Prostatitis

Prostatitis, an inflammation or infection of the prostate gland, is a common and usually painful condition that can affect men of all ages. Up to 50 percent of all men experience prostatitis-like symptoms at some point during their lifetimes.

Prostatitis affects men of all ages but tends to be more common in men 50 or younger. Prostatitis often causes painful or difficult urination. Other symptoms include pain in the groin, pelvic area or genitals and sometimes flu-like symptoms.

Depending on the cause, prostatitis can come on gradually or suddenly. It might improve quickly, either on its own or with treatment. Some types of prostatitis last for months or keep recurring (chronic prostatitis).

Types of prostatitis include:

Acute bacterial prostatitis— Often caused by common strains of bacteria, this type of prostatitis generally starts suddenly and causes flu-like signs and symptoms, such as fever, chills, nausea, and vomiting.
Chronic bacterial prostatitis— When antibiotics don’t eliminate the bacteria causing prostatitis, you can develop recurring or difficult-to-treat infections. Between bouts of chronic bacterial prostatitis, you might have no symptoms or only minor ones.

Chronic prostatitis/chronic pelvic pain syndrome— This type of prostatitis (the most common) isn’t caused by bacteria. Often an exact cause can’t be identified. For some men, symptoms stay about the same over time. For others, the symptoms go through cycles of being more and less severe.

Asymptomatic inflammatory prostatitis— This type of prostatitis doesn’t cause symptoms and is usually found only by chance when you’re undergoing tests for other conditions. It doesn’t require treatment.

Risk Factors

Risk factors for prostatitis include:

• Being a young or middle-aged
• Having had prostatitis
• Having an infection in the bladder or the tube that transports semen and urine to the penis (urethra)
• Having pelvic trauma, such as an injury from bicycling or horseback riding
• Using a tube inserted into the urethra to drain the bladder (urinary catheter)
• Having HIV/AIDS
• Having had a prostate biopsy

Symptoms

Prostatitis signs and symptoms depend on the cause. They can include:

• Pain or burning sensation when urinating (dysuria)
• Difficulty urinating, such as dribbling or hesitant urination
• Frequent urination, particularly at night (nocturia)
• An 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
• Flu-like signs and symptoms (with bacterial prostatitis)

Evaluation and Diagnosis

Diagnosing prostatitis involves ruling out other conditions as the cause of your symptoms and determining what kind of prostatitis you have. Your doctor will ask about your medical history and your symptoms. He or she will also do a physical exam, which will likely include a digital rectal examination.

Diagnostic tests might include:

Urine tests— Your doctor might have a sample of your urine analyzed to look for signs of infection in your urine (urinalysis). Your doctor might also send a sample of your urine to a lab to determine if you have an infection.

Blood tests— Your doctor might examine samples of your blood for signs of infection and other prostate problems.

Post-prostatic massage— In rare cases, your doctor might massage your prostate and test the secretions.

Imaging tests— In some cases, your doctor might order a CT scan of your urinary tract and prostate or a sonogram of your prostate.

Cystoscopy— A small telescope is passed through the urethra into the bladder permitting examination of the urethra, prostate, and bladder.
Urine flow studies— Help measure the strength of your urine flow and any obstruction caused by the prostate, urethra or pelvic muscles.

Treatment

Prostatitis treatments depend on the underlying cause. They can include:

Antibiotics — This is the most commonly prescribed treatment for prostatitis. Your doctor will choose your medication based on the type of bacteria that might be causing your infection.

If you have severe symptoms, you might need intravenous (IV) antibiotics. You’ll likely need to take oral antibiotics for four to six weeks but might need longer treatment for chronic or recurring prostatitis.

Alpha blockers — These medications help relax the bladder neck and the muscle fibers where your prostate joins your bladder. This treatment might ease symptoms, such as painful urination.

Anti-inflammatory agents — Nonsteroidal anti-inflammatory drugs (NSAIDs) might make you more comfortable.

The following might ease some symptoms of prostatitis:

• Soak in a warm bath (sitz bath) or use a heating pad.
• Limit or avoid alcohol, caffeine, and spicy or acidic foods, which can irritate your bladder.
• Avoid activities that can irritate your prostate, such as prolonged sitting or bicycling.
• Drink plenty of caffeine-free beverages. This will cause you to urinate more and help flush bacteria from your bladder.