Prostatitis

What is prostatitis?

Prostatitis is inflammation of your prostate gland. Your prostate gland sits below your bladder, in front of your rectum. Your urethra (the tube that carries pee and semen out of your body) runs through the center of your prostate. 

If you have one of the four types of prostatitis, the tissue in and around your prostate gland becomes swollen, tender and irritated. Urinary tract infections (UTIs) and other bacterial infections can cause certain types of prostatitis, but some have no cause. There are treatments that help manage your symptoms. 

What are the types of prostatitis?

Types of prostatitis include:

• Acute bacterial prostatitis: A bacterial infection causes acute prostatitis. Symptoms include fever and chills. You may experience painful and frequent urination or have trouble urinating. Acute bacterial prostatitis requires medical treatment with antibiotics. Acute means it comes on suddenly.
• Chronic bacterial prostatitis: Bacteria also cause this type of prostatitis. Symptoms may come on gradually, and it can take longer to treat. Unlike acute bacterial prostatitis, chronic bacterial prostatitis doesn’t usually cause fever and chills. You’ll still have symptoms like pain when you pee or difficulty urinating. 
• Chronic pelvic pain syndrome (or CPPS): CPPS is the most common type of prostatitis. It occurs in approximately 1 out of 3 men. As the name implies, this type causes chronic pain in your pelvis, perineum (the area between your scrotum and rectum) and genitals. Pain from CPPS can last months or years. It’s not an infection.
• Nonbacterial prostatitis (asymptomatic inflammatory prostatitis): This condition causes prostate gland inflammation but no symptoms. You may learn you have this condition after getting tests to find the cause of other symptoms. This type doesn’t need treatment and isn’t an infection. 

How common is prostatitis?

More than 2 million men see a healthcare provider every year for prostatitis symptoms. Up to 50% of men will have symptoms of prostatitis at some point in their lives. It’s the most common urinary tract issue in people men under 50 and the third most common in men over 50.

What are the symptoms of prostatitis?

Prostatitis symptoms vary depending on the type and cause. It’s important to see a healthcare provider if you feel pain in your pelvis or experience urination changes.

People with nonbacterial prostatitis may not have any symptoms. The other three types of prostatitis share symptoms, such as:

• Pain in your lower abdomen, genitals or perineum. The pain may spread to your lower back.
• Frequent urge to pee.
• Painful urination (dysuria).
• Having a urine stream that stops and starts.
• Blood in your pee (hematuria).
• Blood in semen (hematospermia).
• Pain during sexual intercourse (dyspareunia).
• Painful ejaculation.
• Erectile dysfunction.

Acute bacterial prostatitis causes flu-like symptoms like fever, body aches and chills.

What causes prostatitis?

Different types of prostatitis have different causes. Sometimes the cause isn’t known and other times it’s clear that the cause is a bacterial infection.

Causes of CPPS and nonbacterial prostatitis

Potential contributors to chronic pelvic pain syndrome or CPPS include:

• Autoimmune diseases.
• Pelvic floor muscle damage.
• Pelvic nerve irritation or inflammation.
• Stress.

It’s important to note that bacteria don’t cause CPPS or nonbacterial prostatitis.

Causes of bacterial prostatitis

The bacterial forms of prostatitis happen as a result of a bacterial infection. Bacteria can get in your prostate through your urethra or when your urine flows backward (vesicoureteral reflux).

Potential causes of bacterial forms of prostatitis include:

• Bladder infections or bladder stones.
• Sexually transmitted infections (STIs).
• Using a urinary catheter (tube that drains urine from your bladder).
• Having a prostate biopsy.
• Prostate stones.
• Urinary retention or urinary blockage. 
• UTIs.
• Injury to your pelvic area.

What are the risk factors for prostatitis?

Some risk factors for bacterial prostatitis may include:

• Frequent UTIs or recent bladder infection.
• History of prostatitis.
• An abnormality in your urinary tract.
• Using a catheter.

People with nerve damage or trauma to their pelvises may be more at risk of chronic pelvic pain syndrome.

Being older than 50 and having a condition like enlarged prostate (benign prostatic hyperplasia) also increases your risk for all types of prostatitis.

What are the complications of prostatitis?

People with acute bacterial prostatitis may develop sepsis. This is a life-threatening, widespread infection in your body. It requires immediate medical treatment. Other complications could include:

• Sexual dysfunction.
• Inflammation that spreads to organs near your prostate.

Is prostatitis a sign of prostate cancer?

Prostatitis is benign (not cancerous). It doesn’t increase your risk of prostate cancer. But, inflammation from prostatitis sometimes raises the level of prostate-specific antigens (PSA) in your blood — just like prostate cancer does. Further tests can help determine what’s causing elevated PSA levels.

How is prostatitis diagnosed?

Your healthcare provider will assess your symptoms and do a physical exam.

Less invasive tests for prostatitis may include:

• Digital rectal exam: Your provider inserts a gloved, lubricated finger into your rectum (with your consent) to check the prostate gland for pain and swelling. This exam may include prostate massage to collect a sample of seminal fluid.
• Urinalysis: A urinalysis and urine culture check for bacteria and UTIs.
• Blood test: A blood test measures PSA, a protein made by your prostate gland. High levels may indicate prostatitis, enlarged prostate or prostate cancer.

More invasive tests for prostatitis include:

• Cystoscopy: A cystoscopy can look for other urinary tract problems but doesn’t diagnose prostatitis. Your provider uses a cystoscope (a pencil-sized lighted tube with a camera or viewing lens on the end) to view inside your bladder and urethra.
• Transrectal ultrasound: People with acute bacterial prostatitis or chronic bacterial prostatitis that doesn’t improve with antibiotics may get a transrectal ultrasound. This test can show prostate gland abnormalities, abscesses or stones.
• Urodynamic testing: These tests measure things like nerve and muscle function, pressure in and around your bladder, and urine flow rates. 

How is prostatitis treated?

Prostatitis treatments vary depending on the cause and type. Nonbacterial prostatitis doesn’t require treatment.

For chronic pelvic pain syndrome (CPPS), your healthcare provider may use a system called UPOINT to classify symptoms into six categories. Your provider uses multiple treatments at the same time to treat only the symptoms you’re experiencing.

Approximately 80% of people with CPPS improve with the UPOINT system. The system focuses on these symptoms and treatments:

• Urinary: Medications, such as tamsulosin (Flomax®) and alfuzosin (Uroxatral®), relax muscles around your prostate and bladder to improve urine flow.
• Psychosocial: Stress management can help. Some people benefit from counseling or medications for anxiety, depression and catastrophizing (overreaction to minor stresses common in people with chronic pain).
• Organ: Quercetin and bee pollen supplements may relieve a swollen, inflamed prostate gland.
• Infection: Some healthcare providers use antibiotics as part of treatment for CPPS.
• Neurologic: Prescription pain medicines, such as amitriptyline (Elavil®) and gabapentin (Gralise®), relieve neurogenic pain. This pain can include fibromyalgia or pain that extends into your legs, arms or back.
• Tenderness: Pelvic floor physical therapy may include myofascial release (gentle massage to ease tension on tight pelvic floor muscles). This therapy can reduce or eliminate muscle spasms.

How are bacterial forms of prostatitis treated?

Antibiotics can kill bacteria that cause bacterial types of prostatitis. People with acute bacterial prostatitis may need 14 to 30 days of antibiotics. Some people need antibiotics through an IV (into your vein) in a hospital. Surgery to drain an abscess on your prostate may be necessary, but this is rare.

Treating chronic bacterial prostatitis is more challenging. Most people need between four and 12 weeks of antibiotics. If this approach doesn’t work and your symptoms come back, your provider may prescribe a low-dose antibiotic to prevent recurrent infection.

How can I treat prostatitis at home?

You should always see a healthcare provider before you treat prostatitis on your own at home. But they may recommend additional treatment you can do at home to manage your symptoms. This could include:

• Drinking lots of fluids to stay hydrated.
• Taking over-the-counter (OTC) pain relievers like ibuprofen to help with inflammation and discomfort.
• Avoiding spicy or acidic foods and beverages containing caffeine or alcohol (which can cause dehydration).
• Taking warm baths (sitz baths) or applying a heating pad to your low back to help with pain.
• Performing exercises like Kegels or stretching to help your pelvic floor muscles.
• Sitting on a donut-shaped pillow when you feel pain. Avoid activities that increase your pain (like riding a bike).

Can prostatitis go away on its own?

If a bacterial infection is causing prostatitis, it won’t go away on its own. You need medication to get rid of the infection. But, if you have CPPS or nonbacterial prostatitis, the inflammation and tenderness may subside without medication. Your healthcare provider can let you know what to expect based on your symptoms.

Does drinking a lot of water help prostatitis?

Drinking extra fluids can help you pee more often, which removes bacteria from your body. But you shouldn’t drink extra water as a substitute for getting medical treatment. Your healthcare provider will recommend how much extra fluid you should drink each day if you have prostatitis.

What is the best drink for prostate inflammation?

Staying hydrated is good for not only your prostate health but your overall health. Drinks like water, green tea and noncaffeinated drinks are good choices to maintain hydration. If you have specific questions about what food and drinks you should consume after a prostatitis diagnosis, you should check with your healthcare provider.

How can I prevent prostatitis?

Prompt treatment for UTIs may keep an infection from spreading to your prostate. If you’re sexually active, use a condom during every sexual encounter. Having safe sex can prevent prostatitis that results from STIs.

See a healthcare provider if you have pain in your perineum or experience changes to how you typically urinate. If you have prostatitis, this can prevent it from getting worse.

What can I expect if I have prostatitis?

While it can cause unpleasant symptoms, the good news about prostatitis is that you usually feel relief with the right treatment. It’s not normal to feel pain in and around your rectum and genitals, or to experience changes in how you pee. You should always seek care for these types of symptoms.

Antibiotics treat most cases of bacterial prostatitis. While more challenging to treat, most people with CPPS feel better after receiving treatment for their symptoms using the UPOINT system. If you don’t feel relief with treatment, work with your provider until you do. They can make sure prostatitis doesn’t affect your quality of life.

When should I call my healthcare provider?

You should call your healthcare provider if you experience:

• Blood in your pee or semen.
• Difficulty urinating.
• Frequent urination or sudden urges to pee.
• Pain during urination.
• Painful erections or pain during sex.

What questions should I ask my healthcare provider?

You may want to ask your healthcare provider:

• What type of prostatitis do I have?
• What’s the best treatment for this type of prostatitis?
• What are the treatment risks and side effects?
• How can I avoid getting prostatitis again?
• What type of follow-up care do I need after treatment?
• Should I look out for signs of complications?