Prostatitis

Page last reviewed: 13/07/2011

Prostatitis is a general term that refers to inflammation (swelling) or infection of the prostate gland. It can be very painful and you'll need to see your GP.

The prostate is a small gland found only in men, located between the penis and the bladder (see box on this page).

Symptoms of prostatitis include:

  • pelvic pain
  • pain when urinating
  • pain when ejaculating semen

See Prostatitis - symptoms for more information.

Prostatitis can develop in men of all ages, unlike other types of prostate disease (such as prostate cancer or prostate enlargement), which usually affect older men.

Persistent symptoms but no infection

Most men with prostatitis will have chronic non-bacterial prostatitis, which means symptoms have lasted a long time but there doesn't appear to be an infection.

Chronic non-bacterial prostatitis is poorly understood. Some experts have argued that there may not actually be any inflammation or infection of the prostate, so the condition should be known as 'chronic pelvic pain syndrome'.

It is estimated that as many as 15% of men will have chronic non-bacterial prostatitis at some point in their life.

Symptoms caused by an infection

It is much less common for men to develop prostatitis as a result of a bacterial infection.

It is estimated that one in every 10,000 men will develop a sudden and severe form of prostatitis, called acute prostatitis, caused by a bacterial infection of the prostate gland. This is a medical emergency as without prompt treatment with antibiotics, the prostate and surrounding areas can become damaged.

About 1-2% of all men will develop a less severe but long-lasting bacterial infection of the prostate, causing chronic bacterial prostatitis. The bacteria can spread out of the prostate and into the urinary tract (kidneys, bladder and tubes through which urine passes). Therefore, many men with chronic prostatitis also develop repeated urinary tract infections, such as a bladder or urethra infection. 

Outlook

Chronic non-bacterial prostatitis can be a challenging condition to treat. Very little is known about the causes of the condition, so it can be difficult to identify effective treatments for all cases. However, many men will go through periods of time where their symptoms are not particularly troublesome.

Prostatitis caused by a bacterial infection will usually be successfully treated with antibiotics and most men will make a full recovery within two weeks. Some men may find that symptoms return at some time in the future, which will require further treatment.

For more information, see Prostatitis - treatment.

About the prostate

The prostate is a small gland located in the pelvis, between the penis and the bladder, and surrounds the urethra (the tube that carries urine from the bladder to the penis).

The prostate is involved in the production of semen. It produces a thick, white fluid that is made into a liquid by a protein called prostate-specific antigen (PSA). The liquid is then mixed with sperm, produced by the testicles, to create semen.

Page last reviewed: 13/07/2011

If the symptoms of prostatitis are severe and develop suddenly, see your GP immediately.

This sudden, severe type is known as acute prostatitis and symptoms include:

  • a high temperature of 38ºC (100.4ºF) or above
  • severe pain in the pelvis, genitals, lower back and buttocks
  • pain when urinating
  • frequent need to urinate
  • difficulty urinating, such as problems starting or or 'stop-start' urination
  • pain when ejaculating

Less severe prostatitis

Less severe (chronic) types of prostatitis will cause the same symptoms, but the pain will not be as severe. The symptoms may vary from day to day: some days they may be particularly troublesome, while on other days they may be mild or almost non-existent.

You may also experience tiredness, joint pain and muscle pain with chronic prostatitis.

Page last reviewed: 13/07/2011

It's not known what causes many cases of prostatitis; a bacterial infection is only sometimes responsible.

Often, doctors cannot find any infection in the prostate gland. A number of factors have been suggested to be the cause, such as:

  • underlying problems with the immune system
  • underlying problems with the nervous system
  • an infection with a virus or bacteria that has not yet been identified

Bacterial infection

Sudden, severe causes of prostatitis (acute prostatitis) are usually caused by bacteria in the urinary tract entering the prostate. These bacteria cannot be spread during sexual intercourse, so there is no risk of contaminating your sexual partners.

It is less clear how bacteria infect the prostate in cases of milder but longer-term (chronic) bacterial prostatitis. One theory is that bacteria spread from the urinary tract or bowel to the prostate and create what is known as a biofilm on the surface of the prostate. A biofilm is a small but highly concentrated colony of bacteria that is covered by a sticky, protective surface - a bit like plaque that can sometimes develop on teeth.

Page last reviewed: 13/07/2011

Your GP will be able to diagnose prostatitis by asking about your symptoms and carrying out a number of tests.

If your pain is severe and came on suddenly, your GP will take a sample of your urine, which will be checked for the presence of bacteria.

Your GP may also perform a rectal examination. They will insert a finger into your rectum (bottom) and, because the rectum is close to the prostate gland, they will be able to determine whether your prostate is inflamed.

The above tests may reveal that you have acute bacterial prostatitis.

Less severe, persistent prostatitis

Chronic prostatitis (which is less severe but persistant) is diagnosed by asking about your symptoms and ruling out other conditions that could be causing these symptoms, such as bowel or prostate cancer.

In order to rule out these types of conditions, you may be given a rectal examination and blood tests. Instruments, such as a cytoscope and a colonoscope, can be used to look at your bladder and bowel. Both instruments are flexible tubes that have a light and a camera at the end.

A cytoscope is placed up into your urethra and is used to look at your bladder. A colonoscope is placed into your anus (back passage) and is used to look at your bowel.

A confident diagnosis can usually be made if:

  • you have pain in your pelvis, genitals and/or buttocks
  • you feel pain when urinating
  • you feel pain when ejaculating
  • you have problems with urinating, such as a frequent need to urinate, or a feeling that you have not emptied your bladder properly after urinating
  • the symptoms have persisted for three months or more
  • other possible causes of your symptoms have been ruled out

A urine test can be taken to determine whether you have bacterial or non-bacterial chronic prostatitis.

Page last reviewed: 13/07/2011

You'll need to take a course of antibiotics if your prostatitis is caused by a bacterial infection in your prostate.

Other medicines will be used if the cause is non-bacterial.

Treating acute prostatitis

Acute prostatitis (where the pain is severe and comes on suddenly) will be treated with antibiotic tablets. Most people will need a four-week course. Your symptoms should pass within two weeks, but it is very important that you finish the course of antibiotics to prevent the infection returning.

The pain can be relieved using paracetamol and/or ibuprofen. If your pain is particularly severe you may be prescribed a stronger painkiller, like codeine.

Treating chronic bacterial prostatitis

Chronic bacterial prostatitis (which is less severe but persistant) is also treated with a four-week course of antibiotic tablets. You may also be prescribed a type of medication known as an alpha-blocker.

Alpha-blockers help to relax the bladder muscles and can therefore improve problems with urination, such as problems passing urine.

The possible side effects of alpha-blockers include:

  • dizziness
  • headaches
  • weakness
  • little or no sperm when you ejaculate

Once you have completed your course of antibiotics, you will be given a urine test to check whether any bacteria is left in your prostate or near it. If the test is positive, a further course of antibiotics may be needed.

As with acute prostatitis, paracetamol and/or ibuprofen can be used to help relieve any pain.

Chronic non-bacterial prostatitis

Chronic non-bacterial prostatitis is also treated with alpha-blockers, paracetamol and ibuprofen.

A number of other medications have been used to treat chronic non-bacterial prostatitis, but there is only limited evidence that they are effective.

These medications include:

  • finasteride - a medication usually used to treat prostate enlargement
  • fluoxetine - an antidepressant medication usually used to treat depression
  • mepartricin - a medication usually used to treat fungal infections

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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