Prostatitis: Symptoms, Causes, and Treatments

Medically Reviewed By Matt Coward, MD, FACS
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Prostatitis refers to inflammation of the prostate gland. There are different types of prostatitis, with some more serious than others. Treatment focuses on the underlying reason for the inflammation. The walnut-sized prostate gland is involved in the production of semen. The prostate wraps around the tube that transports urine out of the bladder.

There are different types of prostatitis, including:

  • asymptomatic inflammatory prostatitis
  • chronic bacterial prostatitis
  • chronic prostatitis, or chronic pelvic pain syndrome
  • acute bacterial prostatitis, which is a life threatening condition

Seek immediate medical care (call 911) for serious symptoms, such as high fever (higher than 101ºF or 38ºC), severe pain in the lower back or genital or rectal area, or an inability to urinate. Seek prompt medical care if you are receiving treatment for prostatitis but mild symptoms recur or are persistent.

This article provides an overview of prostatitis, including its symptoms, causes, and treatments.

Acute vs. chronic prostatitis

Senior man lying on couch with hand over stomach and medication bottles on nearby table
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There are four prostatitis classifications, and each has different presentations and causes.

There is a significant difference between acute prostatitis and both kinds of chronic prostatitis — namely, the type of treatment needed. Acute prostatitis is a medical emergency, whereas chronic prostatitis is not.

The four classifications of prostatitis are as follows: 

  • Acute bacterial prostatitis: This condition results from an infection, and it affects the entire prostate gland. Someone with acute prostatitis will typically experience fever, chills, and pain while urinating. Some people with acute prostatitis have difficulty urinating or cannot urinate. Acute prostatitis is an emergency and requires immediate treatment.
  • Chronic bacterial prostatitis: With this type of chronic prostatitis, bacteria trapped in the prostate cause recurrent urinary tract infections (UTIs).
  • Chronic prostatitis, or chronic pelvic pain syndrome: The most common type of prostatitis, chronic prostatitis causes pain in the pelvis and genital area due to inflammation. 
  • Asymptomatic inflammatory prostatitis: People with asymptomatic inflammatory prostatitis do not have symptoms. A doctor may diagnose asymptomatic inflammatory prostatitis when testing for other urinary tract or reproductive tract disorders. This type of prostatitis does not cause complications and does not need treatment.

Symptoms of prostatitis

Prostatitis symptoms affect the prostate gland and sometimes also the urinary tract. The symptoms of prostatitis may vary from person to person.

Common symptoms of prostatitis

You may experience prostatitis symptoms daily or just once in a while. At times, any of these symptoms can be severe:

Serious symptoms that might indicate a life threatening condition

Acute bacterial prostatitis can be life threatening. Seek immediate medical care (call 911) for any of these symptoms:

  • severe abdominal, pelvic, or lower back pain
  • fever higher than 101ºF (38ºC)
  • an inability to urinate

Causes of prostatitis

Prostatitis is a noncancerous condition that often results from an infection in the prostate gland. Prostatitis becomes chronic when it occurs repeatedly. However, doctors cannot always find the cause of prostatitis.

Causes of acute and chronic bacterial prostatitis

Bacterial prostatitis, both acute and chronic, results from an infection in the prostate. This may occur when bacteria from the urethra travel to the prostate.

Causes of nonbacterial prostatitis

Experts do not know exactly what causes chronic prostatitis that does not result from a bacterial infection. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) lists the following possible causes:

  • a nonbacterial microorganism that enters the prostate
  • an immune response to a previous UTI
  • nerve damage in the pelvic area

Because the symptoms of prostatitis are similar to those of other conditions, doctors often diagnose chronic prostatitis after ruling out other possible causes.

Risk factors for prostatitis

A number of factors increase the risk of developing prostatitis. The NIDDK reports that prostatitis is the most common prostate condition in males younger than 50 years. Males ages 50 years and older have a higher risk of chronic prostatitis.

Acute bacterial prostatitis

Risk factors for acute bacterial prostatitis include:

  • a recent urinary catheter
  • a recent infection in the bladder, kidneys, or urinary tract
  • prostate biopsy
  • a recent sexually transmitted infection
  • HIV or AIDS
  • anal sex without a condom
  • injury to the pelvic area

Chronic prostatitis

Risk factors for chronic prostatitis include:

  • age between 50 and 59 years
  • previous case(s) of prostatitis
  • other abdominal conditions that cause pain, such as irritable bowel syndrome
  • a history of sexual abuse

Reducing your risk of prostatitis

There are no definitive ways to prevent prostatitis. However, you can take steps to lower your risk and improve your overall prostate health. These include:

Talk with your urologist about your individual prostatitis risk factors and any symptoms you notice so that you can begin prompt treatment and prevent complications.

Besides prostatitis, several different conditions can also affect the prostate. Those include:

  • BPH: Also called an enlarged prostate, BPH is the most common prostate condition among older males. Symptoms include difficulty starting urination, dribbling afterward, and an urgent need to go, especially during sleep. Someone with BPH might not be able to empty the bladder completely.
  • Prostate cancer: This type of cancer often has successful treatment outcomes when a doctor diagnoses it in the early stages. Like BPH, prostate cancer also causes urination problems, such as difficulty starting and getting up frequently during sleep to go to the bathroom. Ejaculation may be painful, and hip and back pain are also common symptoms.

How doctors diagnose prostatitis

To diagnose prostatitis, your doctor will conduct a physical exam, including a digital rectal exam, to evaluate your prostate.

Your doctor will also want to rule out other health conditions, so they may ask you to take some tests. Those tests could include:

  • urine or blood tests, which can detect an infection 
  • post-prostatic massage, which doctors use to collect secretions for testing 
  • imaging tests, including a CT scan or sonogram
  • cystoscopy, in which the doctor views the inside of the bladder

To diagnose your condition, your doctor may ask you questions such as:

  • What symptoms are you experiencing?
  • Can you describe what you are feeling?
  • How long have these symptoms been going on? 
  • When do your symptoms occur?

Treatments for prostatitis

Treatment for prostatitis will depend on the underlying cause of the condition. Prostatitis that results from a bacterial infection will require a different treatment approach than prostatitis associated with other disorders or conditions.

Asymptomatic inflammatory prostatitis may not require any treatment, though your doctor may choose to test for this condition on a regular basis.

Bacterial prostatitis medications

Acute bacterial prostatitis requires treatment in an emergency setting. Treatment may also require a short hospital stay.

Treatment may continue outside of the hospital for up to 4 weeks and include oral antibiotics or

IV antibiotics, which a healthcare professional will administer through a vein. Oral antibiotics include fluoroquinolones and trimethoprim-sulfamethoxazole (Bactrim). IV antibiotics include vancomycin and Zosyn, and these target culture-sensitive organisms.

Treatment for chronic bacterial prostatitis may last longer and could include medications to help relax the muscles that join the prostate and bladder. Treatment can include:

  • alpha-blockers, such as alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax), or terazosin (Hytrin), to help relax the prostate and the bladder muscle
  • antibiotics
  • anti-inflammatory medications, such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs

Other prostatitis treatments

Nonbacterial prostatitis, including

chronic pelvic pain syndrome, is difficult to treat because experts know little about what causes it. Even with treatment, many people find that recovery is slow, or they may get no symptom relief at all.

Some people eventually feel better without treatment. Often, doctors must use a combination of several treatments to treat the condition.

Research suggests that people who do not smoke, who do not drink or drink only occasionally, and who avoid long periods of sedentary work have an improved outlook with chronic pelvic pain syndrome.

Treatments for chronic pelvic pain syndrome include:

  • avoiding spicy foods and caffeine
  • taking alpha-blockers, though there is no consensus that they are beneficial
  • trying heat therapy
  • undergoing pelvic floor physical therapy
  • trying psychotherapy to improve coping strategies

Potential complications of prostatitis

Acute prostatitis can be a life threatening condition that requires treatment in an emergency setting. Some medications for chronic prostatitis have side effects, such as headaches or low blood pressure.

Complications of untreated prostatitis can be serious, but you can help minimize your risk of serious complications by following the treatment plan that you and your urologist design specifically for you. 

Complications of prostatitis can include:

  • adverse effects of prostatitis treatment
  • epididymitis, which refers to inflammation of the coiled tube in the back of the testicle
  • infertility
  • prostate abscess
  • urosepsis, which is a life threatening bacterial blood infection
  • the spread of infection

Prostatitis outlook

Because there are several types of prostatitis, which have different causes, the outlook for the condition varies.

Someone with prostatitis who also has diabetes or chronic renal failure or who is immunocompromised has a higher risk of death from urosepsis, which is a systemic immune reaction that originates from a UTI. However, for most people with prostatitis, the outlook is favorable.

Acute prostatitis is a medical emergency, but antibiotics can cure the condition if you take them exactly as directed. Antibiotics can eliminate symptoms of chronic bacterial prostatitis in nearly 60% of cases.

The outlook for nonbacterial prostatitis varies because it is difficult to treat. After making lifestyle adjustments, many people have fewer symptoms, even without medicinal treatment. However, some have no symptom relief at all, even after taking medications.

Summary

Prostatitis refers to inflammation in the prostate gland that may or may not result from an infection. Symptoms include pelvic pain, difficulty urinating, and a frequent need to urinate.

Acute bacterial prostatitis results from a bacterial infection and is a life threatening emergency. Chronic bacterial prostatitis occurs when bacteria in the prostate cause recurrent UTIs.

The cause of chronic prostatitis is not clear. Some people experience symptom relief without treatment, while others receive treatment but still have symptoms.

Talk with your doctor about your risk factors for prostatitis and about any symptoms or changes you notice in your prostate health.

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Medical Reviewer: Matt Coward, MD, FACS
Last Review Date: 2022 Feb 24
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