostatic fluid obtained during a rectal exam.

How is prostatitis treated?

Treatment depends on the type of prostatitis.

Treatments include the following:

  • Anti-inflammatory medicines, along with warm sitz baths (sitting in 2-3 inches of warm water). This is the most conservative treatment for chronic prostatitis.
  • Avoiding food that triggers symptoms, such as caffeine, spicy foods, and alcohol
  • Using a cushion if you will be sitting for a long time
  • Antibiotic medicine for infectious prostatitis. For acute infectious prostatitis, patients usually need to take antibiotic medicine for 7-14 days. Almost all acute infections can be cured with this treatment.
  • For chronic infectious prostatitis, antibiotic medicine is taken for a longer period of time — usually 6-12 weeks. About 60% of all cases of chronic infectious prostatitis clear up with this treatment. For cases that don't respond to this treatment, taking antibiotics at a low dose for a long time may be recommended to relieve the symptoms.
  • The natural antioxidant bioflavonoid quercetin has been shown to improve inflammation and symptoms in men with nonbacterial prostatitis/chronic pelvic pain syndrome.
  • Alpha blocking agents can improve the urinary stream and often reduce the other voiding symptoms in patients with chronic prostatitis. Alpha blocking agents include tamsulosin (Flomax®) or alfusozin (Uroxatral®) for patients with voiding symptoms and those who do not empty their bladders well.

Other treatments for chronic noninfectious prostatitis include the drugs finasteride (Proscar®), terazosin (Hytrin®), and doxazosin (Cardura®). These drugs relax the muscles of the prostate and bladder to improve urine flow and decrease symptoms.

Many cases of nonbacterial prostatitis respond to such treatments as exercise, myofascial trigger point release physical therapy, progressive relaxation, and counseling.

Prostatitis is a treatable condition. Even if the problem cannot be cured, you can usually get relief from your symptoms by following the recommended treatment. If you are taking a medication prescribed by your doctor, it is important to follow the full course of the prescription, even if you no longer have any symptoms. With infectious prostatitis, for example, the symptoms may disappear before the infection has completely cleared.

What are the long-term effects of chronic prostatitis?

Chronic prostatitis affects men differently, so discomfort or pain varies.

Prostatitis is not a contagious disease. You can live your life normally and continue sexual relations without passing it on.

Having prostatitis does not increase your risk of developing prostate cancer or any other prostate or kidney disease. But even if your prostatitis is cured, you should continue to have regular examinations to detect prostate cancer.


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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.This document was last reviewed on: 10/25/2016…#15319