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Prostatitis is swelling or infection of the prostate gland. It often hurts. The prostate gland sits just below a man's bladder and makes part of the fluid for semen. In young men, the prostate is about the size of a walnut. It usually grows larger as you grow older.
There are several types of prostatitis. They vary based on how long a man has had the problem and what kind of symptoms he has.
Sometimes prostatitis is caused by bacteria, but often the cause is not known.
Symptoms of long-term (chronic) prostatitis are often mild and start slowly over weeks or months. They may include:
Symptoms of acute prostatitis are the same, but they start suddenly and are severe. They may also include a fever and chills.
Some men may have no symptoms.
A doctor can often tell if you have prostatitis by asking about your symptoms and past health. He or she will also do a physical exam, including a digital rectal exam. In this test, the doctor puts a gloved, lubricated finger in your rectum to feel your prostate. You may also need blood and urine tests to find out which type of prostatitis you have or to look for another cause of your problems.
Prostatitis caused by bacteria is treated with antibiotics and self-care.
Home treatment includes drinking plenty of fluids and getting lots of rest. Taking over-the-counter pain relievers can also help.
Your doctor may prescribe medicine to control pain and reduce swelling. He or she may also prescribe medicine to soften your stool and relax your bladder muscles.
Surgery is rarely used to treat prostatitis.
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Most men with prostatitis have chronic prostatitis, which may also be called pelvic pain syndrome. The cause of this type of prostatitis is not known.
Bacteria infecting the prostate cause acute prostatitis and chronic bacterial prostatitis. Bacteria most likely enter the prostate by:
The symptoms are similar for all forms of prostatitis, with the exception of acute prostatitis.
Symptoms of chronic prostatitis may include:
With acute prostatitis, symptoms are severe, come on suddenly, and include fever and chills. Signs of chronic bacterial prostatitis may be milder and come on suddenly or gradually over weeks or months, and the symptoms may come and go. Symptoms alone cannot be used to determine the type of prostatitis you have.
Other conditions, such as a bladder infection or benign prostatic hyperplasia (BPH), can cause symptoms similar to those of prostatitis.
Prostatitis, especially if it continues for a long time, can cause stress, anxiety, and depression.
Chronic prostatitis often gets better over time without serious complications. But the symptoms sometimes return unexpectedly.
Men with acute prostatitis have severe pain and fever. Most men recover fully when treated with antibiotics. Delaying treatment increases the risk of complications, such as sepsis or an abscess in the prostate.
Chronic bacterial prostatitis can be difficult to treat, because some medicines have a hard time reaching the prostate.
Men with chronic bacterial prostatitis commonly have repeated urinary tract infections. The infection may spread to the epididymis.
The presence of infected prostate stones ( prostatic calculi) can make treatment of chronic bacterial prostatitis more difficult.
Things that can increase your risk for prostatitis include:
If you have had chronic bacterial prostatitis, you have an increased chance of developing it again.
Contact your doctor immediately if you have sudden fever, chills, and urinary symptoms, such as pain or burning with urination or blood or pus in the urine. These symptoms may point to acute prostatitis.
Call your doctor if you have:
Most men will have some discomfort in their prostate (prostatitis) at some time during their lives. If you do not have a fever and chills or extreme pain, you may try home treatment for a few weeks. Take nonprescription pain medicines, such as aspirin, ibuprofen, or acetaminophen, to relieve pain. But if your urinary symptoms and pain continue, be sure to see a doctor.
Health professionals who can evaluate and treat your prostatitis include:
If your doctor suspects that you have prostatitis, he or she will begin with a complete medical history and physical exam. The type of prostatitis that you have cannot be determined solely from your history and symptoms. Your doctor will do tests to find out the cause of your prostatitis.
Acute prostatitis is the least common type but the easiest to diagnose. If acute prostatitis is suspected, a urine culture will be done to test for the presence and type of bacteria.
If your history and physical exam show that you do not have acute prostatitis, a pre- and post-massage test (PPMT) or expressed prostatic secretions test may be done to find out which type of prostatitis you have. An expressed prostatic secretions test is not done if acute prostatitis is suspected, because when the prostate is inflamed or infected, massaging it to obtain a sample for tests is very painful and possibly dangerous. Some doctors believe that massaging an infected prostate increases the risk of developing a bacterial infection of the blood (septicemia).
More tests may be needed if:
Tests that may be done include:
Treatment for prostatitis usually begins with taking an antibiotic for several weeks. If you begin to feel better, you may have to take the medicine for 2 to 3 months. If you do not get better while taking antibiotics, more tests may be done.
You may need to try more than one treatment. There isn't a standard treatment that works well for all men.
Treatment for acute prostatitis is aimed at curing the infection and preventing complications. Acute bacterial prostatitis is treated with antibiotics, pain and fever medicine, stool softeners, fluids, and rest.
Treatment for chronic bacterial prostatitis is aimed at curing the infection and preventing complications. Antibiotics are given for 6 to 12 weeks. Long-term antibiotic treatment may be needed if the infection returns.
You may be able to prevent prostatitis.
Prostatitis is usually treated with antibiotics and other medicines prescribed by your doctor. But there are some things you can try at home that may help you be more comfortable:
Treatment of prostatitis usually begins with antibiotics and possibly other medicines to relieve symptoms. If you begin to get better, you may have to continue taking antibiotics for 2 to 3 months. During this time, be sure to take the antibiotics as prescribed. If you do not begin to get better while taking medicines, your doctor may want you to have more tests.
Chronic prostatitis is usually treated first with antibiotics based on the possibility that you have an infection that didn't show up during testing (false negative). But experts advise against long-term treatment with antibiotics unless an unusual bacterial infection is suspected.
Medicines that may be used to treat chronic prostatitis include:
Acute and chronic bacterial prostatitis
Antibiotics are central to treating acute or chronic bacterial prostatitis. Your doctor may prescribe certain antibiotics based on your medical history, symptoms, and other factors such as your age. Other medicines may also be used to help control symptoms, including:
Chronic bacterial prostatitis may require long-term antibiotics, especially if the symptoms return. Some men need treatment with low doses of antibiotics over a long period to control infection and prevent repeated urinary tract infections (UTIs).
Surgery for prostatitis may be needed to treat chronic bacterial prostatitis that does not respond to long-term antibiotic treatment and that causes repeated urinary tract infections. Surgery may be done to remove part of the prostate or to remove infected prostate stones ( prostatic calculi). But this does not always cure the infection, and it may make the symptoms worse. Surgery is typically done only if all other treatments have failed.
Surgical removal of part of the prostate to remove prostate stones or to treat an infection that does not respond to antibiotic treatment is called transurethral prostatectomy.
Surgery to remove part of the prostate that is blocking urine flow is called transurethral resection of the prostate (TURP). This type of surgery may be done in men with benign prostatic hyperplasia (BPH) who are having problems with prostatitis.
Other treatments that may be helpful for prostatitis include:
Anothaisintawee T, et al. (2011). Management of chronic prostatitis/chronic pelvic pain syndrome. JAMA, 305(1): 78–86.
Nickel JC (2012). Prostatitis and related conditions, orchitis, and epididymitis. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 1, pp. 327–356. Philadelphia: Saunders.
Other Works Consulted
Gupta K, Trautner BW (2015). Urinary tract infections, pyelonephritis, and prostatitis. In DL Kasper et al., eds., Harrison's Principles of Internal Medicine, 19th ed., vol. 2, pp. 861–868. New York: McGraw-Hill Education.
Powell CR (2015). Prostatitis. In ET Bope, RD Kellerman, eds., Conn's Current Therapy 2015, pp. 1008–1010. Philadelphia: Saunders.
Current as ofSeptember 26, 2018
Author: Healthwise StaffMedical Review: E. Gregory Thompson, MD - Internal MedicineAdam Husney, MD - Family MedicineChristopher G. Wood, MD, FACS - Urology
Current as of:
September 26, 2018
Medical Review:E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Christopher G. Wood, MD, FACS - Urology
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